1
|
Wijstma ES, Jongen VW, Boyd A, van den Elshout MAM, de Vries HJC, Davidovich U, Anderson PL, Prins M, Hoornenborg E, Schim van der Loeff MF. Concordance between daily diary reported pre-exposure prophylaxis intake and intraerythrocytic tenofovir diphosphate in the Amsterdam Pre-exposure Prophylaxis demonstration project. AIDS 2024; 38:1248-1256. [PMID: 38518076 DOI: 10.1097/qad.0000000000003889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE We assessed the association and concordance between self-reported oral pre-exposure prophylaxis (PrEP) intake in a diary app and intraerythrocytic drug metabolite concentrations. DESIGN AMPrEP was a prospective demonstration study providing daily and event-driven PrEP to MSM in Amsterdam, the Netherlands (2015-2020). METHODS Participants could record their PrEP intake in a diary app. Dried blood spots (DBS) were taken at 6, 12, 24, and 48 months and analysed for tenofovir diphosphate (TFV-DP) and emtricitabine triphosphate (FTC-TP) concentrations. We included TFV-DP measurements preceded by diary completion on at least 90% of days in the 6 weeks prior. We examined the association between self-reported PrEP intake (i.e. number of pills) and TFV-DP concentrations using tobit regression with a random intercept per participant. We also calculated concordance between categorized PrEP intake (i.e. <2, 2-3, 4-6 or 7 pills per week) and categorized TFV-DP concentrations (i.e. <350, 350-699,700-1249 or ≥1250 fmol/punch) using weighted Cohen's kappa. Last, we calculated concordance between self-reported recent PrEP intake (yes/no, in past 2 days) and quantifiability of FTC-TP (yes/no) using Cohen's kappa. RESULTS Seven hundred and fifty-nine DBS measurements from 282 MSM were included. Self-reported PrEP intake was strongly and positively associated with TFV-DP concentration ( β = 0.77, 95% CI = 0.70-0.84, P < 0.0001). Concordance between categorized PrEP intake and TFV-DP concentration was moderate ( κ = 0.44, 95% CI = 0.39-0.50). Concordance between self-reported recent PrEP intake and FTC-TP quantifiability was perfect ( κ = 0.83, 95% CI 0.76-0.90). CONCLUSION Self-reported PrEP intake in a diary app is strongly correlated with actual use, and therefore reliable for comparing PrEP adherence between groups. Still, suboptimal criterion validity according to clinically relevant categories warrants caution when assessing 6-week reported adherence for individuals.
Collapse
Affiliation(s)
- Eline S Wijstma
- Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Vita W Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Stichting HIV Monitoring
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Stichting HIV Monitoring
- Amsterdam Institute for Immunology & Infection Diseases (AII)
- Department of Infectious Diseases, Amsterdam UMC location University of Amsterdam
| | | | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Amsterdam Institute for Immunology & Infection Diseases (AII)
- Department of Dermatology, Amsterdam UMC location University of Amsterdam
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora CO, USA
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Amsterdam Institute for Immunology & Infection Diseases (AII)
- Department of Infectious Diseases, Amsterdam UMC location University of Amsterdam
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Amsterdam Institute for Immunology & Infection Diseases (AII)
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Amsterdam Institute for Immunology & Infection Diseases (AII)
- Department of Infectious Diseases, Amsterdam UMC location University of Amsterdam
| |
Collapse
|
2
|
Jongen VW, Reyniers T, Schim van der Loeff M, Smekens T, Hoornenborg E, van den Elshout M, Zimmermann H, Coyer L, Kenyon C, De Baetselier I, Davidovich U, de Vries HJC, Prins M, Laga M, Vuylsteke B, Boyd A. Trajectories of PrEP use among men who have sex with men: a pooled analysis of two prospective, observational cohort studies. J Int AIDS Soc 2023; 26:e26133. [PMID: 37501262 PMCID: PMC10374882 DOI: 10.1002/jia2.26133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 05/31/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Daily and event-driven oral pre-exposure prophylaxis (PrEP) reduce the risk of HIV acquisition. PrEP use can vary over time, yet little is known about the trajectories of PrEP use irrespective of the chosen PrEP regimens among men who have sex with men (MSM). METHODS Using data from a mobile, web-based diary application collected daily from 17 August 2015 until 6 May 2018, we analysed PrEP use and sexual behaviour in two large cohorts, AMPrEP (Amsterdam, the Netherlands) and Be-PrEP-ared (Antwerp, Belgium). In both cohorts, participants could choose between daily and event-driven oral