HIV transmission and pre-exposure prophylaxis in a high risk MSM population: A simulation study of location-based selection of sexual partners

Australia introduced a national lockdown on 22 March 2020 in response to the COVID-19 pandemic. Melbourne, but not Sydney, had a second COVID-19 lockdown between July and October 2020. We compared the number of HIV post-exposure prophylaxis (PEP) prescriptions, HIV tests, and new HIV diagnoses during these lockdown periods. The three outcomes in 2020 were compared to 2019 using incidence rate ratio. There was a 37% and 46% reduction in PEP prescriptions in Melbourne and Sydney, respectively, with a larger reduction during lockdown (68% and 57% reductions in Melbourne’s first and second lockdown, 60% reduction in Sydney’s lockdown). There was a 41% and 32% reduction in HIV tests in Melbourne and Sydney, respectively, with a larger reduction during lockdown (57% and 61% reductions in Melbourne’s first and second lockdowns, 58% reduction in Sydney’s lockdown). There was a 44% and 47% reduction in new HIV diagnoses in Melbourne and Sydney, respectively, but no significant reductions during lockdown. The reduction in PEP prescriptions, HIV tests, and new HIV diagnoses during the lockdown periods could be due to the reduction in the number of sexual partners during that period. It could also result in more HIV transmission due to substantial reductions in HIV prevention measures during COVID-19 lockdowns.

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In-depth Sampling of High-risk Populations to Characterize HIV Transmission Epidemics Among Young MSM Using PrEP in France and Quebec

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz080 ◽

2019 ◽

Vol 6 (3) ◽

Cited By ~ 4

Author(s):

Antoine Chaillon ◽

Constance Delaugerre ◽

Bluma Brenner ◽

Alix Armero ◽

Catherine Capitant ◽

...

Keyword(s):

High Risk ◽

Hiv Transmission ◽

High Risk Population ◽

Genotypic Resistance ◽

Transmission Networks ◽

Network Analyses ◽

Median Period ◽

Young Msm ◽

High Risk Populations ◽

Exposure Prophylaxis

Abstract Background A better understanding of HIV transmission dynamics among populations at high risk is important for development of prevention strategies. We determined HIV transmission networks from infected individuals enrolled in the pre-exposure prophylaxis (PrEP) IPERGAY trial in combination with the ANRS PRIMO and Montreal PHI cohorts to identify and characterize active clusters of transmission in this high-risk population. Methods Genotypic resistance tests were performed on plasma samples from 31 IPERGAY participants. Reverse transcriptase sequences were analyzed in combination with unique HIV pol sequences from 1351 individuals enrolled in the PRIMO ANRS cohort (1999–2014) and 511 individuals enrolled in the Montreal PHI cohort (1996–2016). Network analyses were performed to infer putative relationships between all participants. Results Overall, 1893 participants were included. Transmission network analyses revealed that 14 individuals (45.2%) from the IPERGAY trial were involved in 13 clusters sampled over a median period (interquartile range) of 2 (0.3–7.8) years, including 7 dyads and 6 larger clusters ranging from 4 to 28 individuals. When comparing characteristics between clustering individuals enrolled in the PRIMO cohort (n = 377) and in IPERGAY (n = 14), we found that IPERGAY participants had a higher viral load (5.93 vs 5.20 log10 copies/mL, P = .032) and reported a higher number of partners in the last 2 months (P < .01). Conclusions These results demonstrate high rates of HIV transmission clustering among young high-risk MSM enrolled in the IPERGAY trial. In-depth sampling of high-risk populations may help to uncover unobserved transmission intermediaries and improve prevention efforts that could be targeted to the most active clusters.

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Determinants of pre-exposure prophylaxis (PrEP) persistence in a high-risk population in Central Florida

Journal of Investigative Medicine ◽

10.1136/jim-2020-001352 ◽

2020 ◽

pp. jim-2020-001352

Author(s):

Jonathan Keyes ◽

Eloisa Catherine Crouse ◽

Edwin DeJesus ◽

Charlotte-Paige Rolle

Keyword(s):

