Oral antiretroviral pre-exposure prophylaxis reduces the risk of HIV acquisition among men who have sex with men

Background Since 1 June 2017, oral pre-exposure prophylaxis (PrEP) could be prescribed and reimbursed in Belgium as prophylactic medication for people who are at increased risk of HIV acquisition. The aim of this study was to determine the uptake of daily and event-driven PrEP in Belgium during the first 9 months of roll-out. Methods: Routine aggregated data on the number of reimbursement requests and the number of boxes of Truvada (Gilead Sciences, Cambridge, UK) delivered for PrEP through the Belgian pharmacies were obtained from the National Institute for Health and Disability Insurance. We also collected aggregated data from seven Aids Reference Centres (ARCs) currently providing most of the PrEP care in Belgium. Results: From 1 June 2017 to 28 February 2018, 1352 requests for reimbursement were approved by the National Institute for Health and Disability Insurance. Almost 98% of those who bought at least one box of 30 tablets of emtricitabine 200mg/tenofovir disoproxil fumarate 300mg (FTC/TDF) in a Belgian pharmacy were male, and most (67%) were between 30 and 50 years of age. According to data obtained from ARCs, the proportion of those choosing event-driven PrEP initially ranged between 29% and 73%. Conclusions: The uptake of PrEP in Belgium since the start of the roll-out in June 2017 has been high, and almost entirely limited to men who have sex with men, of whom 43% initially prefer a non-daily regimen. A better understanding is needed as to why other populations, such as sub-Saharan African migrants, are not accessing PrEP, as well as the development of a more sustainable PrEP delivery model.

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Early experience of implementing a national HIV pre-exposure prophylaxis service in Wales, United Kingdom 2017

Sexual Health ◽

10.1071/sh18091 ◽

2019 ◽

Vol 16 (1) ◽

pp. 56 ◽

Cited By ~ 2

Author(s):

Laia Fina ◽

Amy L. Phillips ◽

Adam T. Jones ◽

Zoë M. Couzens ◽

Rachel Drayton ◽

...

Keyword(s):

Sexual Health ◽

Early Experience ◽

Hiv Positive ◽

Transgender People ◽

Positive Individual ◽

Sexually Transmissible Infections ◽

Sex With Men ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis

Background Pre-exposure prophylaxis (PrEP) was introduced in Sexual Health Services of the Welsh National Health Service (NHS Wales) in July 2017 as a 3-year pilot service. Methods: Data were collected through the pre-existing Sexual Health in Wales Surveillance System, to which codes were added to capture PrEP eligibility, outcome of offer of PrEP, reasons for declining and adherence. Eligibility categories were defined based on nationally agreed criteria: men who have sex with men (MSM) and transgender people at high risk of HIV acquisition; partners of HIV-positive individuals not known to be virally suppressed; and heterosexuals reporting condomless intercourse with a HIV-positive individual not known to be virally suppressed. Results: During the first 6 months, 516 people were eligible, 96% of which were MSM. Overall, 57% of those eligible (296/516) started PrEP. Reasons for declining PrEP were given by 88 (56%) of 157 people; 50 (57%) of whom did not believe themselves to be at risk. Of the available adherence assessments, 89% considered that all risk episodes had been covered. Persistence at 3 months was assessed for 141 people, of which 93 (66%) were still using PrEP. There were no HIV diagnoses in people taking PrEP during the first 6 months. Twenty-nine people were diagnosed with 37 episodes of sexually transmissible infections (STIs) while on PrEP. STI incidence was 105.7 per 100 person-years. Conclusions: The early trend indicates that implementation of PrEP is progressing as planned, and the service has been utilised by clients. This analysis can help refine implementation, inform planning and research around uptake, use and effect in Wales and internationally.

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Demand for pre-exposure prophylaxis for HIV and the impact on clinical services: Scottish men who have sex with men perspectives

International Journal of STD & AIDS ◽

10.1177/0956462417723817 ◽

2017 ◽

Vol 29 (3) ◽

pp. 273-277

Author(s):

RI Gilson ◽

DJ Clutterbuck ◽

ZE Chen

Keyword(s):

High Risk ◽

Lower Risk ◽

Clinical Services ◽

Anonymous Questionnaire ◽

Sex With Men ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis ◽

The Impact ◽

Ability And Willingness

There is a lack of data on ability and willingness of men who have sex with men (MSM) to self-fund HIV pre-exposure prophylaxis (PrEP). We aimed to explore how many eligible (PROUD study criteria) men may want PrEP and how many lower-risk MSM would be willing and able to self-fund this intervention. A self-completed anonymous questionnaire was distributed to MSM populations attending services. Of 377 participants, 81.5% were aware of PrEP. Fifty-three (15.5 %) were eligible, of whom 43 (81%) were very/extremely likely to want it. Of those ineligible, 229 (80%) were aware of PrEP and 106 (37.3%) were very/extremely likely to want it. Of eligible respondents 23% would be willing and able to pay at least £50 a month for PrEP. Of ineligible respondents this proportion was 21%. Our survey revealed high levels of awareness, understanding and willingness to take PrEP among MSM at high and lower risk of HIV acquisition. It indicated that over 70% of high-risk men would be unwilling or unable to self-fund PrEP, should it not be available on the NHS. For lower-risk MSM we estimated that capacity requirements for monitoring self-funded PrEP will be 50% higher than numbers eligible for PrEP. These factors will need to be taken into account when planning services.

