title: A Latent Class Analysis of Risk Factors for Acquiring HIV Among Men Who Have Sex with Men: Implications for Implementing Pre-Exposure Prophylaxis Programs.
abstract: Current Centers for Disease Control and Prevention (CDC) guidelines for prescribing pre-exposure prophylaxis (PrEP) to prevent HIV transmission are broad. In order to better characterize groups who may benefit most from PrEP, we reviewed demographics, behaviors, and clinical outcomes for individuals presenting to a publicly-funded sexually transmitted diseases (STD) clinic in Providence, Rhode Island, from 2012 to 2014. Latent class analysis (LCA) was used to identify subgroups of men who have sex with men (MSM) at highest risk for contracting HIV. A total of 1723 individuals presented for testing (75% male; 31% MSM). MSM were more likely to test HIV positive than heterosexual men or women. Among 538 MSM, we identified four latent classes. Class 1 had the highest rates of incarceration (33%), forced sex (24%), but had no HIV infections. Class 2 had <5 anal sex partners in the previous 12 months, the lowest rates of drug/alcohol use during sex and lower HIV prevalence (3%). Class 3 had the highest prevalence of HIV (7%) and other STDs (16%), > 10 anal sex partners in the previous 12 months (69%), anonymous partners (100%), drug/alcohol use during sex (76%), and prior STDs (40%). Class 4 had similar characteristics and HIV prevalence as Class 2. In this population, MSM who may benefit most from PrEP include those who have >10 sexual partners per year, anonymous partners, drug/alcohol use during sex and prior STDs. LCA is a useful tool for identifying clusters of characteristics that may place individuals at higher risk for HIV infection and who may benefit most from PrEP in clinical practice.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Chan
authors.affiliation: 2 Department of Psychology, Wesleyan University , Middletown, Connecticut.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rose
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Justine
authors.initials: J
authors.lastname: Maher
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Stacey
authors.initials: S
authors.lastname: Benben
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Kristen
authors.initials: K
authors.lastname: Pfeiffer
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Alexi
authors.initials: A
authors.lastname: Almonte
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Joanna
authors.initials: J
authors.lastname: Poceta
authors.affiliation: 3 Department of Epidemiology, Harvard T.H. Chan School of Public Health , Cambridge, Massachusetts.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.affiliation: 4 Department of Social Work, North Carolina Agricultural and Technical State University , Greensboro, North Carolina.
authors.forename: Sharon
authors.initials: S
authors.lastname: Parker
authors.affiliation: 5 Department of Epidemiology, Brown University School of Public Health , Providence, Rhode Island.
authors.forename: Brandon Dl
authors.initials: BD
authors.lastname: Marshall
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Mickey
authors.initials: M
authors.lastname: Lally
authors.affiliation: 6 Fenway Health, The Fenway Institute , Boston, Massachusetts.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.affiliation: 7 Division of Infectious Diseases, University of Mississippi Medical Center , Jackson, Mississippi.
authors.forename: Leandro
authors.initials: L
authors.lastname: Mena
authors.affiliation: 8 Division of Infectious Diseases, Washington University in St. Louis School of Medicine , St. Louis, Missouri.
authors.forename: Rupa
authors.initials: R
authors.lastname: Patel
authors.affiliation: 9 Department of Behavioral and Social Sciences, Brown University School of Public Health , Providence, Rhode Island.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nunn
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis; D015995:Prevalence; D015397:Program Evaluation; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D014505:Urban Population; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents