Injectable Pre-Exposure Prophylaxis for HIV Prevention: Perspectives on the Benefits and Barriers from Gay, Bisexual, and Queer Men and Health System Stakeholders in Ontario, Canada

Grace, Daniel; Gaspar, Mark; Wells, Alex; Sinno, Jad; Daroya, Emerich; Montess, Michael; Hull, Mark; Lachowsky, Nathan J.; Tan, Darrell H. S.

doi:10.1089/apc.2023.0034

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…Notably, many of our participants identified increased adherence as a significant perceived advantage to injectable PrEP. 35 The effectiveness of HIV biomedical prevention is not simply determined by their scientific efficacy, but by the complex relationship between individuals across serostatus, social norms, practices, and institutions. 42 Our results highlight how two HIV prevention technologies (TasP/U=U and PrEP) are encountered in real life and how GBQM differentially integrate them into their sexual practices.…”

Section: Discussionmentioning

confidence: 99%

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Gay, bisexual, and queer men’s confidence in the Undetectable equals Untransmittable HIV prevention message: longitudinal qualitative analysis of the sexual decision-making of pre-exposure prophylaxis users over time

Grace¹,

Daroya²,

Gaspar³

et al. 2023

Sex. Health

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Background Our objective was to understand what gay, bisexual, and queer men (GBQM) who had experience using pre-exposure prophylaxis (PrEP) thought about the ‘Undetectable equals Untransmittable’ (U=U) message and how it informed their sexual decision-making over time. Methods We conducted annual longitudinal qualitative interviews (2020–22) with 17 current or former PrEP users as part of a mixed-methods implementation science study examining barriers and facilitators to PrEP awareness, access, and adherence. Over 3 years, 47 interviews were conducted with GBQM in Ontario, Canada. Interviews were transcribed verbatim and coded in NVivo following reflexive thematic analysis. Results Participants’ sexual health decision-making was informed by their confidence in biomedical HIV prevention and the person taking medication (i.e. themselves using PrEP versus a real/imagined person living with HIV (PLHIV)). Longitudinal narratives of U=U clustered around four overarching themes: (1) U=U confidence (i.e. increasing trust in U=U irrespective of their PrEP use); (2) PrEP confidence (i.e. accounts of self-reliance and PrEP as sufficient HIV protection); (3) combination confidence (i.e. trusting U=U and PrEP as a package); and (4) partner confidence (i.e. potential ‘distrust’ of U=U due to uncertainties about partners’ medication adherence). Overall, men described increased sex with PLHIV over time, including some participants who, during earlier interviews, said they would ‘never be comfortable’ with serodifferent sexual partners. Conclusions GBQM’s use of PrEP shaped how they thought about U=U and sex with PLHIV. Although many GBQM embraced treatment as prevention/U=U as significant to their sexual lives, longitudinal analysis revealed its varied and uneven adoption across participants and time.

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Section: Discussionmentioning

confidence: 99%

“…Data were collected as part of the PrEP Implemention Project (PRIMP), an ongoing mixed methods implementation science study with the overarching objective of understanding how to better deliver PrEP to GBQM in Ontario and British Columbia, Canada. [33][34][35]…”

Section: Study Settingmentioning

confidence: 99%

Gay, bisexual, and queer men’s confidence in the Undetectable equals Untransmittable HIV prevention message: longitudinal qualitative analysis of the sexual decision-making of pre-exposure prophylaxis users over time

Grace¹,

Daroya²,

Gaspar³

et al. 2023

Sex. Health

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“…In Montréal, despite modest coverage, PrEP had a notable impact on HIV transmission, complementing declining incidence and high ART coverage. Free PrEP could remove important barriers, but more needs to be done to address stigma, discrimination and certain physicians' reticence to prescribe PrEP, among others [44][45][46][47][48][49][50]. The availability of alternative formulations like long-acting injectable PrEP could further usage and support adherence [50].…”

Section: O N C L U S I O N Smentioning

confidence: 99%

“…Free PrEP could remove important barriers, but more needs to be done to address stigma, discrimination and certain physicians' reticence to prescribe PrEP, among others [44][45][46][47][48][49][50]. The availability of alternative formulations like long-acting injectable PrEP could further usage and support adherence [50]. By removing barriers, we can accelerate HIV elimination among MSM and other vulnerable populations [51].…”

Section: O N C L U S I O N Smentioning

confidence: 99%

Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data

Doyle,

Milwid,

Cox

et al. 2023

J Int AIDS Soc.

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IntroductionHIV pre‐exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population‐level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013–2021.MethodsWe used an agent‐based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID‐19 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual‐level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post‐exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (≥11 anal sex partners annually) or aged ⩽45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free‐of‐charge), and improving retention.ResultsOver 2013–2021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3–0.6) to 0.2 (90% CrI: 0.1–0.2) per 100 person‐years. PrEP coverage among HIV‐negative MSM remained low until 2015 (<1%). Afterwards, coverage increased to a maximum of 10% of all HIV‐negative MSM, or about 16% of the 62% PrEP‐eligible HIV‐negative MSM in 2020. Over 2015–2021, PrEP averted an estimated 20% (90% CrI: 11%–30%) of cumulative HIV acquisitions. The hypothetical scenarios modelled showed that, at the same coverage level, prioritizing PrEP to high sexual activity MSM could have averted 30% (90% CrI: 19%–42%) of HIV acquisitions from 2015‐2021. Even larger impacts could have resulted from higher coverage. Under the provincial eligibility criteria, reaching 10% coverage among HIV‐negative MSM in 2015 and 30% in 2019, like attained in Vancouver, could have averted up to 63% (90% CrI: 54%–70%) of HIV acquisitions from 2015 to 2021.ConclusionsPrEP reduced population‐level HIV transmission among Montréal MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition.

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“To do so in a patient-centred way is not particularly lucrative”: The effects of neoliberal health care on PrEP implementation and delivery

Sinno,

Daroya,

Wells

et al. 2024

Social Science & Medicine

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Injectable Pre-Exposure Prophylaxis for HIV Prevention: Perspectives on the Benefits and Barriers from Gay, Bisexual, and Queer Men and Health System Stakeholders in Ontario, Canada

Cited by 7 publications

References 38 publications

Gay, bisexual, and queer men’s confidence in the Undetectable equals Untransmittable HIV prevention message: longitudinal qualitative analysis of the sexual decision-making of pre-exposure prophylaxis users over time

Gay, bisexual, and queer men’s confidence in the Undetectable equals Untransmittable HIV prevention message: longitudinal qualitative analysis of the sexual decision-making of pre-exposure prophylaxis users over time

Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data

“To do so in a patient-centred way is not particularly lucrative”: The effects of neoliberal health care on PrEP implementation and delivery

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