PrEP every 3 months. We used group-based trajectory modelling to identify trajectories of PrEP use over time and their determinants. In addition, we estimated the incidence rate of chlamydia, gonorrhoea and syphilis within these trajectories. RESULTS We included 516 MSM (n = 322 AMPrEP; n = 194 Be-PrEP-ared), of whom 24% chose event-driven PrEP at PrEP initiation. Participants contributed 225,015 days of follow-up (median = 508 days [IQR = 429-511]). Four distinct PrEP use trajectories were identified: ≤2 tablets per week ("low frequency," 12% of the total population), 4 tablets per week ("variable," 17%), "almost daily" (31%) and "always daily" (41%). Compared to participants with "low frequency" PrEP use, participants with "variable" (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.04-4.60) and "almost daily" PrEP use were more often AMPrEP participants (OR = 2.64, 95% CI = 1.27-5.49). "Almost daily" PrEP users were more often employed (OR = 6.76, 95% CI = 2.10-21.75) and were younger compared to participants with "low frequency" PrEP use. In addition, the number of days on which anal sex occurred was lower among participants with "low frequency" PrEP use compared to the other groups (all p<0.001). Compared to "low frequency" PrEP users, the incidence rates of chlamydia and gonorrhoea were higher for participants with "almost daily" and "always daily" PrEP use. CONCLUSIONS We uncovered four distinct PrEP use trajectories, pointing to different patterns of PrEP use in practice beyond the two-regimen dichotomy. These trajectories were related to sexual behaviour and rates of sexually transmitted infection. Tailoring PrEP care according to different PrEP use patterns could be an important strategy to improve efficient PrEP delivery.
Collapse
Affiliation(s)
- Vita W. Jongen
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Thijs Reyniers
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Maarten Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
| | - Tom Smekens
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Elske Hoornenborg
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
| | - Mark van den Elshout
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Hanne Zimmermann
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Work and Social PsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Liza Coyer
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
| | - Chris Kenyon
- Department of Clinical SciencesInstitute of Tropical MedicineAntwerpBelgium
| | | | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Social PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - Henry J. C. de Vries
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
- Department of DermatologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
| | - Marie Laga
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Bea Vuylsteke
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Stichting HIV MonitoringAmsterdamThe Netherlands
| |
Collapse
|
3
|
Rogers BG, Sosnowy C, Chan PA, Patel RR, Mena LA, Arnold T, Gomillia C, Zanowick-Marr A, Curoe K, Underwood A, Villalobos J, Chu C, Galipeau D, Montgomery M, Nunn AS. Factors associated with suboptimal retention in HIV pre-exposure prophylaxis care among men who have sex with men. AIDS Care 2023; 35:495-508. [PMID: 36215734 PMCID: PMC10083191 DOI: 10.1080/09540121.2022.2129036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/20/2022] [Indexed: 01/28/2023]
Abstract
Despite the efficacy of HIV pre-exposure prophylaxis (PrEP), retention in care in the United States remains suboptimal. The goal of this study was to explore factors that lead to suboptimal retention in PrEP care for men who have sex with men (MSM) in real-world clinical settings in the United States. Trained interviewers conducted semi-structured interviews with MSM (N = 49) from three clinics who had been engaged in PrEP care in the Midwest (n = 15), South (n = 15), and Northeast (n = 19) geographic regions and had experienced a lapse in PrEP use. Factors that emerged as related to suboptimal retention in PrEP care included structural factors such as transportation and out-of-pocket costs; social factors such as misinformation on media and in personal networks; clinical factors such as frequency and timing of appointments; and behavioral factors such as changes in sexual behavior and low perceived risk for HIV. Participants suggested reducing the out-of-pocket costs of medications and lab visits, having flexible appointment times, culturally responsive services, and comprehensive patient navigation to help retention in care. These findings leveraged real-world experiences and opinions of patients to inform gaps in current services and how to make changes to optimize PrEP care.
