Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool

Reyniers, Thijs; Hoornenborg, Elske; Vuylsteke, Béa; Wouters, Kristien; Laga, Marie

doi:10.1136/sextrans-2016-052699

Cited by 21 publications

(31 citation statements)

References 56 publications

(51 reference statements)

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“…PrEP can be administered daily or on demand (before and after a sexual contact) [ 3 ], with both regimens demonstrating an effectiveness of 86% [ 5 , 6 ] that we used in our analysis. Our choice of modeling daily PrEP only was motivated by the interim findings on the preference of PrEP regimes in the AMPrEP project, which showed that 72% of participants chose to start daily PrEP [ 3 , 27 ]. We also obtained predictions of the model for other values of effectiveness and varying duration of using PrEP to reflect a real world setting where individuals are themselves responsible for obtaining and taking PrEP drugs.…”

Section: Discussionmentioning

confidence: 99%

“…At present preexposure prophylaxis (PrEP) is considered to be one of the most promising interventions to help end the HIV epidemic in this population [ 3 , 4 ]. Daily or intermittent PrEP uptake was shown to be effective in preventing HIV transmission among MSM in trials [ 5 , 6 ], cohort [ 7 ] and clinical practice studies [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis

Rozhnova

Heijne

Bezemer

et al. 2018

Aids

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Objective:Preexposure prophylaxis (PrEP) is a promising intervention to help end the HIV epidemic among men who have sex with men (MSM) in the Netherlands. We aimed to assess the impact of PrEP on HIV prevalence in this population and to determine the levels of PrEP coverage necessary for HIV elimination.Design and methods:We developed a mathematical model of HIV transmission in a population stratified by sexual risk behavior with universal antiretroviral treatment (ART) and daily PrEP use depending on an individual's risk behavior. We computed the effective reproduction number, HIV prevalence, ART and PrEP coverage for increasing ART and PrEP uptake levels, and examined how these were affected by PrEP effectiveness and duration of PrEP use.Results:At current levels of ART coverage of 80%, PrEP effectiveness of 86% and PrEP duration of 5 years, HIV elimination required 82% PrEP coverage in the highest risk group (12 000 MSM with more than 18 partners per year). If ART coverage increased by 9%, the elimination threshold was at 70% PrEP coverage. For shorter PrEP duration and lower effectiveness elimination prospects were less favorable. For the same number of PrEP users distributed among two groups with highest risk behavior, prevalence dropped from the current 8 to 4.6%.Conclusion:PrEP for HIV prevention among MSM could, in principle, eliminate HIV from this population in the Netherlands. The highest impact of PrEP on prevalence was predicted when ART and PrEP coverage increased simultaneously and PrEP was used by the highest risk individuals.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis

Rozhnova

Heijne

Bezemer

et al. 2018

Aids

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“…Event‐driven PrEP may address the challenges that appear to impede PrEP uptake and implementation, including concerns about PrEP's costs , side‐effects, physical burden, and adhering to PrEP on a daily basis . Event‐driven PrEP was shown to be cost‐effective and can pose a smaller financial burden on the health systems than daily PrEP . Furthermore, event‐driven PrEP may be more acceptable for MSM with less frequent risky sex or more concerns about PrEP's burden.…”

Section: Introductionmentioning

confidence: 99%

Motives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis – a qualitative analysis

et al. 2019

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Introduction In settings where both daily and event‐driven pre‐exposure prophylaxis (PrEP) are offered to men who have sex with men (MSM), a clear understanding of the motives to choose between the different dosing‐regimens can facilitate more effective PrEP implementation. We therefore studied the motives for choosing for, switching between, and stopping daily or event‐driven PrEP. Methods We used data (August 2015‐June 2017) from the prospective, longitudinal, open‐label Amsterdam PrEP demonstration study, in which daily (dPrEP) and event‐driven PrEP (edPrEP) were offered to 374 HIV‐negative MSM and two transgender persons. Participants self‐selected the preferred PrEP‐regimen at baseline and could switch regimens at three‐monthly follow‐up visits. We measured motives for choosing PrEP‐regimen at baseline and for switching and stopping PrEP at follow‐up visits. Open‐ and closed‐end items were combined and qualitatively analysed. Results Choices of PrEP‐regimens were determined by personal and contextual factors, involving the perceived self‐efficacy concerning adherence, the risk‐context, and the anticipated impact of PrEP on physical and sexual wellbeing. dPrEP was preferred because of the anticipated better adherence and the fear of side‐effects relating to edPrEP re‐initiations. Moreover, dPrEP was perceived to be more effective than edPrEP. Motives to choose edPrEP were the expected physical burden of dPrEP, anticipated side‐effects of dPrEP, and fear to forget daily doses. Regarding the risk‐context: dPrEP was preferred for unplanned and/or frequent sex, while edPrEP was chosen when risk was predictable and/or less frequent. While some chose for dPrEP to gain more sexual freedom, others chose for edPrEP to minimize sexual risk episodes. Changes in the above factors, such as changing risk patterns, changing relationships or changing physical conditions, resulted in switching regimens. Choices to stop PrEP were related to lower sexual risk, adherence issues and side‐effects. Conclusions The great diversity of motives illustrates the importance of offering a choice of PrEP‐regimens. In counselling of MSM starting PrEP, choices for PrEP‐regimens may be addressed as a continuum of flexible and changeable options over time. This may help individuals choose the PrEP‐regimen that best fits their current sexual context, priorities and personal capabilities and therefore will be more easily adhered to.

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“…However, we could not have predicted the significant evolution that impacted the HIV prevention landscape soon after HMP was developed and implemented. While behavior change including CAI remains important, biomedical prevention interventions such as preexposure prophylaxis (PrEP) for HIV-negative individuals and treatment as prevention using antiretroviral therapy for positive individuals now has a more central role, among researchers and clinical practice (40)(41)(42). Unfortunately, questions about perceptions and usage of these strategies were not included in this study.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial of an Online Risk Reduction Intervention for Young Black MSM

et al. 2018

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HealthMpowerment.org (HMP), is a mobile optimized, online intervention to reduce sexual risk behaviors among HIV-positive and HIV-negative young Black men who have sex with men (BMSM) by providing information and resources, fostering social support, and including gamebased elements. A randomized controlled trial with 474 young BMSM compared HMP to an information-only control website. The rate of self-reported condomless anal intercourse (CAI) at 3-months was 32% lower in the intervention group compared to the control group (IRR 0.68, 95% CI: 0.43, 0.93), however this effect was not sustained at 12 months. Among HIV-positive participants, the rate of CAI at 3-month follow-up was 82% lower among participants with detectable viral loads in the intervention group compared to the control group (IRR 0.18, 95% CI: 0.04, 0.32). In a secondary analysis, when we limited to those who used HMP for over 60 minutes during the 3-month intervention period (n=50, 25.8%), we estimated 4.85 (95% CI: 2.15, 7.53) fewer CAI events than we would have expected in control participants, had they used the intervention at the same rate as the intervention group. Findings suggest that exposure to an online intervention can reduce the rate of CAI among young BMSM, at least in the short term. Given the stronger effect seen among those participants who complied with HMP, additional intervention engagement strategies are warranted.

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Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool

Cited by 21 publications

References 56 publications

Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis

Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis

Motives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis – a qualitative analysis

A Randomized Trial of an Online Risk Reduction Intervention for Young Black MSM

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