Pre-Exposure Prophylaxis Perspectives, Sociodemographic Characteristics, and HIV Risk Profiles of Cisgender Women Seeking and Initiating PrEP in a US Demonstration Project

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk. Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART). We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP. Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected. Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services. Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV. Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

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Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China

Sexual Health ◽

10.1071/sh17075 ◽

2018 ◽

Vol 15 (1) ◽

pp. 39 ◽

Cited By ~ 11

Author(s):

Chunxing Liu ◽

Yingying Ding ◽

Zhen Ning ◽

Meiyang Gao ◽

Xing Liu ◽

...

Keyword(s):

Hiv Risk ◽

Intervention Study ◽

Implementation Strategies ◽

Self Assessment ◽

Risk Beliefs ◽

Group Data ◽

Prep Implementation ◽

Substantial Risk ◽

Sex With Men ◽

Exposure Prophylaxis

Background: Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. However, its uptake among men who have sex with men (MSM) is low in China. The study aimed to identify factors that might influence MSM’s uptake and use of PrEP. Methods: In-depth interviews were conducted with 32 self-identified MSM from a PrEP intervention study evaluating daily oral tenofovir disoproxil fumarate (TDF) to prevent HIV infection. Of these men, 11 were presently using the ‘TDF’ group; 8 from the ‘change-over’ group (i.e. initially used PrEP but subsequently quitted); and 13 from the non-user group. Data were analysed using thematic approach. Results: Perception of low HIV risk, mistrust of the national PrEP program, and concerns of side effects were the main reasons for not wanting to use PrEP. Also, lack of main sexual partner’s support, difficulties in adhering to the daily TDF regimen, and the inconvenient schedules in securing the medicine were the major reasons for not wanting to use or quitting the use of PrEP. On the other hand, perceived high HIV risk, beliefs in efficacy of PrEP, and worries of transmitting HIV to families were the major motives for PrEP uptake. Conclusions: Findings suggest that PrEP implementation strategies should first address issues including but not limited to accurate self-assessment of HIV risk, mistrust and limited knowledge about medical trials and PrEP, and ease of accessing PrEP.

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1273. Reasons for Disengagement in Care among Individuals Receiving Pre-Exposure Prophylaxis (PrEP) from a Sexual Health Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1136 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S458-S458

Author(s):

Jason Zucker ◽

Deborah Theodore ◽

Caroline Carnevale ◽

Elijah LaSota ◽

Paul Richards ◽

...

Keyword(s):

Hiv Prevention ◽

Sexual Health ◽

Hiv Risk ◽

Perceived Risk ◽

Medical Center ◽

Academic Medical Center ◽

Health Clinic ◽

Receptive Anal Intercourse ◽

Online Questionnaire ◽

Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) effectively reduces HIV acquisition, but its efficacy depends on continued engagement through periods of high and low risk. Persistence in HIV prevention care has been low in real-world settings. In our program, 32% of patients are lost to care after their first visit and only 35% of patients are retained at their planned third visit. Reasons for low persistence in care are poorly described. Methods We identified all MSM who started PrEP between July 2015 and June 2018 at a sexual health clinic in an urban academic medical center in New York and had not had a visit in ≥6 months. We called patients between July 2018 and January 2019; those who were English speaking were given the option to complete an online questionnaire about current PrEP status, reasons for disengagement, and social and behavioral determinants of health (SBDH). Results Up to 710 patients were eligible for the study; over 700 calls were made. 125 participants agreed to participate and 57 (46%) completed the questionnaire. 24 patients (42%) were still actively taking PrEP. The most common reasons for starting PrEP were fear of getting HIV (58%), high self-perceived HIV risk (28%), and recommendations from friends (26%). Among those no longer taking PrEP, the most common reasons for discontinuation were cost/insurance issues (32%), lower perceived HIV risk (18%), concern about long-term side effects (12%), and trouble attending every-3-month appointments (12%). For those stopping due to lower perceived risk, 40% were in a monogamous relationship, 60% were less sexually active, and 20% always used a condom or did not engage in receptive anal intercourse. 56% of patients had at least 1 major life event in the preceding 3 months, including loss of a job (25%), breakup with a partner (12%), illness or death of a family member (11%), or unstable housing (8%). 47% used drugs or alcohol before sex in the past month including 39% not on PrEP. Conclusion Reasons for engagement, disengagement, and re-engagement are highly variable at the individual level. Cost and insurance issues were common in spite if clinic resources available to cover the cost of visits and medications. Life trauma was common. Individualized interventions to address SBDH may be required to engage and retain individuals in HIV prevention care. Disclosures All authors: No reported disclosures.

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Changes in mental health and drug use among men who have sex with men using daily and event-driven pre-exposure prophylaxis: Results from a prospective demonstration project in Amsterdam, the Netherlands

EClinicalMedicine ◽

10.1016/j.eclinm.2020.100505 ◽

2020 ◽

Vol 26 ◽

pp. 100505

Author(s):

R.C.A. Achterbergh ◽

E. Hoornenborg ◽

A. Boyd ◽

L. Coyer ◽

S.J.A. Meuzelaar ◽

...

Keyword(s):

Mental Health ◽

Drug Use ◽

The Netherlands ◽

Demonstration Project ◽

Event Driven ◽

Sex With Men ◽

Exposure Prophylaxis

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Impact of HIV risk perception on both pre-exposure prophylaxis and condom use

Journal of Health Psychology ◽

10.1177/1359105319883927 ◽

2019 ◽

pp. 135910531988392

Author(s):

Marion Di Ciaccio ◽

Luis Sagaon-Teyssier ◽

Christel Protière ◽

Mohamed Mimi ◽

Marie Suzan-Monti ◽

...

Keyword(s):

Risk Perception ◽

High Risk ◽

Condom Use ◽

Hiv Risk ◽

Health Behaviours ◽

Two Dimensions ◽

Hiv Risk Perception ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Trajectory Modelling

Risk perception is one of the several important factors impacting sexual health behaviours. This study investigated the evolution of HIV risk perception on pre-exposure prophylaxis adherence and condom use in men who have sex with men at high risk of HIV and associated factors. Group-based trajectory modelling helped in identifying patterns of risk perception, pre-exposure prophylaxis adherence and condom use over time. The association between the former and the latter two dimensions was then investigated. An estimated 61 per cent ( p < 0.001) of participants perceiving low risk and 100 per cent ( p < 0.001) of those perceiving high risk had systematic pre-exposure prophylaxis adherence, while an estimated 49 per cent ( p < 0.001) and 99.8 per cent ( p < 0.001), respectively, reported low-level condom use.

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