High Risk ◽

Hiv Transmission ◽

Anal Intercourse ◽

Health Clinic ◽

First Year ◽

High Risk Population ◽

Condomless Anal Intercourse ◽

The Usa ◽

Exposure Prophylaxis

Orlando has the second highest HIV incidence in the USA. Tenofovir disoproxil fumarate/emtricitabine is approved as pre-exposure prophylaxis (PrEP) to minimize HIV transmission. Our study describes the PrEP care continuum and factors impacting PrEP persistence during the first year of PrEP care at a sexual health clinic in Orlando. Patients initiating PrEP between 2014 and 2017 with at least 1 year of follow-up were eligible for inclusion. Demographic and clinical factors were extracted from medical records. At the end of the first year of PrEP care, patients seen within the last 6 months were defined as ‘persistent’ whereas patients lost to follow-up for ≥6 months were defined as ‘not persistent’. We evaluated factors associated with PrEP persistence with Firth’s multivariable logistic regression. Of 300 patients meeting inclusion criteria, 96% were male, 59% were ≥30 years old, 59% identified as men who have sex with men and 57% endorsed recent condomless anal intercourse. Of PrEP initiators, 133 (44.3%) were persistent in the first year, whereas 167 (55.7%) were not persistent. PrEP persistence was positively associated with age ≥30 years (OR 1.04, 95% CI 1.0 to 1.08) and negatively associated with non-white race (OR 0.33, 95% CI 0.12 to 0.83). There were no HIV seroconversions among persistent patients. In our study, younger and minority patients were less likely to persist in PrEP care and persistence was poor despite many being insured and ‘high-risk’. Further research is needed to identify and address barriers that hinder PrEP persistence, specifically among younger, minority patients.

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Barriers and facilitators of Pre-exposure Prophylaxis (PrEP) intention among Chinese men who have sex with men

10.21203/rs.2.21052/v1 ◽

2020 ◽

Author(s):

Xiaoyou Su ◽

Mingyu Si ◽

Li Yan ◽

Yu Jiang ◽

Yuanli Liu ◽

...

Keyword(s):

Side Effects ◽

High Risk ◽

Hiv Prevention ◽

Prevention And Control ◽

Sexual Partners ◽

Intention To Use ◽

Sex With Men ◽

Exposure Prophylaxis ◽

And Control ◽

Oral Prep

Abstract BackgroundDespite strengthened efforts on HIV prevention and control, new HIV infections continue to increase among men who have sex with men (MSM) in China. Pre-exposure prophylaxis (PrEP), a highly effective HIV prevention tool, has recently been included in China’s Action Plan of HIV Prevention and Control. To inform future PrEP implementation, this study aims to identify the barriers and facilitators of PrEP intention among MSM in China. MethodsIn 2018, a cross-sectional survey was conducted among 300 MSM in Nanjing, Jiangsu Province. Questions on demographics, sexual behavior (including a 7-item high-risk behavior index), PrEP use intention, PrEP-related awareness and accessibility, and a 7-item public HIV stigma scale were included in the questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP intention. ResultsOverall, 44.67% had more than 2 male sexual partners and 5.56% had HIV-positive sexual partners. Just 57.00% had heard of PrEP and only 4 (1.33%) participants had used PrEP. However, 75.34% expressed a willingness to use oral PrEP if its efficacy was assured. Beliefs that ‘PrEP can prevent HIV if taken as prescribed’ (aOR=4.84, p<0.001), and ‘PrEP can be scaled up in the community’ (aOR=3.24, p<0.001), were positively associated with oral PrEP intention. Concerns of side effects were negatively associated with oral PrEP intention (aOR=0.32, p =0.006). Respectively 77.00% of the participants would choose injectable or implanted PrEP instead of oral PrEP. One of the PrEP stigma items, ‘Not certain if doctors can prescribe PrEP if I go to the clinic’ was positively associated with the intention to use injectable or implanted PrEP (aOR=3.03). Individuals who had heard of PrEP (aOR=2.74) and believed ‘PrEP can prevent HIV if taken as prescribed’ (aOR=2.65) were also positively related to the intention to use injectable or implanted PrEP. The most common concerns regarding PrEP use were efficacy (44.67%) and side effects (38.67%). The most common reasons for using injectable and implanted PrEP were adherence (81.94% and 77.86%, respectively) and privacy concerns (56.48% and 55.00%, respectively). Affordable price and coverage of health insurance are the driving factors for using PrEP. ConclusionsGiven the relatively low awareness of PrEP-related information in China, interventions on awareness and knowledge targeting high risk individuals and communities are needed. Furthermore, additional alternatives to prevent HIV, such as long-acting injectable or implanted PrEP, should be investigated to reduce the risk of HIV infection in at-risk MSM. Particularly, it is necessary to develop a more supportive social environment for MSM when implementing PrEP programs that are approved by China’s FDA.

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Examining potential effects of non-occupational post-exposure prophylaxis (nPEP) on sexual behaviors of Chinese men who have sex with men: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-10283-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Haochu Li ◽

Ran Wei ◽

Jason J. Ong ◽

Eunsook Kim ◽

Traci L. Weinstein ◽

...