Collapse
Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Collette Sosnowy
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Rupa R Patel
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Leandro A Mena
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Trisha Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Courtney Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alexandra Zanowick-Marr
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kate Curoe
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley Underwood
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Jesus Villalobos
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Christina Chu
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Drew Galipeau
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Madeline Montgomery
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy S Nunn
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
4
|
Buchbinder SP, Siegler AJ, Coleman K, Vittinghoff E, Wilde G, Lockard A, Scott H, Anderson PL, Laborde N, van der Straten A, Christie RH, Marlborough M, Liu AY. Randomized Controlled Trial of Automated Directly Observed Therapy for Measurement and Support of PrEP Adherence Among Young Men Who have Sex with Men. AIDS Behav 2023; 27:719-732. [PMID: 35984607 PMCID: PMC9908647 DOI: 10.1007/s10461-022-03805-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Measurement of adherence to oral pre-exposure prophylaxis (PrEP) in real-time has been challenging. We developed DOT Diary, a smartphone application that combines automated directly observed therapy with a PrEP adherence visualization toolkit, and tested its ability to measure PrEP adherence and to increase adherence among a diverse cohort of young men who have sex with men (MSM). We enrolled 100 MSM in San Francisco and Atlanta and randomly assigned them 2:1 to DOT Diary versus standard of care. Concordance between DOT Diary measurement and drug levels in dried blood spots was substantial, with 91.0% and 85.3% concordance between DOT Diary and emtricitabine-triphosphate and tenofovir-diphosphate, respectively. There was no significant difference in the proportion of participants with detectable PrEP drug levels at 24 weeks between study arms. These results suggest DOT Diary is substantially better than self-reported measures of adherence, but additional interventions are needed to improve PrEP adherence over time.
Collapse
Affiliation(s)
- Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA.
| | - Aaron J Siegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Gretchen Wilde
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Annie Lockard
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Ariane van der Straten
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | | | | | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
5
|
Wu HJ, Yu YF, Ku SWW, Tseng YC, Yuan CW, Li CW, Huang PH, Ko NY, Anderson PL, Strong C. 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. Digit Health 2022; 8:20552076221102770. [PMID: 35646378 PMCID: PMC9131382 DOI: 10.1177/20552076221102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The UPrEPU mobile app is a self-monitoring system to enable men who have sex with men to optimize their pre-exposure prophylaxis adherence for HIV prevention. The app was designed to accommodate a rather complicated event-driven dosing schedule. We aim to evaluate the usability of the UPrEPU app and its effectiveness in improving adherence monitoring. Methods From May to October 2020, 35 participants were enrolled for the usability study and followed up for 4 months. Blood samples for the drug concentration in the dried blood spots were obtained once during the second to fourth follow-up visits. The effectiveness of adherence monitoring was analyzed using Cohen's kappa statistic to calculate the concordance between the average number of pills taken and drug concentration in the dried blood spots. Results Overall retention was 91.4% (32 participants) at the end of the study. Participants used the app for a mean of 29 days and made 2565 data entries in total, with an average of 76 data entries. The average systematic usability scale score for the app was 71.5, indicating acceptable usability. Slight agreement was reached between the dried blood spots measurement and the number of pills taken and recorded in the app (weighted kappa: 0.21). Conclusions Our user-centered UPrEPU app demonstrated that it could accommodate both daily and event-driven dosing schedules for men who have sex with men clients with acceptable usability scores. We confirmed that complex behaviors such as different drug-dosing regimens that are contingent on sexual behaviors could be incorporated into the design of a mobile app.
