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Adherence to Pre-exposure Prophylaxis in Black Men Who Have Sex with Men and Transgender Women in a Community Setting in Harlem, NY

Abstract

While oral pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention, consistent use is necessary to achieve its intended impact. We compared effectiveness of enhanced PrEP (enPrEP) adherence support to standard of care (sPrEP) among Black MSM and TGW attending a community clinic in Harlem, NY. EnPrEP included peer navigation, in-person/online support groups, and SMS messages. Self-reported adherence over previous 30 days, collected in quarterly interviews, was defined as ≥ 57%. Crude and adjusted analyses examined factors associated with adherence. A total of 204 participants were enrolled and randomized; 35% were lost to follow-up. PrEP adherence was 30% at 12-months; no intervention effect was observed (p = 0.69). Multivariable regression analysis found that lower adherence was associated with low education and depressive symptoms. We found that an enhanced adherence intervention did not improve PrEP adherence. Findings point to the need for innovative methods to improve PrEP adherence among Black MSM and TGW.

Clinical Trial Registration NCT02167386, June 19, 2014

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Acknowledgements

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH098723 (Colson PI). Gilead Sciences, Inc. donated the study drug and arranged for processing of dried blood spots. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Gilead Sciences, Inc. We would like to thank the administration and staff of Harlem United, along with the participants in the PrEPared & Strong study. Appreciation is also due to students who helped conduct the study: Thomas Silverman, Madeline Schneider, Basma Rustom, Shanel Spence, and Victoria Stoffel.

Funding

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH098723 (Colson PI). Gilead Sciences, Inc. donated the study drug and arranged for processing of dried blood spots. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Gilead Sciences, Inc.

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All authors made substantial contributions to the conception or design of this study; the acquisition, analysis, or interpretation of data; drafting the manuscript or making critical revisions; and giving final approval of the version to be published.

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Correspondence to P. W. Colson.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Columbia University Medical Center (January 7, 2015/No. IRB-AAAO0852.

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Appendix

Appendix

See Tables 5 and 6.

Table 5 Associations between baseline demographic and psychosocial factors and PrEP adherencea from baseline to 12 months (as-treated population—N = 173)
Table 6 Associations between baseline demographic and psychosocial factors and PrEP adherencea from baseline to 12 months (as-treated population—N = 173)

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Colson, P.W., Franks, J., Wu, Y. et al. Adherence to Pre-exposure Prophylaxis in Black Men Who Have Sex with Men and Transgender Women in a Community Setting in Harlem, NY. AIDS Behav 24, 3436–3455 (2020). https://doi.org/10.1007/s10461-020-02901-6

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Keywords

  • Pre-exposure prophylaxis (PrEP)
  • HIV/AIDS
  • Adherence
  • Men who have sex with men (MSM)
  • Transgender women (TGW)
  • Black