In what circumstances could nondaily preexposure prophylaxis for HIV substantially reduce program costs?

Mitchell, Kate; Dimitrov, Dobromir; Xia, Fan; Donnell, Deborah; Amico, K. Rivet; Bokoch, Kevin; Chitwarakorn, Anupong; Bekker, Linda‐Gail; Holtz, Timothy H.; Mannheimer, Sharon; Grant, Robert M.; Boily, Marie‐Claude

doi:10.1097/qad.0000000000001766

Cited by 15 publications

(10 citation statements)

References 35 publications

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“…Because of the recommendations for both daily and on-demand PrEP for MSM, four trials were conducted in developed countries to determine preferences for one regimen over the other and the underlying factors among MSM [8][9][10]; this was particularly important because daily and on-demand regimens differ in terms of pill burden, adherence and cost-effectiveness [11][12][13]. Studies in Belgium, Australia and the Netherlands reported that 66% to 76.5% of MSM preferred daily PrEP, whereas in France, where on-demand PrEP has been recommended since 2015, around 60% of MSM chose on-demand PrEP in the first year of the trial [14].…”

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confidence: 99%

Preference for daily versus on‐demand pre‐exposure prophylaxis for HIV and correlates among men who have sex with men: the China Real‐world Oral PrEP Demonstration study

Zhang

Wang

et al. 2021

J. Intern. AIDS Soc.

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Introduction This study explores the preference for daily versus on‐demand pre‐exposure prophylaxis (PrEP) among men who have sex with men (MSM) in developing countries when both regimens are available. Methods From 11 December 2018 to 19 October 2019, we recruited MSM for an open‐label real‐world PrEP demonstration study in four major cities in China. Subjects selected their preferred PrEP (oral tenofovir/emtricitabine) regimen (daily vs. on‐demand) at recruitment and underwent on‐site screening before initiation of PrEP. We used logistic regression to assess preference for daily PrEP and correlates. Results Of 1933 recruited MSM, the median age was 29 years, 7.6% was currently married to or living with a female; the median number of male sexual partners was four and 6.1% had used post‐exposure prophylaxis (PEP) in the previous six months. HIV infection risk was subjectively determined as very high (>75%) in 7.0% of subjects, high (50% to 75%) in 13.3%, moderate (25% to 49%) in 31.5% and low or none (0% to 24%) in 48.1%. On average, participants preferred on‐demand PrEP over daily PrEP (1104 (57.1%) versus 829 (42.9%)) at recruitment. In multivariable analysis, currently being married to or living with a female was associated with 14.6 percentage points lower preference for daily PrEP (marginal effect = −0.146 [95% CI: −0.230, −0.062], p = 0.001); whereas the number of male sexual partners (marginal effect = 0.003 [95% CI: 0.000, 0.005], p = 0.034) and a subjective assessment of being very high risk of HIV infection (vs. low and no risk, marginal effect size = 0.105 [95% CI: 0.012, 0.198], p = 0.027) were associated with increased preference for daily versus on‐demand PrEP. Among the 1933 potential participants, 721 (37.3%) did not attend the subsequent on‐site screening. Lower‐income, lower education level, lower subjective expected risk of HIV infection risk and younger age positively correlated with the absence of on‐site screening. Conclusions MSM in China prefer both daily and on‐demand PrEP when both regimens are provided free. Social structural factors and subjective risk of HIV infection have significant impacts on PrEP preference and use. The upcoming national PrEP guideline should consider incorporating both regimens and the correlates to help implement PrEP in China.

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mentioning

confidence: 99%

Preference for daily versus on‐demand pre‐exposure prophylaxis for HIV and correlates among men who have sex with men: the China Real‐world Oral PrEP Demonstration study

Zhang

Wang

et al. 2021

J. Intern. AIDS Soc.

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“…As indicated before, being able to safely use PrEP when it is needed may be of paramount importance, rather than focusing on rigidly following a particular dosing regimen for indefinite period of time. Consistent high adherence during periods of non‐exposure is costly . Therefore, Haberer et al called for a novel paradigm: prevention‐effective adherence that proposes the use of PrEP only during periods of heightened risk exposure resulting into effective protection against HIV acquisition .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to anti‐retroviral treatment which need lifelong sustained adherence by people living with HIV, PrEP can be taken temporarily during episodes of anticipated increased risk . Non‐daily regimens also have the advantage of requiring fewer tablets, thus reducing potential side‐effects and cost . However, adherence to these regimens should be optimal, as they are less forgiving of missed doses .…”

