Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection

Ong, Jason J.; Baggaley, Rachel; Wi, Teodora; Tucker, Joseph D.; Fu, Hongyun; Smith, M. Kumi; Rafael, Sabrina; Anglade, Vanessa; Falconer, Jane; Ofori‐Asenso, Richard; Terris‐Prestholt, Fern; Hodges-Mameletzis, Ioannis; Mayaud, Philippe

doi:10.1001/jamanetworkopen.2019.17134

Cited by 111 publications

(126 citation statements)

References 67 publications

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“…Concerns around risk compensation (or an increase in risk-taking behaviors among individuals at risk prompted by a decrease in perceived HIV risk) appear to be one factor that can cause reluctance among some healthcare providers to prescribe PrEP to eligible patients [ 53 ]. While several studies have reported risk compensation behavior in individuals receiving PrEP [ 121 – 123 ], the balance of evidence suggests that patients who are eligible for PrEP inherently have a high baseline risk for STIs, which remains high following initiation of treatment with PrEP [ 88 , 124 – 128 ]. Even if risk compensation does occur in some individuals or populations, related concerns do not justify withholding PrEP from people at risk for HIV infection [ 56 ].…”

Section: Potential Solutions To Barriersmentioning

confidence: 99%

“…Even if risk compensation does occur in some individuals or populations, related concerns do not justify withholding PrEP from people at risk for HIV infection [ 56 ]. Consistent with this notion, it has been proposed that PrEP be viewed as an opportunity for improved STI control [ 124 , 129 ], whereby an increase in detection rates due to more frequent STI testing, with potentially earlier diagnosis and treatment, may counteract or surpass any negative effects of risk compensation [ 130 ]. Nevertheless, patients receiving PrEP should be provided with support for risk-reduction behaviors [ 33 ].…”

Section: Potential Solutions To Barriersmentioning

confidence: 99%

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Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.

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Section: Potential Solutions To Barriersmentioning

confidence: 99%

Section: Potential Solutions To Barriersmentioning

confidence: 99%

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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“…There is growing concern over the burden of bacterial sexually transmitted infections (STIs) reported among individuals using HIV Pre-Exposure Prophylaxis (HIV PrEP) to prevent HIV (1)(2)(3). A meta-analysis of STI prevalence and incidence among individuals using HIV PrEP estimated a pooled STI prevalence of 24% among individuals initiating HIV PrEP and a pooled STI incidence of 72.2 per 100 person-years during persistent HIV PrEP use(3).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with reporting antibiotic use as STI prophylaxis among HIV PrEP users: findings from a cross-sectional online community survey, May–July 2019, UK

et al. 2020

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ObjectivesThe use of antibiotics as pre-exposure or postexposure prophylaxis for sexually transmitted infection (STI) prevention (STI prophylaxis) is not currently recommended in the UK, but there is evidence that self-prescribing occurs among those at greatest risk. We present the prevalence and factors associated with STI prophylaxis among a community sample of HIV pre-exposure prophylaxis (PrEP) users.MethodsThe 2019 online PrEP User Survey ran between 17 May and 1 July. Eligible participants included UK residents reporting HIV PrEP use or having tried to obtain HIV PrEP since January 2017. STI prophylaxis use was defined as reporting buying antibiotics to prevent STIs, either privately or through the internet; this question was only asked to HIV PrEP users. Factors associated with STI prophylaxis use were assessed using univariable and multivariable logistic regression.ResultsOverall, 9% (167/1856) of HIV PrEP users reported STI prophylaxis use; 97% were gay or bisexual men, 84% reported white ethnicity, 55% resided in London and 69% were aged ≥35 years. Factors associated with STI prophylaxis included: reporting ≥5 compared with 1–4 condomless sex partners in the past 6 months (12% vs 5.6%, adjusted odds ratio (aOR)=1.80; 95% CI 1.22 to 2.64), reporting chemsex drug use compared with no sexualised drug use in the past 12 months (13% vs 6.0%, aOR=1.88; 95% CI 1.20 to 2.93) and reporting an STI diagnosis in the past 12 months (12% vs 6.6%, aOR=1.54; 95% CI 1.08 to 2.18). Variables not significant in multivariable analyses included: ethnicity, age, residence and HIV PrEP sourcing.ConclusionsApproximately 1 in 10 HIV PrEP users from this community sample reported self-prescribed STI prophylaxis. STI prophylaxis was associated with sexual behaviour known to facilitate STI transmission and with a history of recent STIs acquisition. Given the potential risk of antimicrobial resistance, sexual health clinicians should consider asking attendees, especially HIV PrEP users, about the use of antibiotics as STI prophylaxis, to inform appropriate counselling, testing and management.

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“…As well, that we diagnosed 16% of PEP2PrEP patients with STIs during follow-up signals ongoing sexual practices that can result in HIV acquisition, which aligns with published literature. 21 This lack of HIV diagnosis, however, could be coincidental or an artefact of missed diagnoses due to PrEP medication affecting diagnosis, although patients did seroconvert in the PrEP studies. 12 It is also reassuring that missed diagnoses are not likely because our patients reported good PEP and PrEP adherence, had no signs/ symptoms of HIV seroconversion, and all had negative HIV test results at PEP initiation, 1 week before starting PrEP, and 1 month after being on PrEP.…”

Section: Discussionmentioning

confidence: 96%

Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

O’Byrne

Orser

Vandyk

2020

J Int Assoc Provid AIDS Care

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Patients who use post-exposure prophylaxis (PEP) are at ongoing risk for HIV acquisition after completing PEP. While the Centers for Disease Control and Prevention recommends pre-exposure prophylaxis (PrEP) use immediately after PEP, some practitioners are hesitant to offer PEP-to-PrEP (PEP2PrEP). We began offering PEP2PrEP in the sexually transmitted infection clinic in Ottawa, Canada on August 5, 2018. During the first 16 months of PEP2PrEP, 61 patients requested PEP and 46 were initiated; 30 of these patients agreed to PEP2PrEP and 26 followed through. None of our PEP patients had confirmed HIV exposures; all fulfilled the initiation criterion of condomless anal sex with a male partner of unknown HIV-status. During the study, the number of PEP requests and initiations was statistical unchanged, yet the seroconversion rate among patients who used PEP decreased from 1.7% pre-PEP2PrEP to 0% post-PEP2PrEP. Regarding follow-up, most discontinuations occurred between the PrEP intake and 1-month follow-up visit.

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Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection

Cited by 111 publications

References 67 publications

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

Factors associated with reporting antibiotic use as STI prophylaxis among HIV PrEP users: findings from a cross-sectional online community survey, May–July 2019, UK

Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

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