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Comparative Study
. 2019 Oct;31(10):1228-1233.
doi: 10.1080/09540121.2019.1595523. Epub 2019 Mar 20.

Effective use of pre-exposure prophylaxis (PrEP) Among stimulant users with multiple condomless sex partners: a longitudinal study of men who have sex with men in Los Angeles

David Goodman-Meza  1 , Matthew R Beymer  1   2 , Ryan M Kofron  3 , K Rivet Amico  4 , Christina Psaros  5 , Lane R Bushman  6 , Peter L Anderson  6 , Robert Bolan  2 , Wilbert C Jordan  7 , James F Rooney  8 , Amy R Wohl  9 , Raphael J Landovitz  1   3
Affiliations
Comparative Study

Effective use of pre-exposure prophylaxis (PrEP) Among stimulant users with multiple condomless sex partners: a longitudinal study of men who have sex with men in Los Angeles

David Goodman-Meza et al. AIDS Care. 2019 Oct.

Abstract

PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04-0.57). From week 4-48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01-1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96-1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time.

Keywords: MSM; PrEP; adherence; condomless anal sex; stimulant.

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Conflict of interest statement

Conflicts of interest: RJL has served as a consultant to and received honoraria and travel support from Gilead Sciences. KRA received an educational grant through the University of Michigan from Gilead Sciences. PLA reports grant and contract work with Gilead Sciences, paid to his institution. JFR is employed by Gilead Sciences. All other authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Predicted probabilities of prevention-effective adherence (TFV-DP ≥700 fmol/punch) by condomless anal sex with multiple partners and stimulant use in a cohort of MSM on PrEP (n=283). Abbreviations: DBS, dried blood spot; PrEP, pre-exposure prophylaxis; TFV-DP, tenofovir diphosphate.
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