Beyond the Biomedical: Preexposure Prophylaxis Failures in a Cohort of Young Black Men Who Have Sex with Men in Atlanta, Georgia

David P. Serota, Eli S. Rosenberg, Annie M. Lockard, Charlotte Paige M. Rolle, Nicole Luisi, Scott Cutro, Carlos Del Rio, Aaron J. Siegler, Travis H. Sanchez, Patrick S. Sullivan, Colleen F. Kelley

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has high biomedical efficacy; however, awareness, access, uptake, and persistence on therapy remain low among black men who have sex with men (BMSM), who are at highest risk of HIV in the United States. To date, discussions of PrEP failure have focused on one typology: rare, documented HIV acquisitions among PrEP users with adequate serum drug levels (ie, biomedical failure). In our cohort of HIV-negative young BMSM in Atlanta, Georgia, we continue to observe a high HIV incidence (6.2% annually at interim analysis) despite access to free PrEP services. Among 14 seroconversions, all were offered PrEP before acquiring HIV. Among these participants, we identified 4 additional typologies of PrEP failure that expand beyond biomedical failure: low PrEP adherence, PrEP discontinuation, PrEP contemplation without initiation, and PrEP refusal. We describe the 5 typologies and suggest interventions to improve PrEP effectiveness among those at highest risk.

Original languageEnglish (US)
Pages (from-to)965-970
Number of pages6
JournalClinical Infectious Diseases
Volume67
Issue number6
DOIs
StatePublished - Aug 31 2018
Externally publishedYes

Keywords

  • health disparities
  • HIV
  • preexposure prophylaxis.

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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