14 Aug Short Term PReP Can Help Protect Men from HIV During Vacation

MedicalResearch.com Interview with:

Dr. Egan

James Egan, Ph.D., M.P.H.
Assistant Professor
Behavioral and Community Health Sciences
Pitt Public Health

MedicalResearch.com: What is the background for this study?

Response: When taken as a daily pill, pre-exposure prophylaxis (PrEP) reduces the risk of getting HIV from sex by about 99%, according to the Centers for Disease Control and Prevention. However, adhering to a daily medication regimen doesn’t work for everyone for reasons that include cost and individual concerns about the biological consequences of long-term medication. Previous studies have shown that there are certain periods when some men who have sex with men may be more vulnerable to contracting HIV, including when traveling, on vacation, moving to a new city or after a break-up. Our team set out to explore whether these men might be more receptive to adhering to PrEP treatment during these times.

We followed 48 adult men from Pittsburgh or Boston who have sex with men in a pilot program to test the daily use of PrEP for 30 days that included an out-of-town vacation, with the men starting the medication seven days before the trip and continuing for at least seven days after vacation. The men were also given a brief session introducing them to the use of PrEP and discussion adherence.

MedicalResearch.com: What are the main findings?

Response: During their vacations, 94% of the men had blood concentrations protective against HIV, consistent with regular use of the medication. Almost 75% reported condomless sex during vacation, and about a third reported substance use. None of the men contracted HIV during their vacation, though one of the men contracted the virus during the three-month post-vacation follow-up period when he’d had a lapse in use of PrEP associated with loss of health insurance and a move to a new city. 

MedicalResearch.com: What should readers take away from your report?

Response: Men at particular risk for HIV are very likely to consistently take prevention medication during vacations when their odds of contracting the virus may be higher. This gives us a promising strategy to pursue in engaging at-risk men in HIV prevention efforts that work for them.

Additionally, 70% of the participants indicated an interest in continuing daily PrEP use long-term. It shows us that introducing short-term use of PrEP before a vacation could lead to longer-term use. This presents an enticing opportunity to reduce HIV transmission.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our study included men who were motivated to enroll and did not address the likelihood of physicians prescribing PrEP for short-term use, the ease of obtaining PrEP for use only during vacations or the impact of the study’s brief counseling on the use of PrEP.

These are all areas that our findings suggest warrant future explorations. Our study tells us short-term adherence to PrEP during high-risk periods is tolerable in men who have sex with men, and that it could lead to long-term use. Now we need to determine how to make it possible in the real-world setting.

Any disclosures?

The senior author on this research is Kenneth Mayer, M.D., medical research director at The Fenway Institute at Fenway Health in Boston and professor of medicine at Harvard University. Additional authors on this research are Ken Ho, M.D., M.P.H., and Ron Stall, Ph.D., M.P.H., of Pitt; Moe T. Drucker, B.S., and Ryan Tappin, N.P., M.P.H., of Fenway Health in Boston; Craig W. Hendrix, M.D., and Mark A. Marzinke, Ph.D., of Johns Hopkins University; Steven A. Safren, Ph.D., of Fenway Health and the University of Miami; Matthew J. Mimiaga, Sc.D., M.P.H., of Fenway Health and Brown University; Cristina Psaros, Ph.D., of Massachusetts General Hospital; and Steven Elsesser, M.D., of Fenway Health and the University of Pennsylvania.

This research was funded by National Institute of Mental Health grant R34-MH104083-03, with medication provided by Gilead Sciences.

Citation:

Egan, James E. MPH, PhD^a,b; Ho, Ken MD, MPH^c; Stall, Ron MPH, PhD^a,b; Drucker, Moe T. BS^d; Tappin, Ryan NP, MSN, MPH^d; Hendrix, Craig W. MD^e; Marzinke, Mark A. PhD^e; Safren, Steven A. PhD^d,f; Mimiaga, Matthew J. ScD, MPH^d,g; Psaros, Christina PhD^h; Elsesser, Steven MD^d,i; Mayer, Kenneth H. MD^d,j Feasibility of Short-Term PrEP Uptake for Men Who Have Sex With Men With Episodic Periods of Increased HIV Risk, JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15, 2020 – Volume 84 – Issue 5 – p 508-513 doi: 10.1097/QAI.0000000000002382

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Last Updated on August 14, 2020 by Marie Benz MD FAAD