scholarly journals Population Impact and Efficiency of Improvements to HIV PrEP Under Conditions of High ART Coverage among San Francisco Men Who Have Sex with Men

2021 ◽  
Author(s):  
Adrien Le Guillou ◽  
Susan Buchbinder ◽  
Hyman Scott ◽  
Albert Liu ◽  
Diane Havlir ◽  
...  
Keyword(s):  
San Francisco ◽  
Hiv Transmission ◽  
Healthcare Access ◽  
Number Needed To Treat ◽  
Sustained Viral Suppression ◽  
Preexposure Prophylaxis ◽  
Sex With Men ◽  
Hiv Antiretroviral Therapy ◽  
Implementation Gaps ◽  
Baseline Coverage

ABSTRACTBackgroundKey components of Ending the HIV Epidemic (EHE) plan include increasing HIV antiretroviral therapy (ART) and HIV preexposure prophylaxis (PrEP) coverage. One complication to addressing this service delivery challenge is the wide heterogeneity of HIV burden and healthcare access across the U.S. It is unclear how the effectiveness and efficiency of expanded PrEP will depend on different baseline ART coverage.MethodsWe used a network-based model of HIV transmission for men who have sex with men (MSM) in San Francisco. Model scenarios increased varying levels of PrEP coverage relative under current empirical levels of baseline ART coverage and two counterfactual levels. We assessed the effectiveness of PrEP with the cumulative percent of infections averted (PIA) over the next decade and efficiency with the number needed to treat (NNT) by PrEP required to avert one HIV infection.ResultsIn our projections, only the highest levels of combined PrEP and ART coverage achieved the EHE goals. Increasing PrEP coverage up to 75% showed that PrEP effectiveness was higher at higher baseline ART coverage with the PIA ranging from 61% in the lowest baseline ART coverage population to 75% in the highest ART coverage. The efficiency declined with increasing ART (NNT range from 41 to 113).ConclusionsImproving both PrEP and ART coverage would have a synergistic impact on HIV prevention even in a high baseline coverage city like San Francisco. Efforts should focus on narrowing the implementation gaps to achieve higher levels of PrEP retention and ART sustained viral suppression.

scholarly journals Intracellular Tenofovir-Diphosphate and Emtricitabine-Triphosphate in Dried Blood Spots following Directly Observed Therapy

2017 ◽  
Vol 62 (1) ◽  
Author(s):  
Peter L. Anderson ◽  
Albert Y. Liu ◽  
Jose R. Castillo-Mancilla ◽  
Edward M. Gardner ◽  
Sharon M. Seifert ◽  
...  
Keyword(s):  
Steady State ◽  
San Francisco ◽  
Dried Blood Spots ◽  
Directly Observed Therapy ◽  
Blood Spots ◽  
Preexposure Prophylaxis ◽  
Dosing Regimens ◽  
Sex With Men ◽  
Tenofovir Diphosphate ◽  
Dose Proportional

ABSTRACT Studies of daily emtricitabine-tenofovir disoproxil fumarate (FTC-TDF) for HIV preexposure prophylaxis (PrEP) in men who have sex with men (MSM) modeled intracellular tenofovir-diphosphate (TFV-DP) in dried blood spots (DBS) to assess adherence and corresponding PrEP outcomes. We conducted a prospective, randomized, crossover pharmacokinetic study of TFV-DP in DBS during 33%, 67%, or 100% of daily dosing under directly observed therapy (DOT). Participants were assigned to two 12-week dosing regimens, separated by a 12-week washout. Forty-eight adults (25 women) from Denver and San Francisco were included. TFV-DP exhibited a median half-life of 17 days, reaching steady state in 8 weeks. TFV-DP was dose proportional with mean (SD) steady-state concentrations of 530 (159), 997 (267), and 1,605 (405) fmol/punch for the 33%, 67%, and 100% arms, respectively. Prior work in MSM demonstrated clinically meaningful TFV-DP thresholds of 350, 700, and 1,250 fmol/punch, which were estimated 25th percentiles for 2, 4, and 7 doses/week. In the present study, corresponding TFV-DP was within 3% of the prior estimates, and subgroups by site, race, and sex were within 14% of prior estimates, although males had 17.6% (95% confidence intervals [CIs], 6.5, 27.4%) lower TFV-DP than females. The thresholds of 350, 700, and 1,250 fmol/punch were achieved by 75% of men taking ≥1.2, 3.2, and 6 doses/week and 75% of women taking ≥0.6, 2.0, and 5.3 doses/week, indicating that lower dosing reached these thresholds for both sexes. In conclusion, TFV-DP arising from DOT was similar to previous estimates and is useful for interpreting PrEP adherence and study outcomes. (This study has been registered at ClinicalTrials.gov under identifier NCT02022657.)