Collapse
Affiliation(s)
- Huei-Jiuan Wu
- UNSW Sydney, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Yi-Fang Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Stephane Wen-Wei Ku
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Infectious Diseases, Department of Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Yuan-Chi Tseng
- Institute of Service Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Chien-Wen Yuan
- Graduate Institute of Library & Information Studies, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Wen Li
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsien Huang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Nai-Ying Ko
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
6
|
Yu YF, Wu HJ, Ku SWW, Huang PH, Li CW, Huang P, Strong C. 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. J Med Internet Res 2021; 23:e33877. [PMID: 34941560 PMCID: PMC8738983 DOI: 10.2196/33877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/26/2021] [Accepted: 11/21/2021] [Indexed: 01/01/2023] Open
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.
Collapse
Affiliation(s)
- Yi-Fang Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huei-Jiuan Wu
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Stephane Wen-Wei Ku
- Division of Infectious Diseases, Department of Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Po-Hsien Huang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Chia-Wen Li
- Center for Infection Control and Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Poyao Huang
- Institute of Health Behavior and Community Sciences, National Taiwan University, Taipei, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
7
|
van den Elshout MAM, Hoornenborg E, Achterbergh RCA, Coyer L, Anderson PL, Davidovich U, de Vries HJC, Prins M, van der Loeff MFS. Improving adherence to daily preexposure prophylaxis among MSM in Amsterdam by providing feedback via a mobile application. AIDS 2021; 35:1823-1834. [PMID: 34001705 DOI: 10.1097/qad.0000000000002949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Improving adherence to preexposure prophylaxis (PrEP) by providing automated feedback on self-reported PrEP use via a mobile application (app). DESIGN Randomized clinical trial among MSM participating in the Amsterdam PrEP demonstration project (AMPrEP). METHODS Eligible participants were randomized 1 : 1 to the control or intervention app. Both allowed daily reporting of sexual behaviour and medication intake; the intervention app also provided visual feedback. Dried blood spots collected at 12 and 24 months yielded intracellular tenofovir diphosphate concentrations (TFV-DP). We assessed proportions of participants with poor (TFV-DP <700 fmol/punch; primary outcome), good (TFV-DP ≥700 fmol/punch) and excellent (TFV-DP ≥1250 fmol/punch; secondary outcome) adherence at both time-points, and the association with the control or intervention app. RESULTS We randomized 229 participants, 118 to the intervention and 111 to the control arm. The primary, per-protocol, analysis included 83 participants per arm. In total, 22/166 (13%) of participants adhered poorly, 144/166 (87%) good and 66/166 (40%) excellently. App feedback did not result in a lower proportion of participants with poor adherence [control: 9 of 83 (11%); intervention: 13 of 83 (16%); P = 0.36]. App feedback did result in a larger proportion of participants with excellent adherence [control: 26/83 (31%); intervention: 40/83 (48%); P = 0.026]. CONCLUSION In this highly adherent population, app feedback did not improve the proportion of participants with poor adherence to PrEP.Clinical Trial Number Netherlands Trial Register: NL5413.