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Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v17i1.455 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 32

Author(s):

Linda-Gail Bekker ◽

Kevin Rebe ◽

Francois Venter ◽

Gary Maartens ◽

Michelle Moorhouse ◽

...

Keyword(s):

At Risk ◽

Treatment Guidelines ◽

World Health ◽

Combination Prevention ◽

Transgender Persons ◽

Sex With Men ◽

Health Organization ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.

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‘Break the Chains 2015’ community-based HIV prevention campaign for men who have sex with men in Switzerland: non-randomised evaluation and cost analysis

BMJ Open ◽

10.1136/bmjopen-2019-032459 ◽

2020 ◽

Vol 10 (1) ◽

pp. e032459

Author(s):

Kathrin Frey ◽

Stéphanie Lociciro ◽

Patricia Blank ◽

Matthias Schwenkglenks ◽

Françoise Dubois-Arber ◽

...

Keyword(s):

At Risk ◽

Hiv Prevention ◽

Cost Analysis ◽

Hiv Testing ◽

Community Based ◽

Prevention Campaign ◽

Sex With Men ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Campaign Message

ObjectivesTo study the implementation, effects and costs of Break the Chains, a community-based HIV prevention campaign for men who have sex with men (MSM) in Switzerland, from March to May 2015, which aimed to reduce early HIV transmission by promoting the campaign message to adopt short-term risk reduction followed by HIV testing.DesignNon-randomised evaluation and cost analysis.SettingGay venues in 11 of 26 cantons in Switzerland and national online media campaign.ParticipantsMSM in online surveys (precampaign n=834, postcampaign n=688) or attending HIV testing centres (n=885); campaign managers (n=9); and campaign staff (n=38) or further intermediaries (n=80) in an online survey.Primary and secondary outcome measuresThe primary outcome measure was the proportion of MSM at risk of HIV acquisition or transmission who adhered to the campaign message. Secondary outcomes were postcampaign test uptake, knowledge about HIV primary infection and sense of belonging to the gay community.ResultsCampaign staff estimated that they contacted 17 145 MSM in 11 cantons. Among 688 respondents to the postcampaign survey, 311 (45.2%) were categorised as MSM at risk. Of 402/688 (58.5%) MSM who had heard about Break the Chains 2015, MSM categorised as being at risk were less likely to report adherence to the campaign message than MSM not at risk (adjusted OR 0.24; 95% CI 0.14 to 0.42). Twenty per cent of MSM with a defined risk of HIV acquisition or transmission who adopted risk reduction declared having done so because of the campaign. Costs for one MSM at risk to adhere to the campaign message were estimated at USD purchasing power parity 36–55. The number of HIV tests in the month after the campaign was twice the monthly average.ConclusionBreak the Chains increased HIV testing, implying that community-based campaigns are useful HIV prevention strategies for MSM. Additional interventions are needed to reach MSM at the highest risk of infection more effectively.

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Actual sexual risk and perceived risk of HIV acquisition among HIV-negative men who have sex with men in Toronto, Canada

BMC Public Health ◽

10.1186/s12889-016-2859-6 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 16

Author(s):

Maya A. Kesler ◽

Rupert Kaul ◽

Juan Liu ◽

Mona Loutfy ◽

Dionne Gesink ◽

...

Keyword(s):

Sexual Risk ◽

Perceived Risk ◽

Sex With Men ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Hiv Negative

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“I wish to remain HIV negative”: Pre-exposure prophylaxis adherence and persistence in transgender women and men who have sex with men in coastal Kenya

PLoS ONE ◽

10.1371/journal.pone.0244226 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244226

Author(s):

Makobu Kimani ◽

Elise M. van der Elst ◽

Oscar Chirro ◽

Elizabeth Wahome ◽

Fauz Ibrahim ◽

...

Keyword(s):

Risk Behaviour ◽

Healthcare Services ◽

Transgender Women ◽

Situational Factors ◽

Sub Saharan Africa ◽

Sexual Risk Behaviour ◽

Sub Saharan ◽

Sex With Men ◽

Hiv Acquisition ◽

Exposure Prophylaxis

Background Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. Methods Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700–1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. Results Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. Conclusion While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.

