Behavioral Changes Following Uptake of HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in a Clinical Setting

Oldenburg, Catherine E.; Nunn, Amy; Montgomery, Madeline C.; Almonte, Alexi; Mena, Leandro; Patel, Rupa; Mayer, Kenneth H.; Chan, Philip A.

doi:10.1007/s10461-017-1701-1

Cited by 54 publications

(38 citation statements)

References 13 publications

(21 reference statements)

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“…Although HIV self-testing may overcome some traditional barriers to HIV testing, such as stigma or logistical challenges, there may be unintended consequences associated with the use of the test, and these unintended consequences may depend on the strategy for HIV self-testing delivery. Changes in sexual behaviors have been considered following HIV prevention interventions including preexposure prophylaxis [ 3 , 4 ], male circumcision [ 5 ], and vaccination [ 6 ]. Among MSM, access to HIV self-testing has resulted in increased awareness of HIV risk, which may have led to reduced sexual risk-taking [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia

Oldenburg

Chanda²,

Ortblad

et al. 2018

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Objectives To assess the effect of two health systems approaches to distribute HIV self-tests on the number of female sex workers’ client and non-client sexual partners in a randomized controlled trial of HIV self-testing among female sex workers (FSW) in Zambia. Design Cluster randomized controlled trial. Methods Peer educators recruited 965 participants. Peer educator-participant groups were randomized 1:1:1 to one of three arms: 1) delivery of HIV self-tests directly from a peer educator, 2) free facility-based delivery of HIV-self tests in exchange for coupons, or 3) referral to standard HIV testing (standard of care). Participants in all three arms completed four peer educator intervention sessions, which included counseling and condom distribution. Participants were asked the average number of client partners they had per night at baseline, one and four months, and the number of non-client partners they had in the past 12 months (at baseline) and in the past month (at one month and four months). Results At four months, participants reported significantly fewer clients per night in the delivery arm (mean difference −0.78 clients, 95% CI −1.28 to −0.28, P=0.002) and the coupon arm (−0.71, 95% CI −1.21 to −0.21, P=0.005) compared to standard-of-care. Similarly, they reported fewer non-client partners in the delivery (−3.19, 95% CI −5.18 to −1.21, P=0.002) and in the coupon arm (−1.84, 95% CI −3.81 to 0.14, P=0.07) arm compared to standard-of-care. Conclusions Expansion of HIV self-testing may have positive spillover effects on HIV prevention efforts among FSW in Zambia. Trial Registration ClinicalTrials.gov NCT02827240

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Section: Introductionmentioning

confidence: 99%

Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia

Oldenburg

Chanda²,

Ortblad

et al. 2018

Aids

Self Cite

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“…Fourth, we did not model behavioral risk compensation, such as a decrease in condom use or an increase in partner acquisition rate, for agents initiating PrEP. An early study of MSM initiating PrEP in Rhode Island indicated a higher number of partnerships within which condomless anal sex occurred but not an overall increase in the number of partners over the first 6 months of follow-up [ 47 ]. We also did not implement the (approximately) 3-month HIV screening interval among MSM agents on PrEP, who continue in the model to test stochastically at the background rate.…”

Section: Discussionmentioning

confidence: 99%

Improving the impact of HIV pre-exposure prophylaxis implementation in small urban centers among men who have sex with men: An agent-based modelling study

et al. 2018

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ObjectivesIdentifying prescribing strategies that improve the efficiency of PrEP should increase its impact at the population level. This study identifies PrEP allocation criteria that most effectively reduce 10-year HIV incidence by 25%, in accordance with the US National HIV/AIDS Strategy’s goal for the proportionate reduction in new diagnoses.MethodsWe used a discrete-time stochastic agent-based model to simulate several PrEP engagement strategies. The model represented MSM aged 15–74 in Rhode Island and was calibrated to statewide prevalence from 2009–2014. We simulated HIV transmission in the absence of PrEP and compared the following PrEP engagement scenarios: 1) allocation to the current patient population; 2) random allocation; 3) allocation to MSM with greater than 5 sexual partners in one year; 4) allocation to MSM with greater than 10 sexual partners in one year.For each scenario and coverage level we estimated the number and proportion of infections averted and the person-years on PrEP per averted infection.ResultsIn 2014, HIV prevalence before PrEP implementation was between 4% and 5%. In the No PrEP scenario 826 new infections (95% simulation limits [SL]: 711, 955) occurred over 10 years, with an incidence rate of 3.51 per 1000 person-years (95% SL: 3.00, 4.08). Prevalence rose to 7.4% (95% SL: 6.7, 8.1). None of the PrEP scenarios reduced new HIV infections by 25% while covering less than 15% of the HIV-uninfected population. At 15% coverage, allocating PrEP to the current patient population, MSM with greater than 5 sexual partners in a year, and MSM with greater than 10 partners reduced new infections by at least 25%, requiring 161 (95% SL: 115, 289), 150 (95% SL: 107, 252), and 128 (95% SL: 100, 184) person-years on PrEP per averted infection, respectively.ConclusionsEngaging MSM with high numbers of sexual partners would improve the population-level impact and efficiency of PrEP in settings where PrEP coverage remains low. However, the sustained population-level PrEP coverage needed to reduce new infections by 25% is substantially higher than current levels of PrEP uptake.

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“…Based on a recent meta‐analysis, individuals starting PrEP have a high burden of STIs . Furthermore, there is emerging evidence from open‐label and demonstration studies and implementation sites among gay, bisexual and other men who have sex with men (MSM) that condom use decreases among some men on PrEP, particularly among those already engaging in condomless sex or other high‐risk behaviours . However, modelling among MSM suggest that if PrEP is accompanied by regular STI services, increased detection and treatment may mitigate increases in STI transmission .…”

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

et al. 2020

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Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre‐exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low‐ and middle‐income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk‐taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single‐focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real‐life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two‐fold increase in condomless sex among FSWs on PrEP, which, given low use of non‐barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW‐focused community‐based HIV services is likely to be the most effective model for improving access to non‐barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women’s rights.

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Behavioral Changes Following Uptake of HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in a Clinical Setting

Cited by 54 publications

References 13 publications

Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia

Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia

Improving the impact of HIV pre-exposure prophylaxis implementation in small urban centers among men who have sex with men: An agent-based modelling study

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

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