Perspectives on and Preferences for On-Demand and Long-Acting PrEP Among Sexual and Gender Minority Adolescents Assigned Male at Birth

Macapagal, Kathryn; Nery-Hurwit, Mara; Matson, Margaret; Crosby, Shariell; Greene, George J.

doi:10.1007/s13178-020-00441-1

Cited by 36 publications

(30 citation statements)

References 39 publications

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“…Our data show that AYP in SSA tend to prefer on‐demand over daily PrEP options, with on‐demand most preferred in Uganda, among males and participants 18‐ to 24‐year‐olds. These data support research suggesting that on‐demand PrEP may be preferred among AYP as the infrequent dosing makes it less burdensome and more discreet [31]. The difficulty of adhering to a strict dosing regimen and predicting when sex will occur might deter AYP from on‐demand PrEP.…”

Section: Resultssupporting

confidence: 76%

“…This might be because these circumstances are more predictable and/or planned, therefore, demanding a less frequent HIV prevention regimen. This is supported by a US study showing that AYP assigned male at birth who were in favour of on-demand PrEP were having sex infrequently [31]. We also observed that a sexual partner's known or unknown HIV-positive status was associated with a preference for daily PrEP.…”

Section: Reasons For Prep Preferencessupporting

confidence: 82%

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A multi‐country cross‐sectional study to assess predictors of daily versus on‐demand oral pre‐exposure prophylaxis in youth from South Africa, Uganda and Zimbabwe

et al. 2022

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Introduction Sub‐Saharan Africa (SSA) carries the burden of the HIV epidemic, especially among adolescents and young people (AYP). Little is known about pre‐exposure prophylaxis (PrEP) uptake and preferences among AYP in SSA. We describe preferences for daily and on‐demand PrEP among AYP in South Africa, Uganda and Zimbabwe. Methods A cross‐sectional survey was conducted in 2019 among 13‐ to 24‐year olds, capturing socio‐demographics, HIV risk behaviours and preferences for daily or on‐demand PrEP. Logistic regression models were used to estimate odds ratios, adjusting for site, sex and age. Results and discussion A total of 1330 participants from Cape Town (n = 239), Johannesburg (n = 200), Entebbe (n = 491) and Chitungwiza (n = 400) were enrolled; 673 (51%) were male, and the median age was 19 years (interquartile range 17–22 years). Of 1287 participants expressing a preference, 60% indicated a preference for on‐demand PrEP with differences by site (p < 0.001), sex (p < 0.001) and age group (p = 0.003). On‐demand PrEP was most preferred in Entebbe (75%), among males (65%) versus females (54%) and in older participants (62% in 18‐ to 24‐year‐olds vs. 47% in 13‐ to 15‐year‐olds). After adjusting for site, sex and age group, preference for on‐demand PrEP decreased as sex frequency over the past month increased (p‐trend = 0.004) and varied with the number of partners in the last 6 months, being least popular among those reporting four or more partners (p = 0.02). Participants knowing further in advance that they were likely to have sex were more likely to prefer on‐demand PrEP (p‐trend = 0.02). Participants having a larger age gap with their most recent partner and participants whose last partner was a transactional sex partner or client were both less likely to prefer on‐demand compared to daily PrEP (p = 0.05 and p = 0.09, respectively). Participants who knew their most recent partner was living with HIV or who did not know the HIV status of their most recent partner were less likely to prefer on‐demand PrEP (p = 0.05). Conclusions Our data show that AYP in four SSA communities prefer on‐demand over daily PrEP options, with differences seen by site, age and sex. PrEP demand creation needs to be reviewed, optimized and tailored to socio‐demographic differences and designed in conjunction with AYP.

