- Category: Pre-exposure Prophylaxis (PrEP)
- Published on Friday, 12 February 2016 00:00
- Written by Liz Highleyman
More than 20% of gay and bisexual men in Washington State considered to be at high risk for HIV infection were taking Truvada pre-exposure prophylaxis (PrEP) in 2015, and a large majority of both higher- and lower-risk men were aware of it, according to a study published in the January 28 edition of AIDS.
Daily Truvada (tenofovir/emtricitabine) PrEP has been shown to be more than 90% effective in preventing HIV infection among people who take it consistently. The U.S. Food and Drug Administration approved Truvada for PrEP in July 2012, but uptake was initially slow, as most people either did not know about PrEP or had concerns about its safety and efficacy. But PrEP use has accelerated over the past couple years in conjunction with community advocacy, especially among men who have sex with men (MSM).
Julia Hood from the Seattle and King County Public Health Department and colleagues assessed trends in PrEP awareness and use among gay and bisexual men in Washington State, which has the country's first PrEP drug assistance program, in addition to most insurance plans and the state's Medicaid program paying for PrEP.
The researchers conducted a cross-sectional survey annually at the Seattle Pride Parade between 2009 and 2015. The Gay Pride survey collects data on respondents’ demographic characteristics, access to healthcare, risk behaviors, HIV and sexually transmitted disease (STD) testing, and awareness of HIV prevention strategies and campaigns. The anonymous survey could be done by an interviewer or self-administered in English or Spanish, and respondents received condoms, information about local services, and a $5 gift card.
This convenience sample included 2168 MSM who reside in Washington State and said they had never tested HIV-positive. Most (71%) were white and the median age was 32. About half had a college education and a third reported an annual income over $50,000. The majority (70%) lived in King County, which includes Seattle, the state's largest city. About a quarter met the health department's criteria for "high risk" of HIV infection, which included having at least 10 anal sex partners, condomless anal sex with a man who was HIV-positive or of unknown status, having a bacterial STD, or using methamphetamine or poppers.
- Prior to FDA approval in 2012, only 5 men reported having ever used PrEP (<1% of 2009-2011 respondents).
- In 2015, 26 out of 115 high-risk MSM, or 23%, reported currently taking PrEP.
- The percentage of high-risk men who reported ever taking PrEP increased from 5% in 2012 to 31% in 2015.
- 72% of men who reported ever using PrEP were currently taking it.
- PrEP use among lower-risk MSM remained low and stable, between 1% and 3% during 2012-2015.
- In multivariate analyses, PrEP use was associated with later calendar years and higher HIV risk (adjusted relative risk 2.29 for 2012-2015 and 2.92, respectively).
- The percentage of high-risk men who had heard of PrEP increased from 13% in 2012 to 86% in 2015, while the proportion of lower-risk men who were familiar with it rose from 29% to 58%.
"PrEP awareness is high and the use has rapidly increased over the last year among MSM in Seattle, Washington, USA," the study authors concluded. "These findings demonstrate that high levels of PrEP use can be achieved among MSM at high-risk for HIV infection."
The researchers added thata number of factors distinguish the survey area from much of the rest of the country, including a relatively well-educated and affluent population, a large number of medical providers offering PrEP, the state PrEP drug assistance program and a Medicaid program that pays for PrEP without copayments, and a state health department campaign to raise PrEP awareness among gay men.
However, they noted that despite the dramatic recent increase in PrEP use among high-risk MSM, only 7% of all 2015 survey respondents said they were currently taking PrEP. As a limitation of the study, they said that gay and bi men who attend Pride events may differ from MSM who do not, and the survey included a relatively small number of black and Latino men -- populations disproportionately affected by HIV nationwide.
"Achieving a population-level effect on HIV transmission may require substantially higher levels of use than we observed," the researchers wrote. "At the same time, modeling studies in the USA and Australia have suggested that given current drug costs, PrEP is only cost-effective if targeted to high-risk MSM. Our findings suggest that such targeting is occurring in King County, Washington, USA. However, some MSM categorized as being low risk in our analysis may be at significant risk for HIV acquisition. Future efforts should focus both on increasing PrEP uptake among high-risk MSM and developing better criteria to identify segments of the MSM population that would benefit most from PrEP."
JE Hood, SE Buskin, JC Dombrowski, et al. Dramatic increase in preexposure prophylaxis use among MSM in Washington state. AIDS 30(3):515-519. January 28,2016.