Keyword(s):

High Risk ◽

Condom Use ◽

Behavioral Change ◽

Sexual Partners ◽

Post Exposure Prophylaxis ◽

Cross Sectional ◽

Chinese Men ◽

Number Of Sexual Partners ◽

Sex With Men ◽

Exposure Prophylaxis

Abstract Background In China, non-occupational post-exposure prophylaxis (nPEP) is not a conventional service yet and nPEP related studies are very few. Recently, China’s 13th Five Year Action Plan for HIV/AIDS Containment and Prevention examines the feasibility of including nPEP as one of the national strategies for HIV prevention. However, there is a concern that nPEP use might exacerbate high-risk sexual activities. In order to facilitate a research-based policy making of routinizing nPEP services, the current study examined potential effects of nPEP use on condom use and number of sexual partners among Chinese men who have sex with men (MSM) . Methods A cross-sectional survey was conducted in two cities of China in November and December 2018. Descriptive analyses of participants’ sociodemographic and behavioral characteristics were conducted using SPSS 24.0. Mplus 7.4 was used to conduct confirmatory factor analysis and structural equation modeling. Results The sample included 419 Chinese MSM with a mean age of 28.04 (SD = 9.71). Participants reported more positive anticipation of their own behaviors than other MSM’s behaviors regarding condom use and number of sexual partners if nPEP were to be routinized in China. About 60% of participants reported discrepancies between anticipated individual and population behaviors as a potential result of routinization of nPEP services. Anticipated individual behavioral change was positively related to age and duration of residence in the current city, and negatively related to education. Anticipated population behavioral change was positively related to age. Anticipated behavioral discrepancy was positively related to being ethnic minority and never married. Conclusions These findings identify a high-risk subgroup of MSM, who reported they would use condoms less and/or have more sexual partners when nPEP becomes available. This subgroup of MSM might benefit from targeted health interventions. Moreover, there is a clear discrepancy between anticipated individual and population behavioral changes regarding future routinization of nPEP services, suggesting incorporating nPEP services as a means of community development for MSM.

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Ethics of pre-exposure prophylaxis in high-risk HIV patients

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v85i2.4134 ◽

2016 ◽

Vol 85 (2) ◽

pp. 53-55

Author(s):

Adriana Cappelletti

Keyword(s):

High Risk ◽

Hiv Transmission ◽

Risk Groups ◽

Mitigation Strategies ◽

Sexual Practices ◽

Heterosexual Couples ◽

Immunodeficiency Virus ◽

Unsafe Sexual Practices ◽

Sex With Men ◽

Exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) is the daily use of antiretrovirals to prevent human immunodeficiency virus (HIV) transmission in uninfected people at high risk of infection, including men who have sex with men and serodiscordant heterosexual couples. PrEP has the potential benefit of reducing the human population’s viral load, and unlike barrier protection, PrEP allows for individual control over HIV exposure. However, ethical concerns have been raised around this intervention’s risk of serious side effects. These side effect risks may not be justifiable given PrEP’s modest benefit and the existence of standard HIV prevention: condoms, counseling, and education. Critics of this preventative approach also worry that PrEP promotes unsafe sexual practices such as sex without barrier protection. However, this discussion is harmful to the underserviced at-risk groups targeted by PrEP, and prohibition of PrEP for this reason is unjustified in a society that allows women to access oral contraceptives despite the risk of adopting unsafe sexual practices. To ensure the safety of high-risk HIV groups, future clinical trials of PrEP should compare this intervention to the standard of prevention rather than placebo, and stigma mitigation strategies must be implemented at the policy level.

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Improving Uptake and Adherence to HIV Prevention Services With Pre-exposure Prophylaxis (PrEP), HIV Self- Testing and Adherence Support for Very High Risk HIV-negative Young Women Aged 15-24 in Kampala, Uganda

Case Medical Research ◽

10.31525/ct1-nct04030520 ◽

2019 ◽

Author(s):

Keyword(s):

High Risk ◽

Hiv Prevention ◽

Young Women ◽

Prevention Services ◽

Self Testing ◽

Adherence Support ◽

Exposure Prophylaxis ◽

Very High ◽

Hiv Negative

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Evaluation of Pre-Exposure Prophylaxis for High Risk Adolescent Girls and Young Women

Case Medical Research ◽

10.31525/ct1-nct04044235 ◽

2019 ◽

Author(s):

Keyword(s):

High Risk ◽

Adolescent Girls ◽

Young Women ◽

Exposure Prophylaxis

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986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1172 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S521-S522

Author(s):

Jennifer R Silva-Nash ◽

Stacie Bordelon ◽

Ryan K Dare ◽

Sherrie Searcy

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Hiv Transmission ◽

Post Exposure Prophylaxis ◽

Intervention Period ◽

Post Intervention ◽

Post Exposure ◽

Assault Victims ◽

Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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