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      Willingness of community-recruited men who have sex with men in Washington, DC to use long-acting injectable HIV pre-exposure prophylaxis

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          Abstract

          Objectives

          Clinical trials are currently investigating the safety and efficacy of long-acting injectable (LAI) agents as HIV pre-exposure prophylaxis (PrEP). Using National HIV Behavioral Surveillance data, we assessed the self-reported willingness of men who have sex with men (MSM) to use LAI PrEP and their preference for LAI versus daily oral PrEP.

          Methods

          In 2014, venue-based sampling was used to recruit MSM aged ≥18 years in Washington, DC. Participants completed an interviewer-administered survey followed by voluntary HIV testing. This analysis included MSM who self-reported negative/unknown HIV status at study entry. Correlates of being “very likely” to use LAI PrEP and preferring it to daily oral PrEP were identified using multivariable logistic regression.

          Results

          Of 314 participants who self-reported negative/unknown HIV status, 50% were <30 years old, 41% were non-Hispanic Black, 37% were non-Hispanic White, and 14% were Hispanic. If LAI PrEP were offered for free or covered by health insurance, 62% were very likely, 25% were somewhat likely, and 12% were unlikely to use it. Regarding preferred PrEP modality, 67% chose LAI PrEP, 24% chose oral PrEP, and 9% chose neither. Correlates of being very likely versus somewhat likely/unlikely to use LAI PrEP included age <30 years (aOR 1.64; 95% CI 1.00–2.68), reporting ≥6 (vs. 1) sex partners in the last year (aOR 2.60; 95% CI 1.22–5.53), previous oral PrEP use (aOR 3.67; 95% CI 1.20–11.24), and being newly identified as HIV-infected during study testing (aOR 4.83; 95% CI 1.03–22.67). Black (vs. White) men (aOR 0.48; 95% CI 0.24–0.96) and men with an income of <$20,000 (vs. ≥$75,000; aOR 0.37; 95% CI 0.15–0.93) were less likely to prefer LAI to oral PrEP.

          Conclusions

          If LAI PrEP were found to be efficacious, its addition to the HIV prevention toolkit could facilitate more complete PrEP coverage among MSM at risk for HIV.

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          Most cited references20

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          From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City.

          This study examined potential facilitators and barriers to pre-exposure prophylaxis (PrEP) use and their association with PrEP acceptability and motivations for adherence among 184 MSM and transgender women living in New York City. Participants were presented with educational information about PrEP and completed a computerized survey. Overall, 55.4% of participants reported willingness to take PrEP. The most highly endorsed barriers to PrEP use were health concerns, including both long-term impacts and short-term side effects, questions about PrEP's impact on future drug resistance, and concerns that PrEP does not provide complete protection against HIV. The most highly endorsed facilitator was free access to PrEP, followed by access to support services such as regular HIV testing, sexual health care/monitoring, and access to one-on-one counseling. Participants of color rated both barriers and facilitators as more important than their White counterparts. In multivariate models, barrier and facilitator scores significantly predicted not only PrEP acceptability, but also motivation for PrEP adherence among those who were likely to use PrEP. PrEP implementation programs should consider addressing these barriers and facilitators in protocol and policy development. Findings underscore the importance of support services, such as sexual health counseling, to the success of PrEP as a prevention strategy.
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            The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men.

            Objectives: We assessed how health care-related stigma, global medical mistrust, and personal trust in one's health care provider relate to engaging in medical care among Black men who have sex with men (MSM).
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              Unraveling the divergent results of pre-exposure prophylaxis trials for HIV prevention.

              Although the balance of recent evidence supports the efficacy of antiretroviral (ARV)-based pre-exposure prophylaxis (PrEP) against HIV-1 infection, recent negative trial results are perplexing. Of seven trials with available HIV endpoints, three different products have been tested: tenofovir 1% vaginal gel, oral tenofovir disoproxil fumarate (TDF) tablets, and TDF/emtricitabine tablets. Six of these trials were conducted exclusively in sub-Saharan Africa; all found the products to be well tolerated, and four demonstrated effectiveness. Furthermore, the HIV Prevention Trial Network (HPTN) 052 trial recently confirmed that antiretroviral treatment leads to 96% reduction in transmission to HIV-negative partners in HIV-serodiscordant couples. These results, along with human and animal data, provide substantial evidence for the efficacy of antiretroviral-based HIV prevention. Yet assessment of oral TDF/emtricitabine in the FEM-PrEP study and of oral and vaginal tenofovir in the Microbicide Trial Network (MTN)-003 trial (VOICE) was stopped for futility. How do we make sense of these discrepant results? We believe that adherence is a key factor, although it cannot be the only factor. Expanding upon a recent editorial in the Lancet, we discuss the impact of suboptimal product adherence on PrEP efficacy in the context of variable drug concentration at the exposure site, integrity of the vaginal epithelium, and the role of acute infection.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 August 2017
                2017
                : 12
                : 8
                : e0183521
                Affiliations
                [1 ] Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
                [2 ] HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, DC, United States of America
                Thai Red Cross AIDS Research Center, THAILAND
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-2164-1726
                Article
                PONE-D-17-16487
                10.1371/journal.pone.0183521
                5565177
                28827821
                a1932329-2dd4-4bf8-99c0-0a45b1ab9387
                © 2017 Levy et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 April 2017
                : 4 August 2017
                Page count
                Figures: 2, Tables: 2, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000030, Centers for Disease Control and Prevention;
                Award ID: 5U1BPS003261
                Funded by: District of Columbia Department of Health
                Award ID: DCPO2011-C-0073
                This work was supported by the National HIV Behavioral Surveillance in Washington, DC is funded through a Centers for Disease Control and Prevention (CDC) grant to the District of Columbia Department of Health (CDC Grant 5U1BPS003261) and the data collection resulted as a public health/academic partnership between the District of Columbia Department of Health and The George Washington University Milken Institute School of Public Health (Contract number: DCPO2011-C-0073). The CDC had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Custom metadata
                Data from the National HIV Behavioral Surveillance system for the Washington, DC site are considered to be protected and confidential under The District of Columbia Municipal Regulations, Chapter 22-B2 Communicable and Reportable Disease, Public Health and Medicine, Rule Number 22-B206 Human Immunodeficiency Virus (HIV) Infection, 206.5. Therefore, we are unable to upload the raw data set for public access. However, a limited, de-identified analytical data set can be made available. To access National HIV Behavioral Surveillance system data from the Washington, DC site, interested parties should submit a concept proposal to Jenevieve Opoku, MPH, DC DOH Principal Investigator for NHBS in Washington, DC, at jenevieve.opoku@ 123456dc.gov . Non-DC DOH investigators with approved concept proposals must sign data use and nondisclosure agreements in order to access a limited, de-identified analytical data set. Data requests may also be sent to Adam Allston, PhD, MPH, MSW (email: Adam.allston@ 123456dc.gov ).

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