HIV, STI and renal function testing frequency and STI history among current users of self-funded HIV pre-exposure prophylaxis, a cross-sectional study, Germany, 2018 and 2019

Abstract

Introduction Users of pre-exposure prophylaxis (PrEP) require periodic testing for HIV, sexually transmitted infections (STI) and renal function. Before PrEP was made free of charge through statutory health insurance in late 2019, PrEP users in Germany had to pay for testing themselves. Aim We investigated self-reported HIV, STI and renal function testing frequencies among self-funded PrEP users in Germany, factors associated with infrequent testing, and STI diagnoses. Methods A cross-sectional anonymous online survey in 2018 and 2019 recruited current PrEP users via dating apps for men who have sex with men (MSM), a PrEP community website, anonymous testing sites and friends. We used descriptive methods and logistic regression for analysis. Results We recruited 4,848 current PrEP users. Median age was 37 years (interquartile range (IQR): 30–45), 88.7% identified as male, and respectively 26.3%, 20.9% and 29.2% were tested less frequently for HIV, STI and renal function than recommended. Participants with lower STI testing frequency were significantly less likely to report STI diagnoses during PrEP use, especially among those with many partners and inconsistent condom use. Factors most strongly associated with infrequent testing included not getting tested before starting PrEP, using PrEP from informal sources and on-demand/intermittent PrEP use. Discussion In a setting of self-funded PrEP, many users obtained medical tests less frequently than recommended, which can lead to missed diagnoses. Barriers to testing should be addressed to enable proper medical supervision. The suitability of testing frequencies to PrEP users with less frequent risk exposures needs to be evaluated.

Trends in Recommended Screening and Monitoring Tests for Users of HIV Pre-Exposure Prophylaxis Before and During the COVID-19 Pandemic

“…In a survey of PrEP users among men who have sex with men in Germany, 59.2% of users were tested for HIV every 3 months or more often, compared with 40.8% in our study. 10 An even higher estimate was reported by Tassi et al among PrEP users in France. Using a historical cohort from the French national health database, 86.3% of users were tested for HIV within 1 month after initiation, 11 suggesting significant room for improvement in the U.S.…”

Awareness of HIV pre-exposure prophylaxis among men who have sex with men using apps for sexual encounters in Turkiye

“…In a study from France comparison of HIV negative PrEP users, HIV negative PrEP non-users and people living with HIV (PLWH) suggested that the overall STI incidence was significantly higher among HIV negative PrEP non-users compared to PLWH, with no difference between PLWH and PrEP users. 53 Another study from Germany reported no association between PrEP use and STI rates. 54 Similarly, adherence to PrEP was not associated with STI rates in a report from the US.…”

Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis

“…Additionally, people who use PrEP intermittently may be less likely to screen frequently for STIs as they may not attend PrEP services on a regular basis. Out-of-pocket costs for increased frequency of STI screening and treatment or transportation when the frequency of screening is shorter than the PrEP follow-up visits [33] can add to the challenges of frequent screening [34] . Interviews from a younger group of people who would benefit from PrEP also indicated that participants were unwilling to be screened every 3 months due to perceptions that follow-ups would be time-consuming and inconvenient [35] .…”