Slow Uptake of PrEP: Behavioral Predictors and the Influence of Price on PrEP Uptake Among MSM with a High Interest in PrEP

Dijk, Mart van; Wit, John de; Guadamuz, Thomas E.; Martínez, Joel E.; Jonas, Kai J.

doi:10.1007/s10461-021-03200-4

Cited by 28 publications

(26 citation statements)

References 44 publications

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“…During an epidemic, individuals may adopt PrEP according to their perceived HIV risk [19], their perceived advantages and disadvantages of PrEP uptake, which includes quality of sex life, price [20] and access model of PrEP [21], adverse effects [22], social stigma [23], perceived consequences of being infected, which includes potential HIV-related stigma, regular clinical visits, lifelong ART, and other pros and cons. These factors, summarizing monetary and/or non-monetary aspects, are expressed in our decision-making model as costs perceived by the individual.…”

Section: The Decision-making Game Modelmentioning

confidence: 99%

Can HIV epidemics among MSM be eliminated through participation in preexposure prophylaxis rollouts?

Jijón¹,

Molina²,

Costagliola³

et al. 2021

Aids

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To study the conditions under which PrEP coverage can eliminate HIV among men who have sex with men (MSM) in the Paris region.Design: Mathematical modeling. Methods:We propose an innovative approach, combining a transmission model with a game-theoretic model, for decision-making about PrEP use. Individuals at high risk of HIV infection decide to use PrEP, depending on their perceived risk of infection and the relative cost of using PrEP versus antiretroviral treatment (ART), which includes monetary and/or non-monetary aspects, such as price and access model of PrEP, consequences of being infected and lifelong ART.Results: If individuals assessed correctly their infection risk, and the cost of using PrEP were sufficiently low, then the PrEP rollout could lead to elimination. Specifically, assuming 86% PrEP effectiveness, as observed in two clinical trials, a minimum PrEP coverage of 55% (95% CI:43%-64%) among high-risk MSM would achieve elimination in the Paris region. A complete condom drop by MSM using PrEP slightly increases the minimum PrEP coverage required for elimination, by ~1%, while underestimation of their own HIV infection risk would require PrEP programs reduce the cost of using PrEP by a factor ~2 to achieve elimination. Conclusions: Elimination conditionsare not yet met in the Paris region, where at most 47% of high-risk MSM were using PrEP as of mid-2019. Further lowering the cost of PrEP and promoting a fair perception of HIV risk are required and should be maintained in the long run, to maintain elimination status.

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Section: The Decision-making Game Modelmentioning

confidence: 99%

Can HIV epidemics among MSM be eliminated through participation in preexposure prophylaxis rollouts?

Jijón¹,

Molina²,

Costagliola³

et al. 2021

Aids

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“…Furthermore, despite that rapid ART initiation has been recommended by the WHO since 2017, the current HIV treatment guidelines in the Philippines in 2018 did not mention this [b] and may explain the low ART initiation rate. Meanwhile, poor PrEP initiation may be explained by cost [ 57 ], especially that, unlike ART, PrEP is neither state-sponsored nor covered by health insurance in the Philippines. Overall, the benefits of online-based HIVST could not be maximized without concurrent innovations in treatment and prevention.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study

Eustaquio¹,

Figuracion

Izumi

et al. 2022

BMC Public Health

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Introduction The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. Methods We did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits. Results HIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01–4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46–7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15–2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32–0.62]). Conclusions HIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.

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“…Before that, there was informal PrEP procurement (e.g., via international pharmacies and “buyers’ clubs”). Procurement via general practitioners picked up in January 2018 when generic formulations became available, and since September 2019 PrEP has been available through sexual health centers [ 2 , 19 , 20 ]. At sexual health centers, PrEP is provided at a reduced price and PrEP care is free of charge.…”

Section: The Dutch Contextmentioning

confidence: 99%

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

et al. 2022

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As a result of the COVID-19 pandemic, HIV care and prevention efforts have been disrupted. We investigated pre-exposure prophylaxis (PrEP) use and testing behaviors among MSM in the Netherlands, and the factors that influenced testing behaviors during the COVID-19 pandemic. A cohort of 766 MSM, established in 2017, was asked in August 2020 to report on their experiences during the COVID-19 pandemic via an online survey. Participants (n = 319) reported increased PrEP use and, among PrEP users (n = 211), significantly lower rates of having tested in the last 3 months for HIV and renal functioning compared to before the pandemic. Daily PrEP use and a higher number of sexual partners during the pandemic was significantly associated with continued HIV testing. Continued renal functioning testing was associated with older age. Correcting for pandemic-related disruptions in PrEP use and care will require sustained effort to understand and address missed opportunities.

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Slow Uptake of PrEP: Behavioral Predictors and the Influence of Price on PrEP Uptake Among MSM with a High Interest in PrEP

Cited by 28 publications

References 44 publications

Can HIV epidemics among MSM be eliminated through participation in preexposure prophylaxis rollouts?

Can HIV epidemics among MSM be eliminated through participation in preexposure prophylaxis rollouts?

Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study

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

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