Adherence support needed for MSM choosing on-demand PrEP, West African study reports

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HIV seroconversion rates were found to be considerably higher among West African men who have sex with men (MSM) who took event-driven pre-exposure prophylaxis (PrEP) rather than daily PrEP, mostly due to adherence challenges. The findings suggest that support beyond simply offering on-demand PrEP as an option is needed to ensure prevention of HIV acquisition.

About This Study

HIV seroconversion among men who have sex with men who use event-driven or daily oral pre-exposure prophylaxis (CohMSM-PrEP): A multi-country demonstration study from West Africa” was published online on April 13, 2023, in Clinical Infectious Diseases. The lead author is Christian Laurent of the TransVIHMI Unit of the Institut de Recherche pour le Développement at the University of Montpellier, France.

Key Research Findings

This prospective cohort study, taking place in 2017-2021, investigated PrEP adherence, plasma drug concentrations, HIV drug resistance, and seroconversions among HIV-negative MSM in West Africa. At each visit, the 647 participants could choose between event-driven (2 pills before a sex act and 1 pill a day for two days after the act, 2+1+1), daily or no PrEP. Generic emtricitabine/tenofovir disoproxil fumarate was dispensed to those who elected either PrEP method. During 5,371 visits, participants selected on-demand PrEP 72% of the time and a daily pill 26% of the time.

After a total follow-up of 1,229 person-years, 25 participants seroconverted. HIV incidence was significantly higher in those on event-driven PrEP (2.4 per 100 person-years) compared to daily PrEP (0.6 per 100 person-years), while two seroconversions occurred in participants who had discontinued PrEP. At HIV diagnosis, 19 of 20 participants with pharmacokinetic data had undetectable levels of the study drug.

Adequate levels of self-reported adherence were less common on non-daily (44%) vs. daily (75%) medication. Interviews with 15 participants who seroconverted showed that ad-hoc sex, changes in routine, and remembering to take the pills after having sex were the main adherence challenges. When PrEP adherence was poor, participants often did not switch to condoms.

Discussion Highlights and Implications for Practice

Some participants temporarily or permanently discontinued PrEP, and this sub-group had the highest HIV incidence in the sample (7.9 per 100 person-years). Others did not systematically use PrEP. As a result, MSM in West Africa and similar areas should be counseled on the potential difficulties with adherence before choosing event-driven PrEP, study authors recommended.

While adherence support is also needed for PrEP, enhanced support should be offered to men who select on-demand prophylaxis, the study authors urged. They added that counseling is also needed regarding the value of condom use when biomedical HIV prevention is stopped or taken inconsistently.

By Barbara Jungwirth


Source : TheBodyPro

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