PrEP Use, Sexual Behaviour, and PrEP Adherence Among Men who have Sex with Men Living in Wales Prior to and During the COVID-19 Pandemic

Abstract

We examined PrEP use, condomless anal sex (CAS), and PrEP adherence among men who have sex with men (MSM) attending sexual health clinics in Wales, UK. In addition, we explored the association between the introduction of measures to control transmission of SARS-CoV-2 on these outcomes. We conducted an ecological momentary assessment study of individuals in receipt of PrEP in Wales. Participants used an electronic medication cap to record PrEP use and completed weekly sexual behaviour surveys. We defined adherence to daily PrEP as the percentage of CAS episodes covered by daily PrEP (preceded by ≥ 3 days of PrEP and followed by ≥ 2 days). Sixty participants were recruited between September 2019 and January 2020. PrEP use data prior to the introduction of control measures were available over 5785 person-days (88%) and following their introduction 7537 person-days (80%). Data on CAS episodes were available for 5559 (85%) and 7354 (78%) person-days prior to and following control measures respectively. Prior to the introduction of control measures, PrEP was taken on 3791/5785 (66%) days, there were CAS episodes on 506/5559 (9%) days, and 207/406 (51%) of CAS episodes were covered by an adequate amount of daily PrEP. The introduction of pandemic-related control measures was associated with a reduction in PrEP use (OR 0.44, 95%CI 0.20–0.95), CAS (OR 0.35, 95%CI 0.17–0.69), and PrEP adherence (RR = 0.55, 95%CI 0.34–0.89) and this may have implications for the health and wellbeing of PrEP users and, in addition to disruption across sexual health services, may contribute to wider threats across the HIV prevention cascade.

Impact of COVID-19 on the Belgian HIV epidemic: slowdown of HIV transmission and testing and adaptation of care

“…A second observation in the same direction is the decrease in the purchase of PrEP pills and the number of PrEP purchasers from April 2020 onwards, meaning that some users have reduced or suspended their PrEP use, and very few initiated PrEP. Studies among PrEP users indicated that they tailor their PrEP use according to their risk exposure [ 18 – 20 ]. Continued use of PrEP during periods of lockdown was found to be associated with having sex with casual partners [ 12 ].…”

Between- and Within-Individual Sociodemographic and Psychological Determinants of PrEP Adherence Among Men Who have Sex with Men Prescribed a Daily PrEP Regimen in Wales

“…We conducted an ecological momentary assessment (EMA) study, using intensive longitudinal methods (i.e. using frequent repeated measurements among participants over time), of individuals accessing oral tenofovir–emtricitabine as HIV PrEP through four National Health Service (NHS) sexual health clinics in Wales, UK [ 12 ]. The NHS in Wales is a comprehensive, publicly-funded health service where PrEP has been available free-of-charge to those at-risk of HIV-acquisition since July 2017.…”

“…Study procedures have been reported in full elsewhere [ 12 ]. Briefly, recruited participants were supplied with a Medication Event Monitoring System (MEMS) cap (a medication bottle cap containing an electronic monitor which records the date and time of each opening) [ 18 , 19 ], and were instructed to store their PrEP medication in the original container with this cap, opening and replacing the cap only when they were taking their medication.…”

“…The majority of previous research concerning adherence to PrEP has either used qualitative methods or focussed on medication taking alone, ignoring whether this occurred during high-risk episodes [ 11 ]. We have recently reported on levels of PrEP adherence among MSM in Wales by collecting concurrent data on PrEP use (via electronic monitors) and on condomless sexual behaviour (via brief weekly online surveys) [ 12 ]. We considered two definitions of PrEP adherence—one which focussed exclusively on medication use (i.e.…”

PrEP Use in Times of COVID-19 in the Netherlands: Men Who Have Sex With Men (MSM) on PrEP Test Less for HIV and Renal Functioning During a COVID-19 Related Lockdown

“…For example, studies from the USA and South Africa report reduced access to PrEP [ 8 – 10 ] while studies conducted in Australia show that access to PrEP remains relatively stable [ 3 , 4 ]. Simultaneously, studies on PrEP use in Wales, Australia, and the Netherlands, report reductions in PrEP use during the COVID-19 pandemic [ 3 – 6 , 11 , 12 ]. However, these studies do not report whether this reduction was due to a change in PrEP regimen, for example from daily to on-demand PrEP use [ 3 , 5 ].…”