Non-occupational post-exposure prophylaxis for HIV prevention among crystal methamphetamine-using men who have sex with men (MSM): An individual- and event-level analysis

Background: MSM who use crystal methamphetamine (“meth”) are at high risk of HIV transmission/acquisition.  Non-occupational post-exposure prophylaxis (NPEP) is a potentially powerful HIV prevention strategy if individuals identify high-risk exposures and seek care quickly.  Here, we assess associations between NPEP and meth use at the individual (documented meth abuse disorder) and event (meth use at the time of exposure) level.

Methods: Data arose from a retrospective longitudinal study of NPEP users from 1997-2013 at a large community health center in Boston, MA.  Multivariable generalized estimating equations and logistic and Cox proportional hazards regression models were used to assess associations between event- and individual-level meth use and NPEP patterns, adjusted for factors potentially confounding the relationship.

 

Results: Of 788 NPEP users, 7.4% had a documented meth abuse disorder, and meth use occurred in the context of 7.4% of 1,130 exposures.  MSM who abused meth more frequently returned for repeat NPEP (aOR=4.92, 95%CI: 2.70-8.96) and HIV seroconverted (>3 months after NPEP, aHR=3.16, 95%CI: 1.36-7.33).  Meth abuse (aOR=2.14, 95%CI: 1.18-3.85) and meth use during exposure (aOR=1.78, 95%CI: 1.05-3.01) were associated with UAS.  Meth abuse was associated with knowing the partner at the time of exposure was HIV-infected (aOR=2.08, 95%CI: 1.24-3.43), but meth use during exposure was not.

 

Conclusions: MSM who used meth had high levels of recurrent risk, as evidenced by repeat PEP use and increased HIV incidence.  These results indicate an urgent need to improve HIV prevention strategies, including early HIV testing and pre-exposure prophylaxis, for this population.