A tailored intervention succeeded in getting black men who have sex with men (MSM) interested in taking Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) and ultimately adhering to the regimen. Researchers in the HPTN 073 recruited 226 black MSM in in Washington, DC, Chapel Hill, North Carolina, and Los Angeles, and offered them PrEP combined with a dynamic counseling approach to promote and support PrEP use.
The intervention combined service referrals, linkage to care, and follow-up strategies to help the participants with unmet psychological needs.
At the study’s outset, the median number of male partners the participants reported during the previous three months was three, with 33 percent of the men reporting a primary partner and 73 percent reporting casual male partners.
A total of 178 (79 percent) of the participants agreed to take PrEP. Twenty three out of 24 (96 percent) of the men reporting an HIV-positive primary partner agreed to take PrEP, as did 104 out of 120 (86 percent) of the men reporting casual partners with HIV-positive men or men of an unknown HIV status. Those who agreed to take PrEP used a median of six sessions of the counseling intervention, compared with a median of four sessions among those who did not agree to take PrEP.
Sixty-eight percent of those who agreed to take PrEP were still on it at the 26-week point. At the four-week point, 85 percent of participants reported taking Truvada on more than half of the days, and 78 percent reported doing so at the 26-week point.
A total of 209 (92 percent) of the participants completed the 12-month follow-up period. Forty percent of them were younger than 25, 27 percent were unemployed, and 31 percent were uninsured.
Among the 178 men who ever agreed to take PrEP, five contracted HIV, during 172 person-years of follow-up (person-years are the cumulative years participants spend in a study), for an HIV infection rate of 2.9 percent per year. By comparison, three people who did not agree to take PrEP contracted HIV, during 39 person-years, for an infection rate of 7.7 percent per year. Two of the five people who agreed to take PrEP and who contracted HIV stopped taking PrEP a respective 50 and 272 days before testing positive for the virus.
The researchers concluded that the intervention was both highly acceptable among the participants and led to study results that suggested the study had led to a lower rate of HIV infection among black MSM on PrEP.