scholarly journals Association Between HIV PrEP Indications and Use in a National Sexual Network Study of Men Who Have Sex with Men

2021 ◽  
Author(s):  
Kevin M Weiss ◽  
Pragati Prasad ◽  
Travis Sanchez ◽  
Steven M Goodreau ◽  
Samuel M Jenness
Keyword(s):  
Hiv Transmission ◽  
Guideline Implementation ◽  
Sexual Network ◽  
Web Based ◽  
Preexposure Prophylaxis ◽  
Binomial Regression ◽  
Sex With Men ◽  
Using Data ◽  
The Relationship ◽  
Hiv Negative

BACKGROUND: HIV preexposure prophylaxis (PrEP) is effective in preventing HIV transmission. US Public Health Service (USPHS) clinical practice guidelines define biobehavioral indications for initiation. To assess guideline implementation, it is critical to quantify PrEP non-users who are indicated and PrEP users who are not indicated. METHODS: Using data from a national web-based study of men who have sex with men (MSM) between 2017 and 2019, we estimated the association between PrEP use and PrEP indications. Log-binomial regression was used to estimate the relationship between PrEP indications and PrEP use, adjusted for geography and demographics. RESULTS: Of 3508 sexually active, HIV-negative MSM, 34% met indications for PrEP. The proportion with current PrEP use was 32% among those meeting indications and 11% among those without indications. Nearly 40% of those currently using PrEP did not meet indications for PrEP, and 68% of MSM with indications for PrEP were not currently using PrEP. After adjusting for geography and demographics, MSM with PrEP indications were about 3 times as likely to be currently using PrEP. This association varied slightly by geography and demography. CONCLUSIONS: Indications for PrEP strongly predicted current PrEP use among MSM. However, we identified substantial misalignment between indications and use in both directions (indicated MSM who were not benefitting from PrEP, and MSM taking PrEP while not presently being indicated). This calls for further implementation efforts to improve PrEP delivery to those most in need during periods of elevated sexual risk.

scholarly journals Correlations Between Community-Level HIV Preexposure Prophylaxis Coverage and Individual-Level Sexual Behaviors among US Men Who Have Sex with Men

2021 ◽  
Author(s):  
Laura M Mann ◽  
Adrien Le Guillou ◽  
Steven M Goodreau ◽  
Julia L Marcus ◽  
Travis Sanchez ◽  
...  
Keyword(s):  
Sexual Behavior ◽  
Condom Use ◽  
San Francisco ◽  
Community Level ◽  
Consistent Condom ◽  
Total Degree ◽  
Modeling Framework ◽  
Consistent Condom Use ◽  
Preexposure Prophylaxis ◽  
Sex With Men

