Among US subgroups, Black men who have sex with men (BMSM) remain at disproportionate risk of HIV acquisition. Comprising less than 0.4% of the U.S. population, they accounted for more than 20% of all new infections in 2013. Identifying effective and innovative methods to deliver effective prevention and halt the epidemic in this key population is an urgent public health priority. HPTN 073 is one of the first studies to evaluate pre-exposure prophylaxis (PrEP) in a US BMSM population.
HIV-uninfected BMSM were enrolled in three U.S. cities (Washington, DC., Los Angeles CA, & Chapel Hill, NC) All participants were offered once daily oral FTC/TDF combined with client-centered care coordination (C4)–a theory-based counseling approach to promote and support PrEP use, which combined service referral, linkage and follow-up strategies to assist participants in addressing unmet psychosocial needs. Each participant was offered PrEP and followed for a total of 12 months.
226 BMSM men were recruited; 209 (92%) completed 12 month of follow-up. 40% were <25 years, 27% were unemployed, 31% did not have health insurance. The median number of male partners in the prior 3 months was 3 (IQR 1-4), 33% reported a primary partner and 73% casual male partners. PrEP was accepted by 178 (79%) of study participants (see Figure); 68% remained on PrEP at 26 weeks. Self-reported adherence above 50% was 85% at 4 weeks and 78% at 26 weeks. 23/24 (96%) men reporting an HIV+ primary partner and 104/120 (86%) of men reporting casual partners with unknown or HIV+ status accepted PrEP. Those agreeing to take PrEP utilized a median of 6 C4 sessions (range 3–8) compared to men not accepting PrEP (median 4 range 2-6]). Among the 178 men who ever accepted PrEP, 5 HIV infections occurred in 172 person years (PY) (incidence=2.9 95%CI(0.9-6.8)) compared to 3 in 39 PY (incidence=7.7 95%CI1.6-22.5) in men who never accepted PrEP. Of the 5 seroconverters who ever took PrEP, 2 had discontinued PrEP at 50 and 272 days prior to seroconversion.
Providing theory-based culturally tailored programs for BMSM can potentially increase their ability to establish and maintain adherence and prevent HIV in this highly impacted group. HPTN 073 demonstrated high uptake of PrEP in BMSM utilizing a novel coordinated counseling model that was highly acceptable, and led to data that could support a reduced rate of HIV-infection for BMSM on PrEP. These findings help address a vital US public health gap in HIV prevention.