Collapse
Affiliation(s)
- Mark A M van den Elshout
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Roel C A Achterbergh
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Social Psychology, University of Amsterdam
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
- Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
| |
Collapse
|
8
|
Kwan TH, Lui GCY, Lam TTN, Lee KCK, Wong NS, Chan DPC, Lee SS. Comparison between daily and on-demand PrEP (pre-exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: A randomized, controlled, open-label, crossover trial. J Int AIDS Soc 2021; 24:e25795. [PMID: 34473402 PMCID: PMC8412015 DOI: 10.1002/jia2.25795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/30/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Both daily and on-demand regimens have been proven effective for pre-exposure prophylaxis (PrEP) against HIV in men who have sex with men (MSM). We aimed to compare the two regimens on their coverage of condomless anal intercourse (CLAI) in MSM. METHODS A randomized, controlled, open-label, crossover trial was conducted in a teaching hospital in Hong Kong. Participants were sexually active HIV-negative MSM aged 18 years or above with normal renal function and without chronic hepatitis B infection. Oral tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg (TDF/FTC) tablets were prescribed for PrEP. After a 2-week lead-in with daily TDF/FTC for treatment-naïve MSM for tolerance assessment, participants were randomly assigned in a 1:1 ratio with a block size of four to either daily-first or on-demand-first arm based on the IPERGAY study, for receiving PrEP for 16 weeks, then crossed-over to the alternative regimen for another 16 weeks. The primary outcome was the proportion of days with PrEP-covered CLAI by intention-to-treat analysis. The trial is registered with the CCRB Clinical Trials Registry, CUHK, CUHK_CCRB00606, and is closed to accrual. RESULTS Between 25 August 2018 and 23 March 2019, 119 eligible participants were assigned to daily-first arm (n = 59) and on-demand-first arm (n = 60) with an 87% overall completion rate (n = 103). With 96% and 54% of days on PrEP during daily and on-demand periods, respectively, the proportion of days with PrEP-covered CLAI between two arms were not statistically different (92% vs. 92%, p = 0.93). About half (47%) were diagnosed with at least one episode of incident sexually transmitted infection. Mild and time-limited adverse events, including diarrhoea, headache, nausea and dizziness, were reported in 37 (31%) and 10 (8%) during the daily and on-demand periods, respectively. At the end of the study, a similar proportion favoured daily or on-demand regimen. CONCLUSIONS High prevention-effective adherence, as reflected from the coverage of CLAI, was achievable by either daily or on-demand PrEP among MSM, albeit a higher number of tablets taken for daily PrEP. As both regimens were well accepted, a flexible approach adopting either or both regimens with possible switching is warranted in order to suit individual health needs.
Collapse
Affiliation(s)
- Tsz Ho Kwan
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongShatinHong Kong
| | - Grace Chung Yan Lui
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongShatinHong Kong
- Department of Medicine and TherapeuticsThe Chinese University of Hong KongShatinHong Kong
| | | | | | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongShatinHong Kong
| | - Denise Pui Chung Chan
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongShatinHong Kong
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongShatinHong Kong
| |
Collapse
|
9
|
Jongen VW, Zimmermann HML, Boyd A, Hoornenborg E, van den Elshout MAM, Davidovich U, van Duijnhoven YTHP, de Vries HJC, Prins M, Schim van der Loeff MF, Coyer L. Transient Changes in Preexposure Prophylaxis Use and Daily Sexual Behavior After the Implementation of COVID-19 Restrictions Among Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2021; 87:1111-1118. [PMID: 34229327 PMCID: PMC8330826 DOI: 10.1097/qai.0000000000002697] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND We assessed how the Dutch restrictions imposed on March 15, 2020, affected sexual behavior, preexposure prophylaxis (PrEP), and condom use among PrEP users in Amsterdam. METHODS We used data on (1) PrEP use, (2) anal sex acts, and (3) condom use, per partner type [steady partners (SPs), known casual partners (KCPs), and unknown casual partners (UCPs)], collected daily through a mobile application used between December 1, 2019, and June 30, 2020. We compared the period before versus after March 15, 2020, regarding average proportion of days per week at which each end point was reported and average proportion of anal sex acts covered by PrEP and/or condoms. RESULTS We included data from 136 men who have sex with men. After March 15, 2020, the proportion of days with anal sex increased with SPs [odds ratio (OR) = 1.26; 95% confidence interval (CI) = 1.10 to 1.44) and decreased with KCPs (OR = 0.73; 95% CI = 0.64 to 0.82) and UCPs (OR = 0.54; 95% CI = 0.48 to 0.61). Shifts in partner types were most profound immediately after March 15, 2020, whereas returning to prerestriction levels mid-May 2020. The proportion of days with PrEP use decreased from 74% before to 58% after March 15, 2020 (P < 0.001). After March 15, 2020, PrEP use during sex decreased with UCPs (β = -0.36; 95% CI = -0.72 to 0.00) but not with SPs and KCPs. Condom use during sex decreased with KCPs (β = -0.36; 95% CI = -0.67 to 0.04) and UCPs (β = -0.24; 95% CI = -0.46 to 0.03) but not with SPs. CONCLUSIONS MSM decreased sex with casual partners and increased sex with SP, but changes were transient. Decreases in sex acts with casual partners paralleled decreases in PrEP use. However, condom use during sex with casual partners decreased, indicating the importance of continued sexual health services, including sexually transmitted infections screening and PrEP care, during COVID-19 restrictions.
