University of California San Diego (UCSD), San Diego, CA, USA.
Medical University of Graz, Graz, Austria.
J Neurovirol. 2019 Jun;25(3):324-330. doi: 10.1007/s13365-018-0716-3. Epub 2019 Jan 7.
The objective of this study was to examine differences in the levels of risky decision making and other frontal system behavior constructs in relation to self-initiated continuance of HIV pre-exposure prophylaxis (PrEP) and PrEP adherence outcomes among men who have sex with men (MSM) following completion of a clinical PrEP trial. At the last PrEP trial visit, study provided PrEP was discontinued and participants were navigated to the community for PrEP continuation. In this cross-sectional analysis, 84/187 (45%) MSM who completed a prospective observational post-PrEP trial follow-up visit at the University of California San Diego were included. PrEP adherence was measured using dried blood spot tenofovir diphosphate (TFV-DP) levels. Risky decision making was assessed using the Iowa Gambling Task (IGT) and the Balloon Analogue Risk Task (BART), while impulsivity/disinhibition, sensation seeking, and substance use were assessed via standardized self-report questionnaires. A total of 58/84 (69%) of MSM who completed the 12-month post-study visit continued PrEP. Of those, n = 46 (79%) reached TFV-DP levels associated with adequate adherence. Individuals who elected to continue PrEP 12 months post-trial had riskier decision making on BART, but less impulsivity/disinhibition compared to individuals who did not continue PrEP. Neither risky decision making nor impulsivity/disinhibition/sensation seeking nor substance use correlated with PrEP adherence. Our findings suggest that those with risky decision making may have greater insight into their HIV risks, and therefore be more likely to continue to use PrEP. However, elevated impulsivity/disinhibition, indicative of greater neurobehavioral alterations, was negatively associated with PrEP continuance and is a potential target for future interventions to help people link to PrEP.
本研究旨在探讨在完成一项临床预防用爱滋病病毒暴露前预防（PrEP）试验后，与男男性行为者（MSM）自行继续使用 PrEP 以及 PrEP 依从性结果相关的风险决策水平和其他额叶系统行为结构的差异。在最后一次 PrEP 试验访视时，停止提供研究用 PrEP，参与者被引导到社区继续使用 PrEP。在这项横断面分析中，共有 187 名完成前瞻性观察性 PrEP 试验随访访视的 MSM 中的 84 名（45%）被纳入，在加利福尼亚大学圣地亚哥分校进行。PrEP 依从性通过检测干血斑中的替诺福韦二磷酸（TFV-DP）水平来衡量。使用爱荷华赌博任务（IGT）和气球模拟风险任务（BART）评估风险决策，而冲动/抑制、感觉寻求和物质使用则通过标准化的自我报告问卷进行评估。共有 84 名 MSM 中的 58 名（69%）完成了 12 个月的研究后访视，继续使用 PrEP。其中，n=46（79%）达到了与充分依从性相关的 TFV-DP 水平。与未继续使用 PrEP 的个体相比，选择在试验后 12 个月继续使用 PrEP 的个体在 BART 上的决策风险更高，但冲动/抑制程度较低。风险决策和冲动/抑制/感觉寻求/物质使用与 PrEP 依从性均无相关性。我们的研究结果表明，那些有风险决策的人可能对自己的艾滋病毒风险有更深入的了解，因此更有可能继续使用 PrEP。然而，升高的冲动/抑制，表明神经行为改变更大，与 PrEP 继续使用呈负相关，是未来干预措施的潜在目标，以帮助人们与 PrEP 联系起来。
