Choosing event‐driven and daily HIV pre‐exposure prophylaxis – data from two European PrEP demonstration projects among men who have sex with men

Abstract

Introduction Daily and event‐driven PrEP are both efficacious in reducing the risk for HIV infection. However, the practice of event‐driven PrEP (edPrEP) is less well studied, in particular when provided as an alternative to daily PrEP. We studied regimen preferences and switches, and sexually transmitted infection (STI) incidence. Methods We analysed pooled data from two prospective cohort studies among MSM: Be‐PrEP‐ared, Belgium and AMPrEP, the Netherlands. In both projects, participants could choose between daily and edPrEP at three‐monthly study visits, when they were also screened for sexually transmitted infections including hepatitis C (HCV). We assessed the proportion choosing each regimen, and the determinants of choosing edPrEP at baseline. Additionally, we compared the incidence rates (IRs) of HCV, syphilis and chlamydia or gonorrhoea between regimens using Poisson regression. The study period was from 3 August 2015 until 24 September 2018. Results and discussion We included 571 MSM, of whom 148 (25.9%) chose edPrEP at baseline. 31.7% of participants switched regimen at least once. After 28 months, 23.5% used edPrEP. Older participants (adjusted odds ratio (aOR) = 1.38 per 10 years, 95% confidence interval (CI) = 1.15 to 1.64) and those unemployed (aOR = 1.68, 95% CI = 1.03 to 1.75) were more likely to initially choose edPrEP. IR of HCV and syphilis did not differ between regimens, but the IR of chlamydia/gonorrhoea was higher among daily users (adjusted incidence rate ratio = 1.61, 95% CI = 1.35 to 1.94). Conclusions A quarter of participants chose edPrEP at baseline and at 28 months this proportion was similar. Although the IR of HCV and syphilis were similar in the two regimens, the lower incidence of chlamydia and gonorrhoea among edPrEP users may suggest that less frequent STI testing of this group could be considered.

PrEP user profiles, dynamics of PrEP use and follow‐up: a cohort analysis at a Belgian HIV centre (2017–2020)

“…Nevertheless, switches between PrEP regimens and (temporarily) interruptions in follow-up and PrEP use occurred. This is consistent with results from other studies, where 17-30% of the PrEP users switched at least once during the study period and 13-69% temporarily interrupted the use of PrEP [18][19][20]. To further enhance preventioneffective PrEP adherence, healthcare providers could offer PrEP as a dynamic intervention over time, such as allowing for switching between PrEP regimens and temporarily interrupting PrEP intake.…”

Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake

“…Australia's specific context may in part explain why more participants preferred daily PrEP and why only 14 had switched to non-daily PrEP. However, these findings nonetheless reflect previous research that has also found PrEP users mainly prefer daily PrEP (albeit in contexts where it is considered the gold-standard) (Broady et al, 2021;Coyer et al, 2020;Hoornenborg et al, 2019;Jongen et al, 2021;Reyniers et al, 2018;Vuylsteke et al, 2019).…”

“…Globally, most (typically about three-quarters) of those on PrEP take and prefer daily PrEP (Broady et al, 2021;Coyer et al, 2020;Hoornenborg et al, 2019;Jongen et al, 2021;Reyniers et al, 2018;Vuylsteke et al, 2019). However, some PrEP users, when given the choice at study enrolment, chose event-driven PrEP over daily PrEP (Wu et al, 2021;Zhang et al, 2021).…”

“…Other studies have found that non-users of PrEP would hypothetically prefer eventdriven PrEP over daily PrEP (Hall et al, 2016) or that interest in event-driven PrEP was growing (Broady et al, 2021). Studies from Belgium, the Netherlands, and Taiwan, countries in which potential PrEP users are actively provided with a choice of event-driven PrEP by care providers (rather than it just being an alternative), have found that between 21 and 34% of participants have switched to event-driven PrEP, and that uptake of event-driven PrEP is high (Coyer et al, 2020;Jongen et al, 2021;Wu et al, 2021).…”

Sexually Transmitted Infections Among Men and Transgender Women Using HIV Pre-exposure Prophylaxis in a Large Integrated Health System—A Cohort Study

“…One small European study of 2 PrEP demonstration projects showed similar incidence rates of syphilis between MSM who used on-demand PrEP and those using daily PrEP, whereas a lower incidence of chlamydia and gonorrhea was found among on-demand PrEP users. 39 It will be important to evaluate the incidence of STIs among individuals using on-demand PrEP in comparison with those using PrEP daily in future large epidemiologic studies among patients in routine PrEP care. Fourth, because information on sexual behavior is not routinely collected in primary care, we could not identify a representative concurrent comparison cohort of MSM.…”