Condomless Anal Sex Associated With Heterogeneous Profiles Of HIV Pre-Exposure Prophylaxis Use and Sexual Activities Among Men Who Have Sex With Men: A Latent Class Analysis Using Sex Diary Data on a Mobile App

Abstract

Background New innovative technologies, such as mobile apps, have been developed to increase pre-exposure prophylaxis (PrEP) adherence and the use of log sex diaries. The contiguity of mobile apps reduces the recall bias that generally affects reported condom and PrEP use. However, none of the currently used mobile apps were designed for event-driven PrEP users, and few studies have demonstrated the potential usage of sex diary data to facilitate the understanding of the different HIV risks among heterogeneous profiles of sex diaries and PrEP use. Objective We aim to discriminate the heterogeneous profiles of sex events and PrEP use and examine the risk of condomless anal sex among different types of sex events. Methods We recruited 35 adult men who have sex with men from two medical centers in Taiwan since May 2020 and followed up for four months. Participants were on PrEP or willing to take PrEP. They were asked to log their sex events, PrEP use, and dosing regimens on a mobile app to improve their PrEP adherence. Latent class analysis was used to distinguish profiles of sex events and PrEP use. Indicators included correct intake of PrEP for each sex event, participants’ sexual positioning, partner’s HIV status, and age. Results A total of 551 sex events were classified into three classes by latent class analysis: PrEP nonadherent flip-flopping (234/551, 42%), PrEP imperfect-adherent power bottoming (284/551, 52%), and PrEP adherent serodiscordant topping (33/551, 6%). “PrEP nonadherent flip-flopping” sex events were more likely to involve condomless anal sex than “PrEP imperfect-adherent power bottoming” (OR 1.83, 95% CI 1.03-3.25) after considering random intercepts for individuals, and this class needed to increase their PrEP adherence and use of condoms. “PrEP imperfect-adherent power bottoming” realized their own risk and packaged PrEP with condoms to protect themselves. Up to 99% (32/33) of sex events in “PrEP adherent serodiscordant topping” were protected by PrEP, but all of the sex events in this group were condomless. Conclusions Using the sex diary data could advance the capacity to identify high-risk groups. HIV prevention strategy should be more flexible and combine PrEP with condom use for future HIV prevention.

The Influencing Factors of HIV-Preventive Behavior Based on Health Belief Model among HIV-Negative MSMs in Western China: A Structural Equation Modeling Analysis

“…Highly effective protection against HIV infections in MSMs has been affirmed in the pre-exposure prophylaxis (PrEP) trials [ 8 , 9 , 10 ]. However, the effectiveness of PrEP largely depends on medication adherence according to the ninth International AIDS Society conference (WHO, 2017) on HIV science in 2017 and our previous research [ 11 , 12 , 13 ]. Adherence may be the most vital determinant factor affecting PrEP effectiveness, and improving adherence has become a common topic accompanied by evidence from existing studies [ 4 ].…”

Usability and effectiveness of adherence monitoring of a mobile app designed to monitor and improve adherence to event-driven and daily HIV pre-exposure prophylaxis among men who have sex with men in Taiwan

“…The frequency of app logins and the use of app components such as anal intercourse and pill-taking records were logged and extracted from the app. 37 For each sexual event, participants also recorded the mood at the moment of sex on the Smiley Face Likert scale (awful, not very good, okay, really good, and fantastic). 38 Secondary feasibility outcomes of this app included a focus on and potential improvement of the app in the future.…”

Understanding the Uptake and Outcomes of Non-occupational Postexposure Prophylaxis Use Through an Online Medical Platform in China: Web-Based Cross-sectional Study

“…A review of available literature shows that there is paucity of data concerning the suitable provision and delivery models of HIV PEP services in China despite the high prevalence of HIV among MSM [ 33 ]. Moreover, PEP could serve as an opportunity to identify individuals eligible for PrEP [ 34 , 35 ], which has been an equally promising and effective tool to prevent HIV transmission [ 36 , 37 ]; however, there is a lack of data on factors of PrEP usage among PEP users in China.…”