Understanding pre-exposure prophylaxis (PrEP) regimen use: Switching and discontinuing daily and event-driven PrEP among men who have sex with men

Abstract

Background Optimising HIV pre-exposure prophylaxis (PrEP) provision requires insight into preferences of PrEP regimens and PrEP discontinuation. We assessed regimen switching and discontinuation and their determinants among men who have sex with men (MSM) participating in the Amsterdam PrEP demonstration project. Methods Between 3-August-2015 and 31-May-2016, we enrolled MSM ( n = 374) and TGP ( n = 2) in a prospective, longitudinal study. Participants could choose between daily or event-driven PrEP regimens at enrolment and every 3 months. We assessed transition intensities (TI) and determinants of switching (i) between regimens, and (ii) from either regimen to discontinuing PrEP using a multi-state Markov model. PrEP discontinuation was defined as formally stopping study participation or having no study visit for ≥6 months. Findings Of 367 analysed participants, 73 · 3% chose daily and 26 · 7% event-driven PrEP at enrolment. Median follow-up was 3 · 1 years (IQR 2 · 9–3 · 2). 121 participants switched their PrEP regimen at least once (cumulative probability 34 · 2%, 95% CI 29 · 4–39 · 6), with 90 switches from event-driven to daily PrEP (TI 0 · 35/PY, 95% CI 0 · 29–0 · 44) and 113 switches from daily to event-driven PrEP (TI 0 · 16/PY, 95% CI 0 · 13–0 · 20). Switching from event-driven to daily PrEP was associated with younger age, not reporting sex with HIV-positive partners, chemsex, and sexual compulsivity. Switching from daily to event-driven PrEP were associated with younger age and lower sexual satisfaction. 67 participants discontinued PrEP (cumulative probability 17 · 7%, 95% CI 14 · 1–22 · 2), with no difference between regimens: event-driven ( n = 23, TI 0 · 08/PY, 95% CI 0 · 05–0 · 13) and daily PrEP ( n = 44, TI 0 · 06/PY, 95% CI 0 · 04–0 · 08). Discontinuing daily PrEP was associated with younger age, fewer casual partners, and higher number of condomless anal sex acts with casual partners. Interpretation Switching between PrEP regimens was common, while going from event-driven to daily PrEP use was associated with certain sexual-related determinants (i.e. chemsex, sexual compulsivity, no known HIV-positive partners). PrEP discontinuation rates were low and independent of regimens...

Choosing event‐driven and daily HIV pre‐exposure prophylaxis – data from two European PrEP demonstration projects among men who have sex with men

“…This may have affected the choice for edPrEP. Last, reasons for switching between PrEP regimens were assessed separately for AMPrEP [ 6 , 31 ] and Be‐PrEP‐ared [ 20 ], but these data were not included and further analysed in this pooled analysis.…”

Kidney function in tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis users: a systematic review and meta-analysis of published literature and a multi-country meta-analysis of individual participant data

“… 41 , 42 , 43 Individuals might also switch between daily and event-driven PrEP. 44 Using PrEP during periods of risk reduces overall tenofovir disoproxil fumarate exposure and thus risks of kidney-related adverse events.…”

Transient Changes in Preexposure Prophylaxis Use and Daily Sexual Behavior After the Implementation of COVID-19 Restrictions Among Men Who Have Sex With Men

“…Fourth, the AMPrEP study population is a selective group of older, highly educated, white, early PrEP adopters who had been taking PrEP for roughly 4 years before the COVID-19 epidemic, and results may not be generalizable to all MSM taking PrEP. Specifically, this cohort of experienced PrEP users has been extensively counseled in safely starting and stopping PrEP and might, therefore, be more equipped to estimate their HIV risk and change their PrEP use accordingly 21 , 25 compared with recent-initiation PrEP users. Therefore, the results of this study should be confirmed in other groups of PrEP users.…”