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A Web-Based Study of HIV Prevention in the Era of Pre-Exposure Prophylaxis Among Vulnerable HIV-Negative Gay and Bisexual Men, Transmen, and Transwomen Who Have Sex With Men: Protocol for an Observational Cohort Study (Preprint)

10.2196/preprints.13715 ◽

2019 ◽

Author(s):

Denis Nash ◽

Matthew Stief ◽

Caitlin MacCrate ◽

Chloe Mirzayi ◽

Viraj V Patel ◽

...

Keyword(s):

High Risk ◽

Hiv Prevention ◽

Hiv Testing ◽

The United States ◽

Racially Diverse ◽

Web Based ◽

Sex With Men ◽

Hiv Acquisition ◽

Exposure Prophylaxis ◽

Hiv Negative

BACKGROUND Gay, bisexual, and other men who have sex with men continue to bear a large burden of the HIV epidemic in the United States and are among the only populations with increasing incidence in recent years. OBJECTIVE The Together 5000 (T5K) Study aimed to enroll a US-based, racially diverse sample of HIV-negative men, transmen, and transwomen who are not on pre-exposure prophylaxis (PrEP) into an observational cohort to inform the design, implementation, scale-up, and evaluation of HIV prevention programs. METHODS We used internet-based strategies to enroll a large, racially diverse national sample of HIV-negative men, transmen, and transwomen aged 16 to 49 years at high risk of HIV acquisition via sexual networking apps. Study participants are contacted every 6 months (in between annual surveys) for a brief survey on HIV testing, HIV diagnosis, and PrEP use (ie, attempts to access, PrEP initiation, and PrEP discontinuation). Participants complete annual self-administered at-home HIV testing and Web-based surveys. Using baseline serologic data and self-reported HIV testing history, we reconstructed a cohort of persons who were HIV negative at 12 months before baseline to estimate HIV incidence leading up to cohort enrollment. RESULTS The study sample included 8777 participants from all 50 US states, Puerto Rico, and Guam; 50.91% (4468/8777) were persons of color and 25.30% (2221/8777) were young individuals aged 16 to 24 years. Per eligibility criteria, all T5K participants reported having sex with >2 male partners in the 90 days before enrollment, self-reported not having been diagnosed with HIV, and were not actively taking PrEP. In addition, 79.39% (6968/8777) reported >2 insertive condomless anal sex (CAS) acts, 61.02% (5356/8777) reported >1 receptive CAS acts in the past 90 days. Furthermore, most (7525/8777, 85.74%) reported never having taken PrEP. In total, 70.25% (6166/8777) were sent a self-administered at-home HIV test kit and 82.29% (5074/6166) of those sent a kit returned a sample for testing. The HIV incidence rate during the 12-month period leading up to enrollment was estimated to be 2.41 (95% CI 2.02-2.90) per 100 person-years. CONCLUSIONS A large, national, and racially diverse fully Web-based cohort of HIV-negative men, transmen, and transwomen at high risk for HIV seroconversion has successfully been recruited into longitudinal follow-up. This cohort is at high risk for HIV acquisition and can provide important insights related to the real-world uptake, impact, and equity of HIV prevention interventions in the United States. Participants can be invited to participate in trials aimed at testing strategies to improve the uptake of and engagement in these interventions. INTERNATIONAL REGISTERED REPORT RR1-10.2196/13715

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Knowledge of HIV pre-exposure prophylaxis among immigrant Asian gay men living in New Zealand

Journal of Primary Health Care ◽

10.1071/hc19076 ◽

2019 ◽

Vol 11 (4) ◽

pp. 351 ◽

Cited By ~ 1

Author(s):

Jeffery Adams ◽

Rommel Coquilla ◽

Jed Montayre ◽

Stephen Neville

Keyword(s):

Health Promotion ◽

New Zealand ◽

Gay Men ◽

Individual Level ◽

Care Services ◽

Primary Care Services ◽

The Individual ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis

ABSTRACT INTRODUCTIONHIV pre-exposure prophylaxis (PrEP) is a new bio-medical means of reducing the risk of HIV infection. It’s use by individuals at high risk of HIV acquisition is recommended. AimsThis study identifies the ways immigrant Asian gay men living in New Zealand talk about and understand issues related to PrEP. METHODSA qualitative descriptive methodology was used. Individual interviews were conducted with 18 immigrant Asian gay men who were not users of PrEP. Participants were aged 21 – 36 years and one-third had arrived in New Zealand within 3 years of completing the interview. Data were analysed using thematic analysis. RESULTSThree themes evident across the men’s talk in relation to pre-exposure prophylaxis were identified: ‘I’m not sure what PrEP is’; ‘PrEP is not proven’; and ‘PrEP is for others, not me’. DISCUSSIONPrEP is necessary for working towards the elimination of HIV. To improve uptake among Asian gay men, improved literacy around HIV and pre-exposure prophylaxis is required. This knowledge needs to be improved at both the individual level in primary care services and collectively through health promotion initiatives. These services and health promotion initiatives need to be provided in ways that encourage engagement by Asian gay men.

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