Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine

Catherine E. Oldenburg, Sachin Jain, Kenneth H. Mayer, Matthew J. Mimiaga

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. Methods: A: Retrospective cohort study of all PEP prescriptions (N= 1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. Results: Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64). Conclusions: While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.

Original languageEnglish (US)
Pages (from-to)75-80
Number of pages6
JournalDrug and Alcohol Dependence
Volume146
Issue number1
DOIs
StatePublished - 2015
Externally publishedYes

Fingerprint

Post-Exposure Prophylaxis
Methamphetamine
HIV
Crystals
Prescriptions
HIV Seropositivity
HIV Infections
Counseling
Cohort Studies
Retrospective Studies

Keywords

  • Crystal methamphetamine
  • HIV prevention
  • Men who have sex with men
  • Post-exposure prophylaxis

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

Cite this

Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine. / Oldenburg, Catherine E.; Jain, Sachin; Mayer, Kenneth H.; Mimiaga, Matthew J.

In: Drug and Alcohol Dependence, Vol. 146, No. 1, 2015, p. 75-80.

Research output: Contribution to journalArticle

Oldenburg, Catherine E. ; Jain, Sachin ; Mayer, Kenneth H. ; Mimiaga, Matthew J. / Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine. In: Drug and Alcohol Dependence. 2015 ; Vol. 146, No. 1. pp. 75-80.
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abstract = "Background: Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. Methods: A: Retrospective cohort study of all PEP prescriptions (N= 1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4{\%} used CM during exposure) and chronically (7.4{\%} of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. Results: Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95{\%} CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95{\%} CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95{\%} CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95{\%} CI 1.42 to 3.64). Conclusions: While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.",
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N2 - Background: Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. Methods: A: Retrospective cohort study of all PEP prescriptions (N= 1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. Results: Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64). Conclusions: While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.

AB - Background: Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. Methods: A: Retrospective cohort study of all PEP prescriptions (N= 1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. Results: Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64). Conclusions: While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.

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