Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Epidemiology and Biostatistics, University of Albany School of Public Health, State University of New York, Rensselaer, New York, USA.
Clin Infect Dis. 2020 Jul 27;71(3):574-582. doi: 10.1093/cid/ciz894.
Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has great potential to reduce HIV incidence among young black men who have sex with men (YBMSM); however, initiation and persistence for this group remain low. We sought to understand the patterns and predictors of PrEP uptake and discontinuation among YBMSM in Atlanta, Georgia.
PrEP was offered to all participants in a prospective cohort of YBMSM aged 18-29 years not living with HIV. Time to PrEP uptake, first discontinuation, and final discontinuation were assessed using the Kaplan-Meier method. Cox proportional hazard models were used to identify predictors of uptake and discontinuation.
After 440 person-years of follow-up, 44% of YBMSM initiated PrEP through the study after a median of 122 days. Of PrEP initiators, 69% had a first discontinuation and 40% had a final discontinuation during the study period. The median time to first PrEP discontinuation was 159 days. Factors associated with PrEP uptake included higher self-efficacy, sexually transmitted infection (STI), and condomless anal intercourse. Factors associated with discontinuation included younger age, cannabis use, STI, and fewer sex partners. HIV incidence was 5.23/100 person-years (95% confidence interval [CI], 3.40-7.23), with a lower rate among those who started PrEP (incidence rate ratio, 0.39; 95% CI, .16-.92).
Persistent PrEP coverage in this cohort of YBMSM was suboptimal, and discontinuations were common despite additional support services available through the study. Interventions to support PrEP uptake and persistence, especially for younger and substance-using YBMSM, are necessary to achieve full PrEP effectiveness.
NCT02503618.
人类免疫缺陷病毒（HIV）暴露前预防（PrEP）有很大潜力降低与男性发生性行为的年轻黑人男性（YBMSM）中的 HIV 发病率；然而，该人群的起始和持续使用仍然很低。我们旨在了解佐治亚州亚特兰大 YBMSM 中 PrEP 采用和停药的模式和预测因素。
向所有未感染 HIV 的年龄在 18-29 岁的前瞻性队列 YBMSM 参与者提供 PrEP。采用 Kaplan-Meier 法评估 PrEP 采用、首次停药和最终停药的时间。使用 Cox 比例风险模型确定采用和停药的预测因素。
在 440 人年的随访后，44%的 YBMSM 在研究中经过中位数为 122 天的时间后开始采用 PrEP。在 PrEP 使用者中，69%有首次停药，40%在研究期间有最终停药。首次 PrEP 停药的中位时间为 159 天。与 PrEP 采用相关的因素包括更高的自我效能、性传播感染（STI）和无保护的肛交。与停药相关的因素包括年龄较小、使用大麻、STI 和性伴侣较少。HIV 发病率为 5.23/100 人年（95%置信区间 [CI]，3.40-7.23），开始采用 PrEP 的人群发病率较低（发病率比，0.39；95%CI，0.16-0.92）。
在本队列的 YBMSM 中，PrEP 的持续覆盖情况并不理想，尽管研究中提供了额外的支持服务，但停药仍然很常见。需要采取干预措施来支持 PrEP 的采用和持续使用，特别是对于年轻和使用物质的 YBMSM，以实现 PrEP 的充分有效性。
NCT02503618。