Background HIV preexposure prophylaxis (PrEP) has been associated with changes in sexual behavior after PrEP initiation. However, behavioral differences may also emerge among PrEP non-users in communities with high PrEP coverage. Methods We used demographic, behavioral, and sexual network data from ARTnet, a cross-sectional study of US men who have sex with men conducted during 2017-2019. Multivariable regression models with a Bayesian modeling framework in which individuals were nested within their residential geographic areas were used to estimate associations between area-level PrEP coverage and five sexual behavior outcomes (number of total, main, and casual male partners [network degree]; count of one-time partnerships; and consistent condom use in one-time partnerships), controlling for individual PrEP use. Findings PrEP coverage ranged from 10.3% (Philadelphia) to 38.9% (San Francisco). Total degree was highest in Miami (1.35) and lowest in Denver (0.78), while the count of one-time partners was highest in San Francisco (11.7/year) and lowest in Detroit (1.5/year). Adjusting for individual PrEP use and demographics, community PrEP coverage was associated with higher total degree (adjusted incidence rate ratio [aIRR]=1.73; 95% CrI, 0.92-3.44), casual degree (aIRR=2.05; 95% CrI, 0.90-5.07), and count of one-time partnerships (aIRR=1.90; 95% CrI, 0.46-8.54). Without adjustment for individual PrEP use, these associations were amplified. There were weaker associations with main degree (aIRR=1.21; 95% CrI, 0.48-3.20) and consistent condom use in one-time partnerships (aIRR=1.68; 95% CrI, 0.86-3.35). Interpretation Most of the associations between community PrEP coverage and sexual behavior were explained by individual PrEP use. However, there were residual associations after controlling for individual PrEP use, suggesting that PrEP coverage may partially drive community-level changes in sexual behavior.

scholarly journals Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

2018 ◽  
Author(s):  
Samuel M. Jenness ◽  
Kevin M. Maloney ◽  
Dawn K. Smith ◽  
Karen W. Hoover ◽  
Steven M. Goodreau ◽  
...  
Keyword(s):  
United States ◽  
Racial Disparities ◽  
Hiv Transmission ◽  
White Men ◽  
The United States ◽  
Hiv Incidence ◽  
Black And White ◽  
Empirical Estimates ◽  
Preexposure Prophylaxis ◽  
Sex With Men

ABSTRACTThe potential for HIV preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States may be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (B/WMSM) in the Atlanta area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could impact HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (HR = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (HR = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.

Fraud Detection Protocol for Web-Based Research Among Men Who Have Sex With Men: Development and Descriptive Evaluation (Preprint)

2018 ◽  
Author(s):  
April M Ballard ◽  
Trey Cardwell ◽  
April M Young
Keyword(s):  
Survey Research ◽  
Hiv Transmission ◽  
Personal Information ◽  
Fraud Detection ◽  
Detection Algorithm ◽  
Cross Sectional ◽  
Web Based ◽  
Young Msm ◽  
Data Survey ◽  
Sex With Men

BACKGROUND Internet is becoming an increasingly common tool for survey research, particularly among “hidden” or vulnerable populations, such as men who have sex with men (MSM). Web-based research has many advantages for participants and researchers, but fraud can present a significant threat to data integrity. OBJECTIVE The purpose of this analysis was to evaluate fraud detection strategies in a Web-based survey of young MSM and describe new protocols to improve fraud detection in Web-based survey research. METHODS This study involved a cross-sectional Web-based survey that examined individual- and network-level risk factors for HIV transmission and substance use among young MSM residing in 15 counties in Central Kentucky. Each survey entry, which was at least 50% complete, was evaluated by the study staff for fraud using an algorithm involving 8 criteria based on a combination of geolocation data, survey data, and personal information. Entries were classified as fraudulent, potentially fraudulent, or valid. Descriptive analyses were performed to describe each fraud detection criterion among entries. RESULTS Of the 414 survey entries, the final categorization resulted in 119 (28.7%) entries identified as fraud, 42 (10.1%) as potential fraud, and 253 (61.1%) as valid. Geolocation outside of the study area (164/414, 39.6%) was the most frequently violated criterion. However, 33.3% (82/246) of the entries that had ineligible geolocations belonged to participants who were in eligible locations (as verified by their request to mail payment to an address within the study area or participation at a local event). The second most frequently violated criterion was an invalid phone number (94/414, 22.7%), followed by mismatching names within an entry (43/414, 10.4%) and unusual email addresses (37/414, 8.9%). Less than 5% (18/414) of the entries had some combination of personal information items matching that of a previous entry. CONCLUSIONS This study suggests that researchers conducting Web-based surveys of MSM should be vigilant about the potential for fraud. Researchers should have a fraud detection algorithm in place prior to data collection and should not rely on the Internet Protocol (IP) address or geolocation alone, but should rather use a combination of indicators.