Section: Introductionmentioning

confidence: 99%

Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence

et al. 2019

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Introduction Pre‐Exposure Prophylaxis (PrEP) is highly effective in reducing the risk for HIV infection among men who have sex with men (MSM) and may have an important impact in slowing down the HIV epidemic. Concerns remain however about low adherence, increased risk behaviour and reduced condom use when using PrEP. The aim of this study was to assess these factors prospectively among MSM using daily and event‐driven PrEP in Belgium. Methods An open‐label prospective cohort study was conducted from October 2017 to May 2018 at the Institute of Tropical Medicine, in Antwerp, Belgium. At enrolment, MSM at high risk for HIV chose between daily or event‐driven PrEP. They were allowed to switch regimens or stop taking PrEP at each of their tri‐monthly visits. Data were collected on an electronic case report form, web‐based diary and self‐administered questionnaire. Screening for HIV and other Sexually Transmitted Infections (STIs) was also performed. Results Two hundred MSM were followed up for a total duration of 318 person‐years. At month 18, 75.4% of the participants were on daily and 24.6% were on event‐driven PrEP. The mean proportion of covered sex acts by PrEP for the complete follow‐up period was 91.5% for all participants, 96.5% for daily and 67.0% for event‐driven PrEP use. The number of casual and anonymous sex partners was significantly higher for daily users, as compared with event‐driven users, but did not change over time. In contrast, the mean proportion of condomless receptive anal intercourse with casual and anonymous partners increased significantly during follow‐up, for both daily and event‐driven use (p < 0.0001 for all 4 trends). No new HIV infection was diagnosed during follow‐up. The incidence of bacterial STIs was 75.4 per 100 person‐years (95% CI 63.8 to 89.1). We did not detect a significant change in N. gonorrhoeae/C. trachomatis incidence over time. The incidence of hepatitis C was 2.9 per 100 person‐years. Conclusions PrEP is an effective and well adopted HIV prevention tool for MSM in Belgium. Participants adapted daily and event‐driven regimens to their own needs and were able to adapt their PrEP adherence to risk exposure.

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“…Despite budgetary constraints, PrEP programs in resource limited settings like Côte d'Ivoire should consider offering it free of charge to MSM. In this respect and to reduce the overall economic burden for countries, PrEP programs could promote PrEP, where possible, to men at higher risk like those who have frequent unprotected sex, high number of sexual partners and HIVpositive sexual partners (Beyrer et al, 2012;Buchbinder et al, 2014;Mitchell et al, 2018). In Côte d'Ivoire, PrEP could be available free of charge for MSM in 2020.…”

Section: Discussionmentioning

confidence: 99%

Pre-exposure prophylaxis among men who have sex with men in Côte d’Ivoire: a quantitative study of acceptability

et al. 2020

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This cross sectional study was conducted in 2018 in Côte d'Ivoire to assess PrEP acceptability among men who have sex with men (MSM). Two hundred and one men were asked on their intention to use PrEP if made available. Logistic regression accounting for the sampling design was used to analyze associations between high PrEP acceptability and different independent variables including barriers and facilitators. Participants were mostly young (mean age = 25 years), educated (82% with secondary/postsecondary education) and single (95.5%). On average, 3.4 episodes of anal sex were reported monthly and 37.8% of men did not use a condom at last sex. Most MSM (72.6%) had heard of PrEP before enrollment. Overall, 35.3% reported that they would use PrEP very probably if made available. In multivariate analysis, factors associated with high PrEP acceptability were condom use at last sexual intercourse (Odds ratio (OR) = 2.51; 95% Confidence interval (95%CI) = 1.45-4.33); insertive sex as compared to versatile sex (OR = 2.56; 95%CI = 1.14-5.67); free PrEP delivery (OR = 2.45; 95%CI = 1.07-5.59), concerns about side effects (OR = 0.66; 95%CI = 0.48-0.90), and being preoccupied by the fact that post-PrEP antiretroviral therapy could be inefficient (OR = 0.25; 95%CI = 0.14-0.44). PrEP implementation among MSM in Côte d'Ivoire should be accompanied by awareness raising campaigns explaining its utility.

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In what circumstances could nondaily preexposure prophylaxis for HIV substantially reduce program costs?

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 35 publications

Preference for daily versus on‐demand pre‐exposure prophylaxis for HIV and correlates among men who have sex with men: the China Real‐world Oral PrEP Demonstration study

Preference for daily versus on‐demand pre‐exposure prophylaxis for HIV and correlates among men who have sex with men: the China Real‐world Oral PrEP Demonstration study

Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence

Pre-exposure prophylaxis among men who have sex with men in Côte d’Ivoire: a quantitative study of acceptability

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