A practical online tool to estimate antiretroviral coverage for HIV infected and susceptible populations needed to reduce local HIV epidemics

Community Levels of PrEP Use Among Men Who Have Sex with Men by Race/Ethnicity, San Francisco, 2017

Efforts in San Francisco are maximizing the use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) where high levels of use are needed to maximize reducing new HIV infections. National HIV Behavioral Surveillance surveys MSM in San Francisco. Demographics, health care and risk behaviors are assessed. PrEP use is measured for 12 month, 6 month and 30 day periods. Of 399 HIV uninfected men sampled in 2017, 43.4% used PrEP in the past 12 months. Proportions of men using PrEP by race/ethnicity were not significant at any time point. Decreases between 6 month and 30 day use were highest among African American and Latino men. These men had the highest proportion of intermittent use in the past 30 days but not significantly. While our data suggest the disparity in PrEP use by race/ethnicity has narrowed in San Francisco, novel delivery of PrEP may narrow disparity further.

Inconsistent condom use with known HIV-positive partners among newly diagnosed HIV-positive men who have sex with men interviewed for partner services in New York City, 2014

OBJECTIVES

Condomless anal intercourse contributes significantly to the spread of HIV among men who have sex with men (MSM). Factors related to condomless anal intercourse with known HIV-positive partners among MSM are not well understood. The authors describe factors associated with inconsistent condom use with known HIV-positive partners prior to participants' diagnosis with HIV.

METHODS

New York City health department disease intervention specialists interviewed newly HIV-diagnosed MSM ages ≥13 years reporting knowingly having anal sex with HIV-positive partners between June 2013 and October 2014. Univariate and bivariate statistics were calculated, in addition to logistic regression analysis.

RESULTS

Among 95 MSM interviewed, 56% were >30 years and 74% had higher than a high school education. Respondents reported a median of 2 known HIV-positive sex partners. Drug or alcohol use during last sex with their last known HIV-positive partner was reported by 53% of participants. Sixty-five per cent of participants reported inconsistent condom use with last known HIV-positive partner. Inconsistent condom use with all HIV-positive partners was higher among individuals reporting two or more known HIV-positive partners since sexual debut than among those with one (90% vs 59%, p<0.01) and among those reporting feelings of love/emotional attachment as a reason for having sex (85% vs 63%, p=0.02). In the bivariate logistic regression models for inconsistent condom use, feelings of love or emotional attachment were the only significant predictor of inconsistent condom use (OR 3.43, 95%  CI 1.23 to 9.58). After adjusting for confounding, the relationship feelings of love or emotional attachment continued to be the only significant predictor of inconsistent condom use (OR 3.69, 95%  CI 1.06 to 12.82).

CONCLUSIONS

Surveyed MSM engaged in high-risk behaviours, including condomless anal sex and drug or alcohol use during sex with persons known to be HIV-positive. These findings can inform interventions with MSM in serodiscordant partnerships.

Elevated HIV Prevalence and Correlates of PrEP Use Among a Community Sample of Black Men Who Have Sex With Men

BACKGROUND

The HIV epidemic among black men who have sex with men (BMSM) demands urgent public health attention. Pre-exposure prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood.

METHODS

A serial cross-sectional survey assessment (N = 4184 BMSM reporting HIV-negative/unsure status) and HIV testing were conducted at Black Gay Pride events in 6 US cities in 2014, 2015, 2016, and 2017.

RESULTS

HIV prevalence was higher among BMSM self-reporting current PrEP use (1 of 3 participants) than BMSM not self-reporting current PrEP use (1 of 5 participants) [32.3%, N = 103/319 vs. 20.0%, N = 639/3,193, adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.31 to 2.15]. BMSM reporting current PrEP use (N = 380) were more likely to report having a greater number of male sex partners (aOR = 1.02, 95% CI: 1.01 to 1.03), a sexually transmitted infection diagnosis (aOR = 2.44, 95% CI: 1.88 to 3.16), and stimulant drug use (aOR = 2.05, 95% CI, 1.21 to 3.47) when compared with BMSM not reporting current PrEP use (N = 3804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR = 1.19, 95% CI: 1.13 to 1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV-positive (aOR = 2.10, 95% CI: 1.24 to 3.56).

CONCLUSIONS

The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, sexually transmitted infection treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP is needed to guide operational and behavioral interventions that close the gap on incident infection.

Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted?

Pre-exposure prophylaxis (PrEP) targeting high-risk men who have sex with men (MSM) has been shown to be a cost-effective HIV control measure. However, the approach could be a challenge in low HIV incidence places with a low proportion of high-risk MSM. To examine the impact of PrEP in such setting in Asia, we developed an epidemic model and conducted cost-effectiveness analysis using empirical multicentre clinical and HIV sequence data from HIV-infected MSM in Hong Kong, in conjunction with behavioural data of local MSM. Without PrEP, the HIV incidence (per 100 person-years) would increase from 1.1 to 1.6 between 2011 and 2021. PrEP could avert 3–63% of total new infections in a five-year period (2017–2021), the variability of which depends on the implementation strategies and combination with test-and-treat. However, under current market drug price in 2016, the incremental cost per quality-adjusted life-year gained (QALYG) of PrEP (USD1583136/QALYG) is almost 3 times higher than test-and-treat intervention alone (USD396874/QALYG). Assuming 93% fall of PrEP drug price and in combination with test-and-treat, putting 30% of MSM on non-targeting PrEP would be more feasible, cost-effective (USD268915/QALYG), and could avert more new infections (40%). PrEP could contribute to HIV epidemic control in a low incidence place.