Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

Abstract

Introduction Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but the PrEP care continuum also involves improving PrEP awareness, uptake, adherence, and retention in care. Users’ awareness is often compromised because of vulnerability factors and risk behaviors, such as chemsex practice or specific substance use, which could lead to risk compensation. Correct adherence and retention in care are essential to achieve the full effectiveness of PrEP. This study describes changes in users’ risk behaviors and sexually transmitted infections (STIs), as well also PrEP care continuum details. Methods This was a descriptive single-center retrospective study including adults at high HIV risk screened between November 2019 and June 2021 in the PrEP program of our hospital. Demographic, behavioral, STI, adherence, and retention in care variables were assessed. Data were collected from medical records and self-report questionnaires. Results A total of 295 people were included, 94% men and 5% transgender women, with a mean age of 34 years (SD 10) and 10% sex workers. At baseline, 55% disclosed chemsex practice and 3% slamming. During follow-up, condom use for anal intercourse decreased from 41% to 13% ( p ≤ 0.0001) and one HIV infection was detected; other risk behaviors and STIs remained stable. Chemsex, group sex, fluid exchange, and condomless anal intercourse were related to STI risk. Adherence was correct in 80% of users, and retention in care was 57%. Discontinuations and loss to follow-up were high, mainly affecting transgender women, sex workers, and people practicing fisting. Conclusion PrEP program implementation in our hospital was adequate, since it allowed, in a population at high HIV risk, overall users’ risk behaviors and STIs to remain stable, with only one HIV diagnosis during the follow-up. We should target specific strategies to improve adherence and retention in care, as vulnerable subgroups at higher risk of loss to follow-up are identified.

Slovenia‘s national HIV PrEP programme: Evaluation of real-world implementation

“…The number of subjects who had previously used PEP was significantly lower in our cohort than in the Australian PrEPX study, where 40.7% had used PEP 7 and lower than in the pilot study, where this percentage was 24.6%. 14 Chemsex use was less common than in other European countries, with 38.4% of subjects using chemsex in our cohort, compared to 55% in Barcelona 19 and 42.6% in Paris, 15 consistent with data that Ljubljana ranks among the cities with a lower level of use of chemsex within the EU. 20 Adherence is vital for the effectiveness of PrEP.…”

“…7 No difference was observed in the PROUD study 2 and in the Barcelona cohort. 19 In the future, it would be reasonable to analyze the difference in the incidence of STIs according to the method of use, as the results of international research show that the incidence of STIs among on-demand users is lower, and in this way, the frequency of testing could be adjusted. 16,17 It would also be reasonable to identify other characteristics of the group of PrEP users in whom STIs are more often diagnosed.…”

The impact of HIV preexposure prophylaxis on bacterial sexually transmitted infection occurrence in MSM: a systematic review and meta-analysis

“…Twenty-three studies were included , with 11 776 participants in total, from which 18 were journal articles [18,20,22,23,[25][26][27][28][29][30][31][32][33][34][35][36]38,39], and five conference abstracts [19,21,24,37,40]. Twenty-two studies were cohort studies [18][19][20][21][22][23][24][25][26][27][28][29][31][32][33][34][35][36][37][38][39][40] (either prospective or retrospective) and one was a randomized controlled trial [30]. Articles included were published from 2015 to 2022 with a median sample size of 280 (interquartile range: 158-682) ranging from 81 to 2404.…”

“…Length of follow-up ranged from 3 to 24 months (median: 12; interquartile range: 12-18). Seventeen studies were conducted in high-income countries [18,20,[22][23][24]26,27,[29][30][31]33,34,[36][37][38][39][40], three in upper middle-income countries [19,25,35], two in lower middle-income countries [21,32] and one study was performed in four countries from which three were low income and one was lower middle income [28]. The study characteristics and STIrelated data are summarized in Table 1 and Supplemental PrEP initiation was associated with significantly increased occurrence of any STI (pooled effect size: 1.15, 95% CI: 1.04-1.26, I 2 ¼ 54.5%, Fig.…”

Application of the Delphi Method for Content Validity Analysis of a Questionnaire to Determine the Risk Factors of the Chemsex

“…The assessment of mood disorders and addiction linked to the practice of chemsex is of interest given the psychoactive substances used [11]. The practice of chemsex has been linked to increased suicide, sexually transmitted infections (STIs) [12][13][14][15], psychosis [16], and mental problems [9], and decreased adherence to pre-exposure prophylaxis treatment (PrEP) among others [17].…”