Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project

Vaccher, Stefanie; Gianacas, Christopher; Templeton, David J; Poynten, I. Mary; Haire, Bridget; Ooi, Catriona; Foster, Rosalind; McNulty, Anna; Grulich, Andrew E.; Zablotska, Iryna; Team, Prelude Study

doi:10.3389/fpubh.2017.00341

Cited by 33 publications

(32 citation statements)

References 37 publications

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“…Regarding the type of PrEP use, previous studies in Belgium, the Netherlands and Australia found that between 23.5% and 48% of the participants preferred non-daily PrEP [12,[28][29][30][31]. A single-centre study in France found the preference for on-demand PrEP to be as high as 75.6% [9].…”

Section: Discussionmentioning

confidence: 98%

Factors associated with the informal use of HIV pre‐exposure prophylaxis in Germany: a cross‐sectional study

et al. 2019

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Introduction Until September 2019, pre‐exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self‐pay or through informal non‐prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use. Methods We conducted a cross‐sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions. Results We recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informal PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum‐specific OR = 31.7, 95% CI 4.6 to 219.5). Conclusions Informal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use.

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Section: Discussionmentioning

confidence: 98%

Factors associated with the informal use of HIV pre‐exposure prophylaxis in Germany: a cross‐sectional study

et al. 2019

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“…Considerable uptake of this biomedical intervention has been observed in mostly men who have sex with men (MSM). Recent studies conducted in this population have shown that there is substantial variation in whether MSM prefer to initiate daily over event-driven PrEP [ [3] , [4] , [5] – 6 ]. An individual's choice of regimen over time is also likely to fluctuate with changing sexual and social contexts [7] .…”

Section: Introductionmentioning

confidence: 99%

Understanding pre-exposure prophylaxis (PrEP) regimen use: Switching and discontinuing daily and event-driven PrEP among men who have sex with men

et al. 2020

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Background Optimising HIV pre-exposure prophylaxis (PrEP) provision requires insight into preferences of PrEP regimens and PrEP discontinuation. We assessed regimen switching and discontinuation and their determinants among men who have sex with men (MSM) participating in the Amsterdam PrEP demonstration project. Methods Between 3-August-2015 and 31-May-2016, we enrolled MSM ( n = 374) and TGP ( n = 2) in a prospective, longitudinal study. Participants could choose between daily or event-driven PrEP regimens at enrolment and every 3 months. We assessed transition intensities (TI) and determinants of switching (i) between regimens, and (ii) from either regimen to discontinuing PrEP using a multi-state Markov model. PrEP discontinuation was defined as formally stopping study participation or having no study visit for ≥6 months. Findings Of 367 analysed participants, 73 · 3% chose daily and 26 · 7% event-driven PrEP at enrolment. Median follow-up was 3 · 1 years (IQR 2 · 9–3 · 2). 121 participants switched their PrEP regimen at least once (cumulative probability 34 · 2%, 95% CI 29 · 4–39 · 6), with 90 switches from event-driven to daily PrEP (TI 0 · 35/PY, 95% CI 0 · 29–0 · 44) and 113 switches from daily to event-driven PrEP (TI 0 · 16/PY, 95% CI 0 · 13–0 · 20). Switching from event-driven to daily PrEP was associated with younger age, not reporting sex with HIV-positive partners, chemsex, and sexual compulsivity. Switching from daily to event-driven PrEP were associated with younger age and lower sexual satisfaction. 67 participants discontinued PrEP (cumulative probability 17 · 7%, 95% CI 14 · 1–22 · 2), with no difference between regimens: event-driven ( n = 23, TI 0 · 08/PY, 95% CI 0 · 05–0 · 13) and daily PrEP ( n = 44, TI 0 · 06/PY, 95% CI 0 · 04–0 · 08). Discontinuing daily PrEP was associated with younger age, fewer casual partners, and higher number of condomless anal sex acts with casual partners. Interpretation Switching between PrEP regimens was common, while going from event-driven to daily PrEP use was associated with certain sexual-related determinants (i.e. chemsex, sexual compulsivity, no known HIV-positive partners). PrEP discontinuation rates were low and independent of regimens...

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“…While there are data on the motives to use daily PrEP , little is known about the reasons to choose between daily and event‐driven PrEP, to switch between these regimens, or to discontinue PrEP use altogether in a setting that offers both regimens. The majority of previous studies reported on situations in which event‐driven PrEP was only a hypothetical option , and where stops were associated with daily adherence problems and reduced risk . Data on actual choices between daily and event‐driven PrEP among MSM are only available from three studies in the European setting, the roll‐out programme in France , the Be‐Prepared study in Belgium , and our own study, the Amsterdam PrEP (AMPrEP) demonstration project in the Netherlands .…”

Section: Introductionmentioning

confidence: 99%

Motives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis – a qualitative analysis

et al. 2019

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Introduction In settings where both daily and event‐driven pre‐exposure prophylaxis (PrEP) are offered to men who have sex with men (MSM), a clear understanding of the motives to choose between the different dosing‐regimens can facilitate more effective PrEP implementation. We therefore studied the motives for choosing for, switching between, and stopping daily or event‐driven PrEP. Methods We used data (August 2015‐June 2017) from the prospective, longitudinal, open‐label Amsterdam PrEP demonstration study, in which daily (dPrEP) and event‐driven PrEP (edPrEP) were offered to 374 HIV‐negative MSM and two transgender persons. Participants self‐selected the preferred PrEP‐regimen at baseline and could switch regimens at three‐monthly follow‐up visits. We measured motives for choosing PrEP‐regimen at baseline and for switching and stopping PrEP at follow‐up visits. Open‐ and closed‐end items were combined and qualitatively analysed. Results Choices of PrEP‐regimens were determined by personal and contextual factors, involving the perceived self‐efficacy concerning adherence, the risk‐context, and the anticipated impact of PrEP on physical and sexual wellbeing. dPrEP was preferred because of the anticipated better adherence and the fear of side‐effects relating to edPrEP re‐initiations. Moreover, dPrEP was perceived to be more effective than edPrEP. Motives to choose edPrEP were the expected physical burden of dPrEP, anticipated side‐effects of dPrEP, and fear to forget daily doses. Regarding the risk‐context: dPrEP was preferred for unplanned and/or frequent sex, while edPrEP was chosen when risk was predictable and/or less frequent. While some chose for dPrEP to gain more sexual freedom, others chose for edPrEP to minimize sexual risk episodes. Changes in the above factors, such as changing risk patterns, changing relationships or changing physical conditions, resulted in switching regimens. Choices to stop PrEP were related to lower sexual risk, adherence issues and side‐effects. Conclusions The great diversity of motives illustrates the importance of offering a choice of PrEP‐regimens. In counselling of MSM starting PrEP, choices for PrEP‐regimens may be addressed as a continuum of flexible and changeable options over time. This may help individuals choose the PrEP‐regimen that best fits their current sexual context, priorities and personal capabilities and therefore will be more easily adhered to.

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Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project

Cited by 33 publications

References 37 publications

Factors associated with the informal use of HIV pre‐exposure prophylaxis in Germany: a cross‐sectional study

Factors associated with the informal use of HIV pre‐exposure prophylaxis in Germany: a cross‐sectional study

Understanding pre-exposure prophylaxis (PrEP) regimen use: Switching and discontinuing daily and event-driven PrEP among men who have sex with men

Motives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis – a qualitative analysis

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