HIV Pre-exposure Prophylaxis Persistence and Adherence Among Men Who Have Sex With Men in Four US Cities

Abstract

Background: HIV pre-exposure prophylaxis (PrEP) persistence and adherence are critical to ending the HIV epidemic in the United States.

Setting: In 2017 National HIV Behavioral Surveillance, HIV-negative men who have sex with men (MSM) in 4 US cities completed a survey, HIV testing, and dried blood spots at recruitment.

Methods: We assessed 3 PrEP outcomes: persistence (self-reported PrEP use at any time in the past 12 months and had tenofovir, emtricitabine, or tenofovir diphosphate detected in dried blood spots), adherence at ≥4 doses/week (self-reported past-month PrEP use and tenofovir diphosphate concentration ≥700 fmol/punch), and adherence at 7 doses/week (self-reported past-month PrEP use and tenofovir diphosphate concentration ≥1250 fmol/punch). Associations with key characteristics were examined using log-linked Poisson regression models with generalized estimating equations.

Results: Among 391 MSM who took PrEP in the past year, persistence was 80% and was lower among MSM who were younger, had lower education, and had fewer sex partners. Of 302 MSM who took PrEP in the past month, adherence at ≥4 doses/week was 80% and adherence at 7 doses/week was 66%. Adherence was lower among MSM who were younger, were Black, and had fewer sex partners.

Conclusions: Although persistence and adherence among MSM were high, 1 in 5 past-year PrEP users were not persistent and 1 in 5 past-month PrEP users were not adherent at levels that would effectively protect them from acquiring HIV (ie, ≥4 doses/week). Efforts to support PrEP persistence and adherence should include MSM who are young, are Black, and have less education.

Figure 1.. PrEP continuum among men who have sex with men by PrEP indication status—National HIV Behavioral Surveillance, 4 U.S. cities, 2017

Notes: MSM likely indicated for PrEP self-reported 1) having an HIV-positive male sex partner at last sex or ≥2 male sex partners in the past 12 months AND 2) having condomless anal sex in the past 12 months or a bacterial STI in the past 12 months. *Persistence was defined as self-reporting PrEP use in the past 12 months and having any tenofovir (TFV), emtricitabine (FTC), or tenofovir diphosphate (TFV-DP) detected by liquid chromatography mass spectrometry in DBS. **Adherent at ≥4 doses per week was defined as self-reporting PrEP use in past month and having TFV-DP detected at ≥700 fmol/punch by liquid chromatography mass spectrometry in DBS. Adherent at 7 doses per week was defined as self-reporting PrEP use in past month and having TFV-DP detected at ≥1250 fmol/punch by liquid chromatography mass spectrometry in DBS.