Effective use of pre-exposure prophylaxis (PrEP) Among stimulant users with multiple condomless sex partners: a longitudinal study of men who have sex with men in Los Angeles

ABSTRACT

PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04–0.57). From week 4–48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01–1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96–1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time.

KEYWORDS:

• PrEP
• adherence
• MSM
• stimulant
• condomless anal sex

Acknowledgements

We would like to acknowledge the participants in the study for their time and effort and the staff that recruited, screened, enrolled the participants, and collected the data for the parent study.

Disclosure statement

RJL has served as a consultant to and received honoraria and travel support from Gilead Sciences. KRA received an educational grant through the University of Michigan from Gilead Sciences. PLA reports grant and contract work with Gilead Sciences, paid to his institution. JFR is employed by Gilead Sciences.

Compliance with ethical standards

Ethical approval

The Institutional Review Boards at the University of California Los Angeles (approval number 12-001265) and Charles R. Drew University of Medicine and Science (approval number 13-01-2395-01) approved the parent study. 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. All participants provided written informed consent before screening.

ORCID

David Goodman-Meza http://orcid.org/0000-0001-9382-3564

Matthew R. Beymer http://orcid.org/0000-0001-5258-1095

Ryan M. Kofron http://orcid.org/0000-0002-9748-6531

K. Rivet Amico http://orcid.org/0000-0002-4458-6934

Christina Psaros http://orcid.org/0000-0002-0705-2239

Raphael J. Landovitz http://orcid.org/0000-0002-1442-714X

Additional information

Funding

The original data collection was funded by the California HIV/AIDS Research Program (EI11-LA-002). Gilead Sciences provided drug supply and additional support for some drug-assay testing. DGM and MRB were supported by the US National Institute of Mental Health (DA-2T32MH080634-11). This work was also supported by the National Institute of Mental Health (grant P30MH58107) via the UCLA Center for HIV Identification, Prevention, and Treatment Services (CHIPTS); the National Institute of Allergy and Infectious Diseases (P30AI028697) by way of the UCLA Center for AIDS Research (CFAR); and the National Center for Advancing Translational Sciences (UL1TR001881) through the UCLA Clinical Translational Science Institute (CTSI). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.