Examining provincial PrEP coverage and characterizing PrEP awareness and use among gay, bisexual and other men who have sex with men in Vancouver, Toronto and Montreal, 2017–2020

Abstract

Introduction Accessibility of pre‐exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out‐of‐pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use. Methods Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent‐driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self‐reported HIV‐negative/unknown GBM. Results Of 2008 self‐identified HIV‐negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all p<0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (p<0.001), Toronto 21.4–31.4% (p<0.001) and Vancouver 21.7–59.5% (p<0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60–2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68–1.18). Conclusions Full free‐of‐charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.

Pre-exposure Prophylaxis Awareness and Use Among Transgender and Nonbinary Individuals in Canada

“…PrEP awareness among the PrEP-indicated subgroup (82%) was comparable with estimates among PrEP-indicated trans women (83%) 31 and trans men who have sex with men (84%) 32 in the United States, but lower than estimates among MSM in major Canadian cities (88%). 33 PrEP uptake was low—only 3.8% of PrEP-indicated participants were currently using PrEP compared with estimates ranging from 11% to 20% among PrEP-indicated trans and nonbinary US samples. 11 , 31 , 32 However, this may be partially explained by the broader PrEP indication criteria used in this study compared with US studies.…”

“…The need to improve PrEP awareness among older adults, transfeminine groups, and those with lower education is consistent with previous studies. 11,33,35 Encouragingly for transfeminine groups, researchers have begun working with community members to develop and test PrEP education materials specifically for trans women, which may help address barriers related to the targeting of PrEP information primarily to cisgender MSM. 14,15,36 Potential explanations for the effects of GAMC include a positive impact of medical gender affirmation on PrEP awareness and/or effects related to greater contact with the health care system among those receiving GAMC.…”

Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data

“…Given the coverage estimates over 2017-2020 for Vancouver MSM, we believe that levels of 10% in 2015 and 30% in 2019 could have been feasible in Montréal and an estimated 63% (90% CrI: 54%-70%) of HIV acquisitions would have been averted instead of 20%. Vancouver's higher coverage has been attributed to total public funding for PrEP in that province [40], whereas the PrEP co-payment in Québec can be as high as CAD$97 per month [18]. Even matching 5% coverage in 2015 and 20% in 2019 could have averted 49% (90% CrI: 39%-57%) of HIV acquisitions between 2015 and 2022, rising to 68% (90% CrI: 54%-70%) if efforts focused on MSM frequently engaging in anal sex with different partners.…”

Examining the secondary impacts of the COVID-19 pandemic on syndemic production and PrEP use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada

“…Overall, we found a trend of increased PrEP interruptions over time. However, our findings should be considered with the fact that PrEP became publicly funded in BC in January 2018 and since then the province has reported general trends of increasing PrEP uptake [ 27 , 45 ]. Thus, it may be expected that as the number of PrEP users increases, the number of interruptions may also increase.…”