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Adherence to PrEP Among Young Men Who Have Sex With Men Participating in a Sexual Health Services Demonstration Project in Alameda County, California

Myers, Janet J. PhD, MPHa; Kang Dufour, Mi-Suk PhD, MPHa; Koester, Kimberly A. PhD, MAa; Udoh, Ifeoma PhDb,c; Frazier, Remi MSa; Packard, Rebecca BAd; Kennedy, Kristin MS, MPH, CPHe,f; Erguera, Xavier BAa; Horowitz, Jessica NPe,g; Grant, Robert MDa; Burack, Jeffrey H. MD, MPP, BPhila,e,h

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1, 2019 - Volume 81 - Issue 4 - p 406–413
doi: 10.1097/QAI.0000000000002051
Prevention Research

Background: Young men of color who have sex with men face a continual increase in rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an important prevention method for these young men.

Setting: The Connecting Resources for Urban Sexual Health (CRUSH) demonstration project provided sexual health services, including PrEP, to young men who have sex with men aged 18–29 years. We report on adherence and factors influencing it.

Methods: Participants were offered HIV and sexually transmitted infection testing, prevention counseling, PrEP, and when appropriate, sexually transmitted infection treatment and postexposure prophylaxis. Participants taking PrEP had erythrocyte tenofovir diphosphate and emtricitabine levels measured through dried blood spot testing at 4, 12, and 24 weeks to estimate medication adherence. Participants also completed surveys to assess demographic and psychosocial measures.

Results: From February 2014 to November 2015, CRUSH enrolled 257 participants. Ninety-three percent started PrEP, 81% of whom initiated it at their first visit. Twelve percent required postexposure prophylaxis before starting PrEP. Adherence at protective levels was initially high with 87% demonstrating levels consistent with at least 4 doses per week at week 4, compared with 77% at the 48-week follow-up. African American race, exposure to violence, and having survival needs were associated with significantly lower levels of adherence [odds ratio (OR): 0.33; confidence interval (CI): 0.11 to 0.97, P < 0.04; OR: 0.79; CI: 0.59 to 1.04, P < 0.10; OR: 0.51; CI: 0.24 to 1.05, P < 0.07].

Conclusions: Most young men who initiate PrEP adhere at levels that confer protection against HIV infection. Interventions should account for differences in life experiences, particularly addressing the structural challenges facing young African American men.

aDepartment of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA;

bPangea Global AIDS Foundation, Oakland, CA;

cCurrently, ETR;

dCurrently, Self-employed;

eAlta Bates Summit Medical Center, Oakland, CA;

fCurrently, Student;

gCurrently, Nurx; and

hSchool of Public Health, University of California, Berkeley.

Correspondence to: Janet J. Myers, PhD, MPH, Centre for AIDS Prevention Studies, University of California, 550 16th Street, 3rd Floor, San Francisco, CA 94143 (e-mail:

Supported by the California HIV/AIDS Research Program (Grant number EI14-SF-009). J.H.B. has received honoraria from Gilead Sciences, Janssen Therapeutics, ViiV Healthcare, and Theratechnologies; has received research support from Gilead Sciences; and has served on advisory boards for Gilead Sciences and ViiV Healthcare.

Preliminary data presented at IAPAC Adherence; June 2016; Miami, FL.

The authors have no conflicts of interest to disclose.

Received October 21, 2018

Accepted March 11, 2019

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