title: Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine.
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.
  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.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; The Fenway Institute, Fenway Community Health, Boston, MA, United States. Electronic address: ceo242@mail.harvard.edu.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Sachin
authors.initials: S
authors.lastname: Jain
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
mesh_terms: D000328:Adult; D001900:Boston / Q000453:epidemiology; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D000069078:Seroconversion / Q000187:drug effects; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D047568:Unsafe Sex / Q000187:drug effects
chemical_list: D008694:Methamphetamine
keywords: Crystal methamphetamine; HIV prevention; Men who have sex with men; Post-exposure prophylaxis