Collapse
Affiliation(s)
- Vita W. Jongen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Hanne M. L. Zimmermann
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | | | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands; and
| | | | - Henry J C. de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Departments of Dermatology
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity (AII), Amsterdam, the Netherlands
| | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity (AII), Amsterdam, the Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Jongen VW, Reyniers T, Ypma ZMH, Schim van der Loeff MF, Davidovich U, Zimmermann HML, Coyer L, van den Elshout MAM, de Vries HJC, Wouters K, Smekens T, Vuylsteke B, Prins M, Laga M, Hoornenborg E. Choosing event-driven and daily HIV pre-exposure prophylaxis - data from two European PrEP demonstration projects among men who have sex with men. J Int AIDS Soc 2021; 24:e25768. [PMID: 34382345 PMCID: PMC8358711 DOI: 10.1002/jia2.25768] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Daily and event-driven PrEP are both efficacious in reducing the risk for HIV infection. However, the practice of event-driven PrEP (edPrEP) is less well studied, in particular when provided as an alternative to daily PrEP. We studied regimen preferences and switches, and sexually transmitted infection (STI) incidence. METHODS We analysed pooled data from two prospective cohort studies among MSM: Be-PrEP-ared, Belgium and AMPrEP, the Netherlands. In both projects, participants could choose between daily and edPrEP at three-monthly study visits, when they were also screened for sexually transmitted infections including hepatitis C (HCV). We assessed the proportion choosing each regimen, and the determinants of choosing edPrEP at baseline. Additionally, we compared the incidence rates (IRs) of HCV, syphilis and chlamydia or gonorrhoea between regimens using Poisson regression. The study period was from 3 August 2015 until 24 September 2018. RESULTS AND DISCUSSION We included 571 MSM, of whom 148 (25.9%) chose edPrEP at baseline. 31.7% of participants switched regimen at least once. After 28 months, 23.5% used edPrEP. Older participants (adjusted odds ratio (aOR) = 1.38 per 10 years, 95% confidence interval (CI) = 1.15 to 1.64) and those unemployed (aOR = 1.68, 95% CI = 1.03 to 1.75) were more likely to initially choose edPrEP. IR of HCV and syphilis did not differ between regimens, but the IR of chlamydia/gonorrhoea was higher among daily users (adjusted incidence rate ratio = 1.61, 95% CI = 1.35 to 1.94). CONCLUSIONS A quarter of participants chose edPrEP at baseline and at 28 months this proportion was similar. Although the IR of HCV and syphilis were similar in the two regimens, the lower incidence of chlamydia and gonorrhoea among edPrEP users may suggest that less frequent STI testing of this group could be considered.
Collapse
Affiliation(s)
- Vita W Jongen
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Thijs Reyniers
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Zorah MH Ypma
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Internal MedicineAmsterdam Infection and Immunity (AII)Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Social PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - Hanne ML Zimmermann
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Liza Coyer
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | | | - Henry JC de Vries
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of DermatologyAmsterdam Infection and Immunity (AII), location Academic Medical CentreAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Kristien Wouters
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Tom Smekens
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Bea Vuylsteke
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Internal MedicineAmsterdam Infection and Immunity (AII)Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marie Laga
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Elske Hoornenborg
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
11
|
Jongen VW, Hoornenborg E, van den Elshout MAM, Boyd A, Zimmermann HML, Coyer L, Davidovich U, Anderson PL, de Vries HJC, Prins M, Schim van der Loeff MF. 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. J Int AIDS Soc 2021; 24:e25708. [PMID: 33973373 PMCID: PMC8110892 DOI: 10.1002/jia2.25708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 11/08/2022] Open
Abstract
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 three-month 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.
