Community program increases PrEP use among black gay, bi men

By Andrew M. Seaman

By Andrew M. Seaman

(Reuters Health) - Black gay and bisexual men enrolled in a program that helps them overcome personal barriers to treatment are likely to keep taking a daily anti-HIV pill, according to new research.

Of 178 men who started taking the preventive pill as part of the program, nearly 70 percent were still taking the so-called pre-exposure prophylaxis (PrEP) a year later, researchers reported Wednesday at the Conference on Retroviruses and Opportunistic Infections in Boston.

"I think it’s an important study because one of the major stumbling blocks of PrEP is adherence," said Dr. Anthony Fauci, director of U.S. National Institute of Allergy and Infectious Diseases in Bethesda, Maryland.

Young black men who have sex with men are a segment of the population that has low rates of PrEP adherence, added Fauci, who wasn't involved with the new study.

"That is really unfortunate, because that’s the vulnerable group that can benefit most from PrEP," he said.

One in two black gay and bisexual men will be diagnosed with the human immunodeficiency virus over their lifetimes if diagnosis rates remain unchanged, the U.S. Centers for Disease Control (CDC) announced at the conference. That compares to one in four Latino gay and bisexual men and one in 11 white gay and bisexual men.

Gilead's daily pill Truvada, a combination of emtricitabine and tenofovir, is currently the only drug approved for PrEP. When used consistently, the CDC says, it can reduce HIV transmission through sex by 90 percent.

Expanding HIV treatment, testing and PrEP programs could lead to 185,000 fewer infections - a 70 percent reduction in expected cases - by 2020, the CDC also reported at the conference.

For the new study, researchers from the HIV Prevention Trials Network recruited 226 black gay and bisexual men from Chapel Hill, North Carolina; Los Angeles and Washington, D.C.

After confirming the men were HIV-negative, the researchers offered them a chance to participate in a program known as client-centered care coordination - or C4 - and receive PrEP for 12 months.

The C4 program invited participants to take part in sessions where they could get personal problems addressed, said Darrell Wheeler, who was in charge of protocol for the new study.

For example, a person may come to a C4 session needing help with housing, domestic violence, substance abuse and other medical issues. The counselor would help with those issues but would also make sure to bring the discussion back to PrEP use.

Overall, 209 participants were followed for an entire year.

PrEP was accepted by 178 of the participants. Of those, 70 percent had protective levels of the drug in their blood at six months. At the end of the year, 67 percent of the participants said they were still taking the pills.

On average, the men who accepted PrEP attended more C4 sessions than participants who didn't take the drug.

Ultimately, there were about three new HIV infections per 100 men per year among those taking PrEP, and about eight new infections per 100 men per year among those not taking PrEP.

The researchers note that two of the men who became HIV-positive in the PrEP group had stopped taking their pills.

"I would describe the results as compelling for a couple of reasons," said Wheeler, of the State University of New York at Albany.

The new study shows that it's possible to recruit and retain African American and black men in research studies, he said. It shows black gay and bisexual men will accept and adhere to PrEP. Also, a program that addresses personal barriers is part of a comprehensive package to support black men's wellbeing and health.

Wheeler said his team is currently examining the burden the C4 program put on community groups providing the services, but initial results suggest it isn't significant. He also said the study's design shows it can be implemented in urban and rural areas.

SOURCE: Conference on Retroviruses and Opportunistic Infections, online February 24, 2016.