Piloting a partially self-financed mode of human immunodeficiency virus pre-exposure prophylaxis delivery for men who have sex with men in Hong Kong

Ss, Lee; Kwan, Tsz Ho; Wong, Ngai Sze; Lee, Krystal Ck; Chan, Daniel; Lam, Teddy Tn; Lui, Grace

doi:10.12809/hkmj198030

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…Eligible participants were MSM, aged 18 years or above, who had had CLAI with men in the preceding 6 months, inclined to have CLAI in the coming 6 months, were HIV-negative, not hepatitis B carriers, had a creatinine clearance of at least 60 ml/min and occurrence of at least one behavioural risk in the past 6 months, including chemsex engagement, STI diagnosis, had multiple sex partners and had people living with HIV (PLHIV) as sex partners regardless of their viral load status [11]. Participants were ineligible if they were unable to communicate in either Chinese or English, were not normally residing in Hong Kong, or had any form of mental illnesses.…”

Section: Participantsmentioning

confidence: 99%

“…In Hong Kong, there have not been any government-funded PrEP programmes and only patented TDF/FTC was available through prescriptions, the cost of which was well beyond the local MSM's affordability [11]. Despite the use of identical antiretrovirals, on-demand and daily PrEP each requires very different forms of life adjustment.…”

Section: Introductionmentioning

confidence: 99%

“…In open‐label trials, breakthrough HIV infection was similarly uncommon for both daily and on‐demand PrEP [7–10]. In Hong Kong, there have not been any government‐funded PrEP programmes and only patented TDF/FTC was available through prescriptions, the cost of which was well beyond the local MSM's affordability [11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison between daily and on‐demand PrEP (pre‐exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: A randomized, controlled, open‐label, crossover trial

et al. 2021

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Introduction: Both daily and on-demand regimens have been proven effective for pre-exposure prophylaxis (PrEP) against HIV in men who have sex with men (MSM). We aimed to compare the two regimens on their coverage of condomless anal intercourse (CLAI) in MSM. Methods: A randomized, controlled, open-label, crossover trial was conducted in a teaching hospital in Hong Kong. Participants were sexually active HIV-negative MSM aged 18 years or above with normal renal function and without chronic hepatitis B infection. Oral tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg (TDF/FTC) tablets were prescribed for PrEP. After a 2-week lead-in with daily TDF/FTC for treatment-naïve MSM for tolerance assessment, participants were randomly assigned in a 1:1 ratio with a block size of four to either daily-first or on-demand-first arm based on the IPERGAY study, for receiving PrEP for 16 weeks, then crossed-over to the alternative regimen for another 16 weeks. The primary outcome was the proportion of days with PrEP-covered CLAI by intention-to-treat analysis. The trial is registered with the CCRB Clinical Trials Registry, CUHK, CUHK_CCRB00606, and is closed to accrual. Results: Between 25 August 2018 and 23 March 2019, 119 eligible participants were assigned to daily-first arm (n = 59) and on-demand-first arm (n = 60) with an 87% overall completion rate (n = 103). With 96% and 54% of days on PrEP during daily and on-demand periods, respectively, the proportion of days with PrEP-covered CLAI between two arms were not statistically different (92% vs. 92%, p = 0.93). About half (47%) were diagnosed with at least one episode of incident sexually transmitted infection. Mild and time-limited adverse events, including diarrhoea, headache, nausea and dizziness, were reported in 37 (31%) and 10 (8%) during the daily and on-demand periods, respectively. At the end of the study, a similar proportion favoured daily or on-demand regimen. Conclusions: High prevention-effective adherence, as reflected from the coverage of CLAI, was achievable by either daily or on-demand PrEP among MSM, albeit a higher number of tablets taken for daily PrEP. As both regimens were well accepted, a flexible approach adopting either or both regimens with possible switching is warranted in order to suit individual health needs.

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Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison between daily and on‐demand PrEP (pre‐exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: A randomized, controlled, open‐label, crossover trial

et al. 2021

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“…The first project offered partially self-financed TDF/FTC for daily PrEP ( n = 71); the logistical procedure of which has been described elsewhere. 26 The second project was a cross-over study ( n = 119) involving the prescription of free daily followed by on-demand PrEP and vice versa each for a period of 16 weeks. 27 During the on-demand phase, participants took two tablets of TDF/FTC 2–24 h before sex followed by one tablet each at 24 and 48 h afterwards, referenced from the regimen for the IPERGAY study.…”

Section: Methodsmentioning

confidence: 99%

What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM

et al. 2022

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Background Pre-exposure prophylaxis (PrEP) is an effective means of HIV prevention for men who have sex with men (MSM), a key population whose engagement is crucial for achieving effective public health outcomes. An optimal service model would be important in planning the implementation of PrEP in places where such service has not been established. Methods A qualitative study was conducted to delineate the attributes of an optimal PrEP service model for MSM in Hong Kong, a city where no formal PrEP programs existed. Twenty purposively sampled MSM who were enrollees of two pilot PrEP projects participated in the semi-structured interviews promoting story-telling. The coded data were thematically analyzed following Grounded Theory approach, focusing on uncovering a typology of the essential attributes of an optimal PrEP service model, and the reasons for such preferences. Results Participating MSM were all ethnic Chinese and aged 26 to 52 years. All had received PrEP from pilot projects in conjunction with periodic screening of sexually transmitted infections (STI), HIV antibody, and plasma creatinine. Four major themes emerged as regards the attributes of a preferred PrEP service: (i) comprehensiveness of HIV/STI and safety monitoring; (ii) convenient unitary service; (iii) stigma-free PrEP access and protecting confidentiality; and (iv) affordable price. Whereas regular provision of PrEP was acceptable to MSM, unaffordability and related stigma were the anticipated challenges for potential service providers. Conclusions The qualitative assessment of MSM’s preference for PrEP service delivery has yielded important information on the many facets of a desirable service model.

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“…The ever-testing rate among MSM ranged from 52% in Brazil [ 5 ], 70% in China [ 6 ], and 85% in the United States [ 7 ]. In Hong Kong, where MSM accounted for a majority of the newly diagnosed HIV cases [ 8 ] and pre-exposure prophylaxis (PrEP) is only available from clinical studies but not public health care services [ 9 , 10 ], only 64% had ever tested for HIV and half (50%) of the population last tested within a year [ 11 ]. Various reasons were cited as barriers to HIV testing in the community, such as low perceived risk and poverty [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study

Kwan¹,

Chan²,

Wong³

et al. 2023

J Med Internet Res

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Background HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network–based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective This study aimed to assess the implementation cascade of a social network–based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P<.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users’ individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206

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Piloting a partially self-financed mode of human immunodeficiency virus pre-exposure prophylaxis delivery for men who have sex with men in Hong Kong

Cited by 4 publications

References 26 publications

Comparison between daily and on‐demand PrEP (pre‐exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: A randomized, controlled, open‐label, crossover trial

Comparison between daily and on‐demand PrEP (pre‐exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: A randomized, controlled, open‐label, crossover trial

What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM

Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study

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