Collapse
Affiliation(s)
- Vita W Jongen
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Elske Hoornenborg
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | | | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Stichting HIV MonitoringAmsterdamthe Netherlands
| | - Hanne ML Zimmermann
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Liza Coyer
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Social PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical SciencesUniversity of ColoradoAnschutz Medical CampusAuroraCOUSA
| | - Henry JC de Vries
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCDepartment of DermatologyAmsterdam institute for Infection and Immunity (AII)location Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - M Prins
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCInternal MedicineAmsterdam institute for Infection and Immunity (AII)University of AmsterdamAmsterdamThe Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCInternal MedicineAmsterdam institute for Infection and Immunity (AII)University of AmsterdamAmsterdamThe Netherlands
| | | |
Collapse
|
12
|
Liu AY, Laborde ND, Coleman K, Vittinghoff E, Gonzalez R, Wilde G, Thorne AL, Ikeguchi E, Shafner L, Sunshine L, van der Straten A, Siegler AJ, Buchbinder S. DOT Diary: Developing a Novel Mobile App Using Artificial Intelligence and an Electronic Sexual Diary to Measure and Support PrEP Adherence Among Young Men Who Have Sex with Men. AIDS Behav 2021; 25:1001-1012. [PMID: 33044687 DOI: 10.1007/s10461-020-03054-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
Young men who have sex with men (YMSM) are highly vulnerable to HIV. While pre-exposure prophylaxis (PrEP) has demonstrated effectiveness, adherence has been low among YMSM and difficult to measure accurately. In collaboration with a healthcare company, we configured an automated directly-observed therapy (aDOT) platform for monitoring and supporting PrEP use. Based on interest expressed in focus groups among 54 YMSM, we combined aDOT with an electronic sexual diary to provide feedback on level of protection during sex and to motivate app use. In an 8-week optimization pilot with 20 YMSM in San Francisco and Atlanta, the app was found to be highly acceptable, with median System Usability Scale scores in the "excellent" range (80/100). App use was high, with median PrEP adherence of 91% based on aDOT-confirmed dosing. Most (84%) participants reported the app helped with taking PrEP. These promising findings support further evaluation of DOT Diary in future effectiveness studies.
Collapse
Affiliation(s)
- Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rafael Gonzalez
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
| | - Gretchen Wilde
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Annie L Thorne
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | | | - Ariane van der Straten
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
13
|
Songtaweesin WN, Kawichai S, Phanuphak N, Cressey TR, Wongharn P, Saisaengjan C, Chinbunchorn T, Janyam S, Linjongrat D, Puthanakit T. Youth-friendly services and a mobile phone application to promote adherence to pre-exposure prophylaxis among adolescent men who have sex with men and transgender women at-risk for HIV in Thailand: a randomized control trial. J Int AIDS Soc 2020; 23 Suppl 5:e25564. [PMID: 32869511 PMCID: PMC7459171 DOI: 10.1002/jia2.25564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Strategies are needed to curb the increasing HIV incidence in young men who have sex with men (YMSM) and transgender women (YTGW) worldwide. We assessed the impact of youth-friendly services (YFS) and a mobile phone application (app) on adherence to pre-exposure prophylaxis (PrEP) in YMSM and YTGW in Thailand. METHODS A randomized control trial was conducted in YMSM and YTGW aged 15 to 19 years. Participants were provided daily oral tenofovir disoproxil fumerate/emtricitabine (TDF/FTC), condoms and randomized to receive either YFS or YFS plus a PrEP app (YFS + APP), whose features included self-assessment of HIV acquisition risk, point rewards and reminders for PrEP and clinic appointments. Clinic visits occurred at zero, one, three and six months and telephone contact at two, four and five months. HIV testing was performed at every clinic visit. PrEP adherence was evaluated with intracellular tenofovir diphosphate (TFV-DP) concentrations in dried blood spot (DBS) samples at months 3 and 6. The primary endpoint assessed was "PrEP adherence" defined as TFV-DP DBS concentrations ≥700 fmol/punch (equivalent to ≥4 doses of