Combination HIV Prevention Strategies Among Montreal Gay, Bisexual, and Other Men Who Have Sex with Men in the PrEP Era: A Latent Class Analysis

Abstract

Pre-exposure prophylaxis (PrEP) became publicly available in Quebec for gay, bisexual and other men who have sex with men (GBM) in 2013. We used baseline data from Engage, a cohort of GBM recruited by respondent-driven sampling, to examine patterns of combination HIV prevention use among Montreal GBM since PrEP became available. Latent class analysis, stratified by HIV status, was used to categorize GBM by self-reported use of biomedical and behavioural prevention strategies. Correlates of resulting classes were identified using multinomial logistic regression. Among HIV-negative/unknown GBM (n = 968), we identified four classes: low use of prevention (32%), condoms (40%), seroadaptive behaviour (21%), and biomedical (including PrEP; 7%). Those using prevention (condoms, seroadaptive behaviour, and biomedical) had a higher number of anal sex partners and were more likely to report a recent sexually transmitted infection diagnosis. GBM using biomedical prevention also had a higher level of formal education. Among GBM living with HIV (n = 200), we identified three classes: mainly antiretroviral treatment (ART) with viral suppression (53%), ART with viral suppression and condoms (19%), and ART with viral suppression and seroadaptive behaviour (18%). Again, the number of anal sex partners was higher among those using condoms and seroadaptive behaviours. Our findings show antiretroviral-based prevention, either alone or in combination with other strategies, is clearly a component of the HIV prevention landscape for GBM in Montreal. Nevertheless, PrEP uptake remains low, and there is a need to promote its availability more widely.

Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study

“…Further details on the RDS method are described elsewhere. 26 The STROBE-RDS checklist guided reporting. 32 Participants were recruited from February 2017 to June 2018 in Montréal, May 2017 to August 2019 in Toronto, and February 2017 to August 2019 in Vancouver; periods varied based on differences in recruitment rates across cities.…”

Past dynamics of HIV transmission among men who have sex with men in Montréal, Canada: a mathematical modeling study

“…Data from the peer-reviewed and grey literature, and individual-level data from the two cross-sectional Argus surveys (2005; n = 1957 and 2008; n = 1873), the Engage cohort (2017; n = 1179, 2018; n = 887, 2019; n = 850), and the L'Actuel PrEP Cohort (2013-2019; n = 2746) studies were analyzed to identify temporal trends in sexual behaviors and HIV interventions uptake. Details on the studies can be found elsewhere [20][21][22][23][24][25][26]. Briefly, the Argus surveys used venue-based convenience sampling to recruit gbMSM aged 18 + years from the island of Montréal who reported sex with another man during their lifetime.…”

Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities

“…Despite imperfect adherence, no participant acquired HIV during study follow-up. Participants reported fewer male sexual partners over time [median (IQR) for baseline = 10.5 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), visit 4 = 6 (4-12); RR 0.71, 95% CI 0.66-0.77] [for mean (SD), see Table 2]. However, the number of condomless receptive anal intercourse partners was steady [median (IQR) for baseline = 3 (2-7) vs visit 4 = 2 (1-5); RR 1.10, 95% CI 0.98-1.24] [for mean, (SD) see Table 2].…”

“…PrEP is now an essential component of combination HIV prevention for GBM including condoms, HIV testing and viral suppression of people living with HIV [3,13]. Modelling suggests that high PrEP uptake can help eliminate HIV transmission at the population level [14][15][16] and ecological data support this [17,18].…”