Daily and Nondaily Oral Preexposure Prophylaxis in Men and Transgender Women Who Have Sex With Men: The Human Immunodeficiency Virus Prevention Trials Network 067/ADAPT Study

Grant, Robert M.; Mannheimer, Sharon; Hughes, James P.; Hirsch‐Moverman, Yael; Loquere, A.; Chitwarakorn, Anupong; Curlin, Marcel E.; Li, Maoji; Amico, K. Rivet; Hendrix, Craig W.; Anderson, Peter L.; Dye, Bonnie J.; Marzinke, Mark A.; Piwowar‐Manning, Estelle; McKinstry, Laura; Elharrar, Vanessa; Stirratt, Michael J.; Rooney, James F.; Eshleman, Susan H.; McNicholl, Janet M.; Griensven, Frits van; Holtz, Timothy H.

doi:10.1093/cid/cix1086

Cited by 49 publications

(66 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Event-driven PrEP use may lead to lower adherence compared to daily use, as suggested by other studies [13,24]. In our study, we found a proportion of covered sex days of 67% while on event-driven and 96% while on daily PrEP.…”

Section: Discussionsupporting

confidence: 76%

“…In our study, we found a proportion of covered sex days of 67% while on event‐driven and 96% while on daily PrEP. In the Adapt study, the proportion covered sex acts was 74% and 85% among MSM in Bangkok and 52% and 75% among women in Capetown, for event‐driven and daily PrEP respectively . It should be noted however that participants of the Adapt study were randomly assigned to a PrEP regimen, as opposed to our study, where participants self‐selected and could switch between daily and event‐driven, according their preference, during the entire follow‐up period.…”

Section: Discussionmentioning

confidence: 89%

See 1 more Smart Citation

Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence

et al. 2019

View full text Add to dashboard Cite

Introduction Pre‐Exposure Prophylaxis (PrEP) is highly effective in reducing the risk for HIV infection among men who have sex with men (MSM) and may have an important impact in slowing down the HIV epidemic. Concerns remain however about low adherence, increased risk behaviour and reduced condom use when using PrEP. The aim of this study was to assess these factors prospectively among MSM using daily and event‐driven PrEP in Belgium. Methods An open‐label prospective cohort study was conducted from October 2017 to May 2018 at the Institute of Tropical Medicine, in Antwerp, Belgium. At enrolment, MSM at high risk for HIV chose between daily or event‐driven PrEP. They were allowed to switch regimens or stop taking PrEP at each of their tri‐monthly visits. Data were collected on an electronic case report form, web‐based diary and self‐administered questionnaire. Screening for HIV and other Sexually Transmitted Infections (STIs) was also performed. Results Two hundred MSM were followed up for a total duration of 318 person‐years. At month 18, 75.4% of the participants were on daily and 24.6% were on event‐driven PrEP. The mean proportion of covered sex acts by PrEP for the complete follow‐up period was 91.5% for all participants, 96.5% for daily and 67.0% for event‐driven PrEP use. The number of casual and anonymous sex partners was significantly higher for daily users, as compared with event‐driven users, but did not change over time. In contrast, the mean proportion of condomless receptive anal intercourse with casual and anonymous partners increased significantly during follow‐up, for both daily and event‐driven use (p < 0.0001 for all 4 trends). No new HIV infection was diagnosed during follow‐up. The incidence of bacterial STIs was 75.4 per 100 person‐years (95% CI 63.8 to 89.1). We did not detect a significant change in N. gonorrhoeae/C. trachomatis incidence over time. The incidence of hepatitis C was 2.9 per 100 person‐years. Conclusions PrEP is an effective and well adopted HIV prevention tool for MSM in Belgium. Participants adapted daily and event‐driven regimens to their own needs and were able to adapt their PrEP adherence to risk exposure.

show abstract

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 89%

Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Interestingly, we did not find this association for on‐demand/intermittent users, indicating that daily PrEP use without health insurance coverage is likely too expensive for some, and the high cost prevents access to all people who could benefit from it. This is noticeable in light of recent results indicating that in some populations daily PrEP might allow for more intercourse events to be protected against HIV . In contrast, about half of the informal PrEP users indicated that generic PrEP would be affordable to them.…”

Section: Discussionmentioning

confidence: 91%

Factors associated with the informal use of HIV pre‐exposure prophylaxis in Germany: a cross‐sectional study

et al. 2019

View full text Add to dashboard Cite

Introduction Until September 2019, pre‐exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self‐pay or through informal non‐prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use. Methods We conducted a cross‐sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions. Results We recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informal PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum‐specific OR = 31.7, 95% CI 4.6 to 219.5). Conclusions Informal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use.

show abstract

“…Setting programmatic benchmarks for adherence is essential for identifying shortfalls for further evaluation and intervention. Daily adherence will be the goal for most individuals , but perfection need not be a barrier to potential users ; event‐driven and seasonal use of PrEP present additional challenges for assessing adherence that require consideration. Given programmatic constraints, adherence should be measured through the most reasonably accessible and preferably objective measure .…”

Section: Discussionmentioning

confidence: 99%

Global implementation of PrEP for HIV prevention: setting expectations for impact

Pyra

Haberer

Hasen³

et al. 2019

J Intern AIDS Soc

View full text Add to dashboard Cite

Introduction Questions remain whether HIV pre‐exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population‐level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence, and persistence and their combined impact on the epidemic. Discussion Targets for PrEP uptake must be based on the local HIV epidemic and will depend on appropriate estimates of the key populations at risk for HIV. However, there is evidence that targets, once established, can successfully be met and that uptake may increase with awareness. Messaging around adherence should include that daily adherence is the goal (except for those MSM for whom event‐driven dosing is a good fit), but perfect adherence should not be a barrier. Ideally, clients persist on PrEP for as long as they are at risk for HIV. While PrEP will be most effective when coverage is focused on high‐risk populations, normalizing rather than stigmatizing PrEP will be highly beneficial. Conclusions While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.

show abstract

Daily and Nondaily Oral Preexposure Prophylaxis in Men and Transgender Women Who Have Sex With Men: The Human Immunodeficiency Virus Prevention Trials Network 067/ADAPT Study

Abstract: NCT01327651.

Cited by 49 publications

References 19 publications

Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence

Daily and event‐driven pre‐exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence

Factors associated with the informal use of HIV pre‐exposure prophylaxis in Germany: a cross‐sectional study

Global implementation of PrEP for HIV prevention: setting expectations for impact

Contact Info

Product

Resources

About