TDF/week). RESULTS Between March 2018 and June 2019, 489 adolescents were screened at three centres in Bangkok. Twenty-seven (6%) adolescents tested positive for HIV and 200 (41%) adolescents participated in the study. Of these, 147 were YMSM (74%) and 53 YTGW (26%). At baseline, median age was 18 years (IQR 17 to 19), 66% reported inconsistent condom use in the past month. Sexually transmitted infection prevalence was 23%. Retention at six months was 73%. In the YFS + APP arm, median app use duration was three months (IQR 1 to 5). PrEP adherence at month 3 was 51% in YFS and 54% in YFS + APP (p-value 0.64) and at month 6 was 44% in YFS and 49% in YFS + APP (p-value 0.54). No HIV seroconversions occurred during 75 person years of follow-up. CONCLUSIONS Youth-friendly PrEP services enabled good adherence among half of adolescent PrEP users. However, the mobile phone application tested did not provide additional PrEP adherence benefit in this randomized trial. Adolescent risk behaviours are dynamic and require adaptive programmes that focus on "prevention-effective adherence."
Collapse
Affiliation(s)
- Wipaporn Natalie Songtaweesin
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Surinda Kawichai
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Tim R Cressey
- PHPT/IRD UMI 174Faculty of Associated Medical SciencesChiang Mai UniversityChiang MaiThailand
- Department of Immunology & Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of Molecular & Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Prissana Wongharn
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Chutima Saisaengjan
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Surang Janyam
- The Service Workers IN Group FoundationBangkokThailand
| | | | - Thanyawee Puthanakit
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
- Department of PediatricsFaculty of MedicineChulalongkorn UniversityBangkokThailand
| |
Collapse
|
14
|
Vanhamel J, Rotsaert A, Reyniers T, Nöstlinger C, Laga M, Van Landeghem E, Vuylsteke B. The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review. BMC Health Serv Res 2020; 20:704. [PMID: 32736626 PMCID: PMC7395423 DOI: 10.1186/s12913-020-05568-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background Strengthening HIV prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential game changer because of its high clinical efficacy and the feasibility of its provision to different key populations. Documenting the existing experience with PrEP service delivery in a variety of real-world settings will inform how its uptake and usage can be maximised. Methods We conducted a scoping review using the five-step framework provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing the implementation of real-world PrEP service delivery models reporting on four key components: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set. Results This review included 33 articles for charting and analysing of the results. The identified service delivery models showed that PrEP services mainly targeted people at high risk of HIV acquisition, with some models targeting specific key populations, mainly men who have sex with men. PrEP was often delivered centralised and in a clinical or hospital setting. Yet also community-based as well as home-based PrEP delivery models were reported. Providers of PrEP were mainly clinically trained health professionals, but in some rare cases community workers and lay providers also delivered PrEP. In general, in-person visits were used to deliver PrEP. More innovative digital options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied in a minority of the service delivery models in mainly high-resource settings. Conclusions A range of possible combinations was found between all four components of PrEP service delivery models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could be expanded and optimised to respond to key populations with unmet HIV prevention needs in different settings.
Collapse
Affiliation(s)
- Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium.
| | - Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Ella Van Landeghem
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
| |
Collapse
|
15
|
Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, Dodge B. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-1588. [PMID: 32338061 DOI: 10.1080/09540121.2020.1757021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions.
Collapse
Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Jessica Nina Lester
- Deparmtent of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| |
Collapse
|