An observational study of preexposure prophylaxis uptake, sexual practices, and HIV incidence among men and transgender women who have sex with men

By Robert M. Grant, P. Anderson, V. McMahan, A. Liu, K. Amico, Megha L. Mehrotra, S. Hosek, C. Mosquera, Martin Casapia, O. Montoya and 12 more. Lancet. Infectious Diseases (Print), 2014

1,110 citations recorded by the source corpus.

Background The impact of HIV pre-exposure prophylaxis (PrEP) depends on uptake, adherence, and sexual practices. Methods Men and transgender women who have sex with men (MSM/TGW) previously enrolled in PrEP trials were enrolled in a 72 week open label extension (iPrEx OLE). Drug concentrations were measured in plasma and dried blood spots (DBS) in seroconverters and a random sample of seronegatives. Findings 1603 HIV uninfected persons were enrolled, of whom 76% received PrEP. PrEP uptake was higher among those reporting condomless receptive anal intercourse (ncRAI; P=0.003) and having serological evidence of herpes (P=0.03). Among those receiving PrEP, HIV incidence was 1.8/100PY, which was 49% (95% CI: −1 to 74%) lower than among those who concurrently did not choose PrEP after adjusting for sexual behavior, and 53% (95% CI: 26 to 70%) lower than in the placebo arm of the prior randomized phase (3.9/100PY). Among those receiving PrEP, HIV incidence was 4.7/100PY if drug was not detected in DBS, 2.3/100PY if drug concentrations indicated use of less than 2 tablets per week, 0.6/100PY for use of 2 to 3 tablets per week, and 0/100PY for use of 4 or more tablets per week (P<0.0001). PrEP drug concentrations were higher among people with older age, more schooling, ncRAI, more sexual partners, trans-identification, and a history of syphilis or herpes. Interpretation PrEP uptake was high when made available free of charge by experienced providers. PrEP impact is increased by greater uptake and adherence during periods of higher risk; disengagement after initial use is common. DBS drug concentrations are strongly correlated with PrEP’s protective benefit.

Subfields: Epidemiology, Infectious Diseases, Virology

View Paper: https://www.semanticscholar.org/paper/2a49553ee4ecfd3cec11dc817489379877674f77

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

  1. V. Fonner
  2. Sarah L Dalglish
  3. C. Kennedy
  4. K. O'reilly
  5. R. Baggaley
  6. Florence M. Koechlin
  7. M. Rodolph
  8. I. Hodges-Mameletzis

Citations in the corpus