在美国三个城市中，开始接受暴露前预防（PrEP）并坚持使用的男男性行为者（MSM）中的黑人：来自 HPTN 073 研究的结果。
Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study.
机构信息
School of Social Welfare, University at Albany - SUNY, Albany, NY, USA.
School of Health Professions, New York Institute of Technology, New York, NY, USA.
出版信息
J Int AIDS Soc. 2019 Feb;22(2):e25223. doi: 10.1002/jia2.25223.
INTRODUCTION
Randomized clinical trials have demonstrated the efficacy of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client-centered care coordination (C4) model.
METHODS
The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring.
RESULTS
Of the 226 men enrolled, 178 participants initiated PrEP (79%), and of these 64% demonstrated PrEP utilization at week 26 (mid-point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV-infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95% confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 -6.37), perception of having enough money (OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18).
CONCLUSIONS
Results suggest a high level of PrEP initiation among at-risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.
简介
随机临床试验已经证明，在男男性行为者（MSM）中，抗逆转录病毒预先暴露预防（PrEP）在预防 HIV 感染方面是有效的。然而，在美国（US），针对黑人男男性行为者（BMSM）的 PrEP 起始和依从性的研究非常有限，而这些黑人男男性行为者在新感染 HIV 和晚期接受护理的人群中所占比例过高。本研究报告了 HIV 预防试验网络 073 （HPTN 073）研究，该研究旨在利用理论原则、文化知情和以客户为中心的护理协调（C4）模型，研究黑人男男性行为者中 PrEP 的起始、利用和依从性。
方法
HPTN 073 研究于 2013 年 2 月至 2015 年 9 月在三个美国城市（加利福尼亚州洛杉矶、华盛顿特区和北卡罗来纳州查珀尔希尔）招募并随访了 226 名未感染 HIV 的黑人男男性行为者。研究参与者提供了每日一次的口服恩曲他滨/替诺福韦（FTC/TDF）PrEP，并结合 C4 进行治疗，随访 52 周。参与者接受了 HIV 检测、风险降低教育和临床监测。
结果
在招募的 226 名男性中，有 178 名参与者开始接受 PrEP（79%），其中 64%的参与者在 26 周（研究的中点）根据药代动力学检测显示 PrEP 的利用。与 HIV 感染或未知状态的偶然男性伴侣发生无保护的肛交性行为与 PrEP 起始的可能性更大有关（调整后的优势比（OR）4.4，95%置信区间（CI）1.7，11.7）。年龄较大（≥25 岁与＜25 岁，OR 2.95，95% CI 1.37-6.37）、认为自己有足够的钱（OR 3.6，95% CI 1.7 至 7.7）和知道男性伴侣在发生性行为前使用 PrEP（OR 2.22，95% CI 1.03 至 4.79）与 26 周时 PrEP 依从性的可能性增加有关。与未开始 PrEP 的参与者相比（7.7，95% CI 2.5 至 24.1），开始 PrEP 的参与者的年化 HIV 发病率为 2.9（95% CI 1.2 至 7.9）（p=0.18）。
结论
结果表明，高危黑人男男性行为者中 PrEP 的起始率很高，这一群体在历史上一直难以接触。数据支持解决影响 PrEP 起始和依从性的背景因素的重要性，以及在黑人男男性行为者中开展关于 PrEP 在 HIV 预防中最终益处的额外研究。
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