icon-    folder.gif   Conference Reports for NATAP  
  Conference on Retroviruses
and Opportunistic Infections (CROI)
Boston, Massachusetts
March 4-7, 2018
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HIV Risk Perception Among Men who have Sex with Men (MSM): A Randomized Controlled Trial
  Reported by Jules Levin
CROI 2018 March 4-7 Boston MA
Jill Blumenthal*1, Sonia Jain1, Evan Mulvihill1, Shelly Sun1, Marvin Hanashiro1, Eric Ellorin1, Sara Graber1, Richard Haubrich2, Sheldon Morris1 1University of California, San Diego, La Jolla, CA, 2 Gilead Sciences, Foster City, CA


Program Abstract:
Despite greater access to PrEP, one barrier to HIV prevention is inaccurate risk perception by MSM. Providing information about objective HIV risk could improve PrEP uptake.
PrEP Accessability Research and Evaluation 2 (PrEPARE2) was an RCT examining if providing a calculated HIV risk score affects PrEP uptake in at-risk HIV- MSM recruited from HIV testing sites. Participants received a baseline survey assessing demographics, risk behaviors and HIV risk perception. Self-perceived risk (SPR) score was the perceived likelihood of acquiring HIV based on 3 risk perception questions. The survey also generated an HIV risk score (CalcR), which estimated an individual's 1 year risk of acquiring HIV compared to the average risk for MSM based on reported condomless anal sex acts, STIs and needle sharing events. SPR and CalcR scores categorized risk as low, medium, high and very high. Participants randomized 1:1 to the intervention arm were provided the CalcR category; control subjects received standard risk reduction counseling. Participants were contacted at 8 weeks to determine if they had started PrEP (primary endpoint). Fisher's exact test was used to compare the difference in PrEP uptake between arms. Cohen's kappa coefficient evaluated the agreement between the 2 risk scores. Of 171 participants (n=85 control and n=86 CalcR intervention), median age was 32, 29% Latino, 60% White, 8% Black. Most had heard of PrEP (81%), and 57% thought they were good PrEP candidates. Participants had a median of 5 partners in the past 6 months (IQR: 3-10). SPR had poor agreement with the CalcR score (kappa=0.176) with more than one-third underestimating their HIV risk. At week 8, n=135 participants were reached for follow up, notably n=59 (70%) in control and n=76 (87%) in the intervention arm (p<0.001). Only 14 subjects reached for follow up initiated PrEP with no difference between randomized groups (CalcR 11%, control 10%, p=1.0). The most common reasons for not starting PrEP were low risk perception (36%), and not wanting to take pills (18%); 13% reported waiting for a PrEP visit.
In this cohort of at-risk MSM, providing an objective HIV risk score alone did not increase PrEP uptake, perhaps due to discordance between self-perceived and actual HIV risk. Further, many participants did not think their risk was high enough to use PrEP. Thus, HIV testing may be a crucial time to correct misperceptions about HIV risk and initiate same day PrEP to facilitate greater PrEP uptake.