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Section: Resultssupporting

confidence: 76%

Section: Reasons For Prep Preferencessupporting

confidence: 82%

A multi‐country cross‐sectional study to assess predictors of daily versus on‐demand oral pre‐exposure prophylaxis in youth from South Africa, Uganda and Zimbabwe

et al. 2022

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Section: Introductionmentioning

confidence: 99%

“…5,11,16,17 Conversely, common reasons expressed by PrEP users for preferring daily PrEP over ED-PrEP include feeling greater control, being protected from HIV during more spontaneous sexual encounters, and perceived lower efficacy of ED-PrEP. 5,11,13,18 Despite multiple studies that indicate that a substantial minority of GBM PrEP users express an interest in taking ED-PrEP, 4,11,13 there is a lack of research on whether GBM have correct knowledge on how to take ED-PrEP. This method is less "forgiving" than the daily method, which can accommodate up to 3 missed doses per week because of the long medication half-life and build-up of drug concentration over time.…”

Section: Introductionmentioning

confidence: 99%

Incorrect Knowledge of Event-Driven PrEP “2-1-1” Dosing Regimen Among PrEP-Experienced Gay and Bisexual Men in Australia

Chan

Vaccher

Fraser

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Event-driven pre-exposure prophylaxis (ED-PrEP), when taken according to the “2-1-1” dosing method, is highly effective at preventing HIV acquisition for gay, bisexual, and other men who have sex with men (GBM). Any missed doses when using ED-PrEP drastically reduce its effectiveness, so it is vital that people using this method know how to take it correctly. This study investigated Australian GBM's awareness of ED-PrEP and their knowledge of how to take it correctly.Method:We conducted a survey of 1471 PrEP-experienced GBM in Australia, between October 2019 and March 2020. The survey assessed awareness and knowledge of the 3 components of the “2-1-1” ED-PrEP dosing regimen (number of pills for loading dose, timing of loading dose, and number of days after sex to take PrEP pills) among GBM. Characteristics associated with ED-PrEP awareness and correct knowledge of how to take ED-PrEP were assessed with multivariate logistic regression.Results:Two-thirds (n = 1004, 68.4%) had heard of ED-PrEP, of whom only one-eighth (n = 125, 12.5%) knew the correct details of the “2-1-1” ED-PrEP method; one-third (n = 339, 33.8%) did not know any of the 3 key components. Awareness of ED-PrEP and correct knowledge was associated with greater belief in PrEP efficacy, university education, and intention to take a nondaily PrEP regimen in the next 6 months.Conclusions:Although ED-PrEP awareness was considerable, most participants did not know how to use ED-PrEP correctly. Further work is needed to increase awareness and knowledge of ED-PrEP among GBM.

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“…unprotected anal sex) whereas PrEP uptake is hindered by individual, contextual, and structural factors. Macapagal et al [14] ran a qualitative online study among 59 adolescents MSM to explore preferences for different methods of HIV prevention. Most youths selected condoms as the preferential method (39.6%), due to familiarity, availability, access, and cost, followed by a yearly implant (37.7%), due to the opportunity to be protected for longer periods of time without access issues.…”

Section: Adolescents Have Interest But More Barriers To Accessmentioning

confidence: 99%

Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review

Sued

Nardi

Spadaccini

2022

Current Opinion in HIV and AIDS

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Purpose of reviewKey populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it.Recent findingsAccording to the review preferences for LA vary with the population studied. Regarding people living with HIV (PLWH), male having sex with men are interested in having different options, adolescents are interested in LA (strong preference for implants), yet also perceive substantial obstacles to using biomedical prevention; transgender women aimed to nonvisible small implants, with long-lasting effects or LA injections that can be applied in other areas than buttocks, and women who experienced history of medical injections might increase preference for LA (except for history of people who inject drugs [IDU]). Female sex workers and IDU both showed interest in LA-PrEP. Regarding antiretroviral therapy, LA increased treatment satisfaction and acceptance, mainly among those receiving injections every 2 months. LA helped overcome pill fatigue, stigma, and adherence issues.SummaryKnowing preferences for biomedical interventions will contribute to better understanding and developing effective strategies for these populations.

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Perspectives on and Preferences for On-Demand and Long-Acting PrEP Among Sexual and Gender Minority Adolescents Assigned Male at Birth

Cited by 36 publications

References 39 publications

A multi‐country cross‐sectional study to assess predictors of daily versus on‐demand oral pre‐exposure prophylaxis in youth from South Africa, Uganda and Zimbabwe

A multi‐country cross‐sectional study to assess predictors of daily versus on‐demand oral pre‐exposure prophylaxis in youth from South Africa, Uganda and Zimbabwe

Incorrect Knowledge of Event-Driven PrEP “2-1-1” Dosing Regimen Among PrEP-Experienced Gay and Bisexual Men in Australia

Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review

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