scholarly journals Prevalence and correlates of hazardous alcohol consumption and binge drinking among men who have sex with men (MSM) in San Francisco

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0202170 ◽  
Author(s):  
Glenn-Milo Santos ◽  
Christopher Rowe ◽  
Jaclyn Hern ◽  
John E. Walker ◽  
Arsheen Ali ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Binge Drinking ◽  
San Francisco ◽  
Hazardous Alcohol ◽  
Hazardous Alcohol Consumption ◽  
Sex With Men

Indicators of use of methamphetamine and other substances among men who have sex with men, San Francisco, 2003–2006

2007 ◽  
Vol 90 (1) ◽  
pp. 97-100 ◽  
Author(s):  
Jason Vaudrey ◽  
H. Fisher Raymond ◽  
Sanny Chen ◽  
Jennifer Hecht ◽  
Katherine Ahrens ◽  
...  
Keyword(s):  
San Francisco ◽  
Other Substances ◽  
Sex With Men

scholarly journals Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

2021 ◽  
Vol 18 (15) ◽  
pp. 8031
Author(s):  
Dharma N. Bhatta ◽  
Jennifer Hecht ◽  
Shelley N. Facente
Keyword(s):  
Mental Health ◽  
San Francisco ◽  
Age Groups ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Sex With Men ◽  
Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

scholarly journals Mapping the current knowledge in syndemic research applied to men who have sex with men: a scoping review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041238
Author(s):  
Maxence Ouafik ◽  
Laetitia Buret ◽  
Jean-Luc Belche ◽  
Beatrice Scholtes
Keyword(s):  
Scoping Review ◽  
Current Knowledge ◽  
Healthcare Access ◽  
Open Science ◽  
Health Conditions ◽  
Manuscript Submission ◽  
Cochrane Central Register ◽  
Evidence Map ◽  
Sex With Men ◽  
Syndemic Theory

IntroductionMen who have sex with men (MSM) are disproportionally affected by a number of health conditions that are associated with violence, stigma, discrimination, poverty, unemployment or poor healthcare access. In recent years, syndemic theory provided a framework to explore the interactions of these health disparities on the biological and social levels. Research in this field has been increasing for the past 10 years, but methodologies have evolved and sometimes differed from the original concept. The aim of this paper is to provide an overview of the existing literature on syndemic theory applied to MSM in order to identify knowledge gaps, inform future investigations and expand our understanding of the complex interactions between avoidable health conditions in a vulnerable population.Methods and analysisThe proposed scoping review will follow the methodological framework developed by Arksey and O’Malley with subsequent enhancements by Levac et al, Colquhoun et al and Peters et al as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review. A systematic search of MEDLINE, PsycInfo, Scopus, Cochrane Central Register of Controlled Trials and ProQuest Sociological Abstracts will be conducted. Reference lists of the included studies will be hand-searched for additional studies. Screening and data charting will be achieved using DistillerSR. Data collating, summarising and reporting will be performed using R and RStudio. Tabular and graphical summaries will be presented, alongside an evidence map and a descriptive overview of the main results.Ethics and disseminationThis scoping review does not require ethical approval. Data and code will be made accessible after manuscript submission. Final results will be disseminated through publication in a peer-reviewed journal and collaboration with grassroots Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) organisations.RegistrationThis protocol was registered on manuscript submission on the Open Science Framework at the following address: https://osf.io/jwxtd; DOI: 10.17605/OSF.IO/JWXTD.

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