What are the situational and behavioral factors associated with condomless anal sex without pre-exposure prophylaxis in MSM?

Ciaccio, Marion Di; Sagaon-Teyssier, Luis; Mimi, Mohamed; Suzan‐Monti, Marie; Protière, Christel; Castro, Daniela Rojas; Meyer, Laurence; Tremblay, Cécile; Chidiac, Christian; Capitant, Catherine; Préau, Marie; Molina, Jean‐Michel; Spire, Bruno

doi:10.1097/qad.0000000000002542

Cited by 9 publications

(4 citation statements)

References 42 publications

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“…There was a higher PrEP protection during CAS days with known and unknown casual partners compared to steady partners, as observed by others [11,23]. Low perceived HIV risk has been identified as a major driver for no condom or PrEPuse in a mixed-methods study from our research group [24].…”

Section: Discussionsupporting

confidence: 82%

Adherence to event‐driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: analysis based on online diary data, 3‐monthly questionnaires and intracellular TFV‐DP

et al. 2021

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Introduction: Event-driven pre-exposure prophylaxis (edPrEP) with oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective for preventing HIV acquisition in men who have sex with men (MSM) and is preferred over daily PrEP by some MSM. However, it is largely unknown how well MSM adhere to edPrEP. We then aimed to assess PrEP protection during CAS among MSM using edPrEP and participating in the Amsterdam PrEP demonstration project (AMPrEP). Methods: We analysed data from participants enrolled in AMPrEP who were taking edPrEP. We measured adherence through (1) a mobile application in which sexual behaviour and PrEP-use were recorded daily, (2) three-monthly self-completed questionnaires and (3) dried blood spot (DBS) samples collected around six, twelve and twenty-four months after PrEP initiation. We assessed the proportion of days with condomless anal sex (CAS) acts that were protected by PrEP, per partner type (i.e. steady partners, known casual partners, unknown casual partners), and the proportion of three-month periods during which PrEP was correctly used. Intracellular TFV-diphosphate (TFV-DP) concentrations were determined from DBS. Good adherence was defined as at least one tablet before and one tablet within 48 hours after a CAS act. Results: Between 11 September 2015 and 6 October 2019, 182 of 376 MSM (48.4%) used edPrEP for at least one threemonth period. Of the 8224 CAS days that were reported in the app during edPrEP-use, we observed good protection for most CAS days involving steady partners (n = 1625/2455, 66.9%), known casual partners (n = 3216/3472, 92.6%) and unknown casual partners (n = 2074/2297, 90.3%). Men reported consistently correct PrEP-use in 851 (81.4%) of the 1046 three-month periods of edPrEP-use. The median TFV-DP concentration was 591 fmol/sample (interquartile range = 270 to 896). Conclusions: Adherence to edPrEP was high as determined from the online app and questionnaire. DBS measurements were consistent with two to three tablets per week on average.

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Section: Discussionsupporting

confidence: 82%

Adherence to event‐driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: analysis based on online diary data, 3‐monthly questionnaires and intracellular TFV‐DP

et al. 2021

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“…Managing sexual risk by taking into account the serology of their partner(s) would seem consistent with a rationale based on lay knowledge of perceived low (e.g., intercourse with an HIV negative partner) or high (intercourse with partners who are seropositive or whose serology is unknown) “risky” sexual activity (even if sexual intercourse with a HIV positive partner with UVL represents no risk of HIV transmission (Vernazza et al, 2008 )). Similar results were found in the ANRS-IPERGAY trial (Di Ciaccio et al, 2020 ).…”

Section: Discussionsupporting

confidence: 86%

PrEP in the Context of Other HIV Risk Reduction Strategies Among Men Who Have Sex with Men: Results from the Flash! PrEP in Europe Survey

Ciaccio

Delabre²,

Vilotitch

et al. 2022

Arch Sex Behav

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Combination HIV prevention covers a range of biomedical, behavioral, and socio-structural interventions. Despite the growing availability of pre-exposure prophylaxis (PrEP), it is not always accessible in European Centre for Disease Prevention and Control reporting countries and may not meet the needs of all at-risk populations. Based on the Flash! PrEP in Europe data, multiple correspondence analysis and hierarchical clustering were used to identify patterns in HIV prevention strategies among 9980 men who have sex with men (MSM). PrEP interest was evaluated among four identified clusters: (A) “high condom use, sometimes Treatment as Prevention (TasP)”; (B) “mix of methods, infrequent condom use”; (C) “high condom use, tendency to choose partners based on serological status” and (D) “moderate use of condoms mixed with other prevention strategies”. Clusters B and D had higher PrEP interest. These results suggest that MSM use a range of behavioral and biomedical risk reduction strategies that are often combined. On-demand PrEP may meet the needs of MSM who infrequently use condoms and other prevention methods.

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“…Based on prior work in our group and other cohorts, it has been shown that there is differential participation in condomless acts between main or primary partners and other types of partnerships (casual, anonymous, clients etc), and that there is differential HIV risk associated with CLAI in different partnerships. 21 , 22 , 47 , 48 Therefore, in this study, we used the time-updated count of CLAI acts with all non-main partnership as the exposure of interest. We also explored use of all reported CLAI acts, but found this variable to be less predictive, as expected, and also created distortions in models.…”

Section: Methodsmentioning

confidence: 99%

Dynamic immune markers predict HIV acquisition and augment associations with sociobehavioral factors for HIV exposure

Ignacio¹,

Dasgupta²,

Valdez³

et al. 2022

iScience

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What are the situational and behavioral factors associated with condomless anal sex without pre-exposure prophylaxis in MSM?

Cited by 9 publications

References 42 publications

Adherence to event‐driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: analysis based on online diary data, 3‐monthly questionnaires and intracellular TFV‐DP

Adherence to event‐driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: analysis based on online diary data, 3‐monthly questionnaires and intracellular TFV‐DP

PrEP in the Context of Other HIV Risk Reduction Strategies Among Men Who Have Sex with Men: Results from the Flash! PrEP in Europe Survey

Dynamic immune markers predict HIV acquisition and augment associations with sociobehavioral factors for HIV exposure

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