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      PrEP guidelines have low sensitivity for identifying seroconverters in a sample of Young Black men who have sex with men in Chicago

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          Abstract

          Background

          Identification of clients at greatest risk of acquiring HIV is critical for PrEP implementation. Young Black men who have sex with men (YBMSM) have high incidence of HIV. We examined published guidelines in identifying eligible PrEP candidates, including seroconverters, in a representative cohort of YBMSM.

          Methods

          The uConnect cohort included YBMSM aged 16-29 years during PrEP roll-out in Chicago from 2013-2016. YBMSM with indications for PrEP were determined using CDC guidelines, the HIRI-MSM scoring tool, and Gilead recommendations with calculation of sensitivities, specificities and area under the curve (AUC) for HIV seroconversion over 18 months. Incidence Rate Ratios using Poisson regression were modeled to compare individual and network factors associated with seroconversion.

          Results

          In the study cohort, 300 HIV uninfected YBMSM contributed 390.4 person-years (PY) of follow-up (mean age (SD), 22.3 years (3.07)). HIV incidence was 8.5 cases per 100 PY (95% CI, 6.0-11.9). One network factor was associated with seroconversion: having partners >10 years older (IRR=4.4, 95% CI 1.6-11.8). Overall, 49% of the cohort had an indication for PrEP using CDC guidelines; 72% using HIRI-MSM, and 86% using Gilead recommendations. HIV seroconverters (n=33) were identified as PrEP eligible prior to seroconversion with sensitivities/AUCs for CDC (52%/0.51), HIRI-MSM (85%/0.57) and Gilead guidelines (94%/0.54).

          Conclusions

          Low sensitivity of CDC guidelines and limited AUC of HIRI-MSM and Gilead screening tools are of concern for PrEP implementation among most at risk populations such as YBMSM. Consideration of demographics, local epidemiology and network factors may better guide identification of clients who could benefit most from PrEP.

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          Author and article information

          Journal
          8710219
          1493
          AIDS
          AIDS
          AIDS (London, England)
          0269-9370
          1473-5571
          11 December 2017
          28 January 2018
          28 January 2019
          : 32
          : 3
          : 383-392
          Affiliations
          [1 ]University of Chicago, Department of Medicine, Chicago, IL USA
          [2 ]Chicago Center for HIV Elimination, Chicago, IL USA
          Author notes
          Corresponding author: John Schneider, MD, MPH, Address: 5837 S. Maryland, L-038 Chicago, IL 60637, Phone: (773) 702-9967, jschnei1@ 123456bsd.uchicago.edu
          Article
          PMC5758406 PMC5758406 5758406 nihpa924070
          10.1097/QAD.0000000000001710
          5758406
          29194116
          7d16f377-5af7-4744-9c29-377e015a9d16
          History
          Categories
          Article

          Preexposure prophylaxis (PrEP),national guidelines,Young Black men who have sex with men,HIV prevention

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