Data on challenges with pre-exposure prophylaxis (PrEP) uptake and adherence among Kenyan gay, bisexual, and other men who have sex with men (GBMSM) are limited. In this mixed-methods sequential explanatory design study, our quantitative phase followed 157 at-risk, HIV-negative GBMSM who accepted PrEP and enrolled in a cohort with 12-month follow-up. Stored dried blood spots collected at two intervals were batch tested for tenofovir diphosphate (TFV-DP) concentrations at study end. Despite high self-reported adherence, only 14.6% of individuals had protective TFV-DP levels at any visit. Protective TFV-DP levels were positively associated with injection drug use and a self-assessed moderate risk of acquiring HIV, and negatively associated with time since enrolment. In our subsequent qualitative phase, an intensive workshop was conducted with the GBMSM community to identify barriers and facilitators to PrEP uptake and adherence. These data revealed numerous challenges with traditional PrEP programs that must be addressed through community collaborations.

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ObjectiveSTIs disproportionately affect men who have sex with men (MSM) in sub-Saharan Africa. We identified factors associated with incident Chlamydiatrachomatis (CT) and Neisseriagonorrhoeae (NG) infections among MSM in the Anza Mapema cohort study in Kisumu, Kenya.MethodsWe enrolled 711 MSM who underwent HIV testing and counselling, medical history and examination, and collection of demographic and behavioural information. They also provided urine and rectal swab specimens for CT and NG testing by qualitative PCR at baseline and at months 6 and 12. Separate multivariable Cox regression models identified factors associated with first incident urethral or rectal infection.ResultsAmong the 619 men aged 18–54 years included in this analysis, there were 83 first incident urethral CT/NG infections (14.4 cases per 100 person-years (PY)) and 40 first incident rectal infections (6.84 cases per 100 PY), and an overall incidence of 18.0 cases per 100 PY (95% CI 14.8 to 21.8). Most urethral (84%) and rectal (81%) infections were asymptomatic. In the adjusted model, the risk of first incident urethral CT/NG decreased by 4% for each 1-year increase in age and was 41% lower for men who reported their partner used condom at last sexual encounter. Men who were HIV-positive had a 68% less risk of urogenital CT/NG compared with those who were negative. Men who reported being usually receptive or versatile as compared with usually insertive had an 81% increased risk of incident urogenital CT/NG.ConclusionOur study demonstrated a high incidence of urethral CT/NG infection, with somewhat lower incidence of rectal CT/NG infection, despite repeated testing and treatment, highlighting the need for preventive interventions to decrease the burden of CT/NG among Kenyan MSM. Most infections were asymptomatic, and routine aetiological screening for STIs is recommended.

Background Some studies have shown an association between HIV pre-exposure prophylaxis (PrEP) use, STD acquisition and increased sexual risk behaviors (e.g. condomless sex). The objective was to determine the association between PrEP use, STD infection (i.e. syphilis, gonorrhea, chlamydia) and sexual risk behaviors (i.e. condomless sex, sex partner concurrency) in one mid-Atlantic city with an established epidemic of HIV. Methods Data came from the Understanding Sexual Health in Networks Study (USHINE), an ongoing longitudinal cohort study of MSM between the ages of 18-45. Participants completed an egocentric sexual network survey. Summary statistics, chi-squared tests, and t-tests were used for hypothesis testing. Results 173 men completed the sexual network survey. 52 (30.1%) men were HIV uninfected and 52 (30.1%) men reported PrEP use. PrEP users (vs non-users) were less likely to be positive for syphilis (10.6% vs 26.8%, p=0.03), but no more likely to be positive for gonorrhea (15.4% vs 8.0%, p=0.25) or chlamydia (17.3% vs 16.0%, p= 0.86). PrEP users (vs non-users) were more likely to report condomless sex (88.5% vs 69.2%, p =0.02) and sex partner concurrency (57.7% vs 32.7%, p=0.01). Conclusion PrEP users were less likely to be infected with syphilis and no more likely than non-PrEP users to be gonorrhea and chlamydia infected. PrEP users were more likely to report sexual risk behaviors including condomless sex and sex partner concurrency compared to non-PrEP users. The increased sexual risk behaviors among PrEP users is concerning and emphasizes the importance of prevention messaging for PrEP users. Disclosure No significant relationships.

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