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Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research

  • Christian Grov
  • H. Jonathon Rendina
  • Steven A. John
  • Jeffrey T. Parsons
Original Paper

Abstract

Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men (GBM) living with HIV. There is limited parallel examination of pre-exposure prophylaxis (PrEP) adherence among HIV-negative GBM. We conducted retrospective 30-day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with 104 PrEP-using GBM, half of whom engaged in club drug use (ketamine, ecstasy, GHB, cocaine, or methamphetamine)—generating 9532 days of data. Participants reported their day-by-day PrEP, club drug, marijuana, and heavy alcohol use (5 + drinks in one sitting). On average, club drug users were no more likely to miss a dose of PrEP than non-club drug users (M = 1.6 doses, SD = 3.0, past 30 days). However, we found that club drug use (at the event level) increased the odds of missing a dose on the same day by 55% and the next day (e.g., a “carryover effect”) by 60%. Further, missing a dose on one day increased the odds of missing a dose the following day by eightfold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence.

Keywords

Pre-exposure prophylaxis (PrEP) Adherence Men who have sex with men HIV Club drugs Alcohol Marijuana 

Resumen

Los investigadores han establecido que el uso de sustancias interfiere con la adherencia a los medicamentos antiretrovirales entre los hombres gay y bisexuales (HGB) viviendo con el VIH. Hay limitada examinación en paralelo de la adherencia a la profilaxis pre-exposición (PrEP) entre los HGB VIH-negativos. Realizamos entrevistas retrospectivas de seguimiento histórico de 30-días y diarios prospectivos realizados dos veces a la semana por 10 semanas con 104 HGB que usan PrEP. La mitad de los participantes utilizaban drogas del club (ketamina, éxtasis, GHB, cocaína o metanfetamina)— generando 9,532 días de data. Los participantes reportaron uso diario de PrEP, drogas del club, marihuana y consumo excesivo de alcohol (5 o mas bebidas en una sesión). En promedio, los usuarios de drogas del club no tuvieron mas probabilidades de perder una dosis de PrEP que los usuarios que no usaban drogas del club (M = 1.6 dósis, SD = 3.0, pasados 30 días). No obstante, encontramos que el uso de drogas del club (al nivel de evento) incrementa la probabilidad de perder una dosis el mismo día por 55% y al próximo día (Por ejemplo, un “efecto de arrastre”) por 60%. Además, perder una dosis en un día aumenta ocho-veces la probabilidad de perder una dosis al día siguiente. No identificamos un efecto a nivel-evento entre uso de marihuana o alcohol excesivo y la adherencia a PrEP. Nuestra data sugiere que los usuarios de drogas del club pueden tener mayores efectos protectivos de PrEP diario oral, o PrEP de accion prolongada inyectable en comparación con un regimen de PrEP a nivel de tiempo debido a la concurrencia del uso de drogas del club y la falta de adherencia a PrEP.

Notes

Acknowledgements

Funding support for the PrEP & Me study and authors of this manuscript came from the National Institute of Drug Abuse (NIDA) (R21-DA039019, PI: Grov) and the National Institute of Mental Health (P30-MH052776, PI: Kelly). H. Jonathon Rendina was funded by a career development award from the National Institute on Drug Abuse (K01-DA039030). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to acknowledge the contributions of the other members of the PrEP & Me study team (Mark Pawson, Andrew Cortopassi, Brian Salfas, Chloe Mirzayi, Juan Castiblanco, and Ruben Jimenez) and other staff from the Center for HIV/AIDS Educational Studies and Training (Chris Hietikko, Tina Koo, Chris Murphy, and Carlos Ponton). Finally, we thank Shoshana Kahana at NIDA and all of our participants who participated in PrEP & Me. NIDA/NIH had no role in the production of this manuscript nor necessarily endorses its findings.

Funding

Support was provided by the National Institute of Drug Abuse (R21-DA039019, PI: Grov) and the National Institute of Mental Health (P30-MH052776, PI: Kelly). H. Jonathon Rendina is funded by a career development award from the National Institute on Drug Abuse (K01-DA039030).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Christian Grov
    • 1
  • H. Jonathon Rendina
    • 2
    • 3
    • 4
  • Steven A. John
    • 5
  • Jeffrey T. Parsons
    • 2
    • 3
    • 4
  1. 1.Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health PolicyThe CUNY Institute for Implementation Science in Population HealthNew YorkUSA
  2. 2.Center for HIV/AIDS Educational Studies & TrainingHunter College of the City University of New York (CUNY)New YorkUSA
  3. 3.Health Psychology and Clinical Science Doctoral ProgramThe Graduate Center of the City University of New York (CUNY)New YorkUSA
  4. 4.Department of PsychologyHunter College of the City University of New York (CUNY)New YorkUSA
  5. 5.Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention ResearchMedical College of WisconsinMilwaukeeUSA

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