Men who have sex with men (MSM) must take numerous cognitive, programmatic and personal steps before taking and achieving maximum protection from Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) against HIV. As a consequence of this so-called PrEP cascade of care, a fraction of those who are good candidates for PrEP are actually benefitting from it.

Publishing their findings in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), researchers analyzed data about 995 men in the longitudinal One Thousand Strong study of HIV-negative MSM in the United States, focusing on responses given during the second half of 2015.

According to Gilead Sciences, an estimated 80,000 U.S. residents were taking PrEP at the end of 2015. By a year later, that figure had swelled to 110,000 people, indicating that the findings of the JAIDS study may already be rather out of date.

Eighty-nine percent of the study’s participants reported being sexually active during the previous three months. Sixty-five percent met the Centers for Disease Control and Prevention’s (CDC) criteria for candidacy for PrEP. Twenty-three percent were in the “precontemplative” stage of the PrEP cascade, meaning they were unwilling to take PrEP or believed they were not good candidates for it. Eleven percent were in the “PrEParation” stage, in which they saw PrEP as something they could access and were planning to start taking it. Four percent had been prescribed PrEP.

Ninety-eight percent of the men with a PrEP prescription reported taking four or more doses a week, which researchers consider enough to confer maximum protection. Seventy-two percent of the men with a PrEP prescription were returning for the recommended quarterly medical visits to maintain their prescription. This meant that 9 percent of those who were good candidates for PrEP according to CDC guidelines were fully benefitting from Truvada as prevention.

The study authors concluded: “These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.”

To read the study abstract, click here.