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Hayes R, Nutland W, Rayment M, Wayal S, Apea V, Clarke A, McOwan A, Sullivan A, Desai M, Jajja A, Rice B, Horne R, McCormack S, Gafos M. "Sex without fear": exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England. AIDS Res Ther 2023; 20:81. [PMID: 37964322 PMCID: PMC10648634 DOI: 10.1186/s12981-023-00568-2] [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: 10/12/2022] [Accepted: 09/02/2023] [Indexed: 11/16/2023] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) experience a high prevalence of psychosocial health problems, such as harmful substance use and depression, as well as being disproportionately affected by HIV. HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users' wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP's psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines.
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Affiliation(s)
- Rosalie Hayes
- Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | | | - Michael Rayment
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- Institute for Global Health, Mortimer Market Centre, University College London, London, UK
| | - Vanesa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Amanda Clarke
- Department of HIV, Sexual Health and Contraception, Royal Sussex County Hospital, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Alan McOwan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann Sullivan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- STI & HIV Division, Blood Safety, Health Security Agency, London, UK
| | - Andrew Jajja
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rob Horne
- School of Pharmacy, University College London, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK.
| | - Mitzy Gafos
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Guimarães NS, Magno L, Monteiro GMB, Ramos ICN, de Castro CT, Aranha-Rossi TR, Pereira M, Dourado I. Demand creation and retention strategies for oral pre-exposure prophylaxis for HIV prevention among men who have sex with men and transgender women: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:793. [PMID: 37964202 PMCID: PMC10644426 DOI: 10.1186/s12879-023-08693-z] [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: 03/27/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TGW) have a disproportionately higher risk of human immunodeficiency virus (HIV) infection than other groups. Oral HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool and should be offered to those at higher risk. Identifying demand creation strategies (DCS) and retention strategies (RS) to improve PrEP persistence is essential to control the HIV epidemic. AIM We aimed to identify the (DCS and RS with higher proportions among MSM and TGW. METHODS A systematic review and meta-analysis of prospective studies were conducted, with studies retrieved from five databases until November, 2022 following the Cochrane and PRISMA guidelines. The study protocol was registered in PROSPERO (CRD42022323220). The outcomes were DCS and RS for PrEP use among MSM and TGW. Strategies used for users enrolled in the PrEP-recruited (DCS) were classified as face-to-face (peer educator recruitment at social venues, nongovernmental organizations, and parties; direct referrals by health services; friends and/or sexual partners); online (chatbot or peer educator recruitment on social media [e.g., , Instagram or Facebook] or dating/hook-up apps [e.g., Grindr, Tinder, Badoo, and Scruff]); and mixed (face-to-face and online). RS was classified as provider counseling (face-to-face by a health professional; prevention of HIV risk counseling, distribution of condoms, lubricants, and testing for HIV or other sexually transmitted infections); online counseling (text messages, chatbots, telephone calls, social media, and peer educators); and mixed (all previous strategies). Subgroup analyses were conducted for each treatment strategy. Meta-analyses were performed using the R software version 4.2.1. RESULTS A total of 1, 129 studies were retrieved from the five databases. After eligibility, 46 studies were included. For MSM, most DCS and RS were online at 91% (95% CI: 0.85-0.97; I2=53%), and 83% (95% CI: 0.80-0.85; I2=17%) respectively. For TGW, mixed DCS and RS were the most frequent at85% (95% CI: 0.60-1.00; I2=91%) and online counseling at 84% (95% CI: 0.64-0.95) compared to other strategies. CONCLUSION Critical issues play. Pivotal role in increasing PrEP awareness among MSM and TGW, minimizing access gaps, and ensuring retention of PrEP services. Offering oral PrEP using online DCS and RS can reach and retain high numbers of MSM and TGW, and reduce HIV incidence in these populations.
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Affiliation(s)
- Nathalia Sernizon Guimarães
- Faculdade Ciências Médicas de Minas Gerais, R. Basílio da Gama, Canela, Salvador, Bahia, 40110-040, Brazil.
- Fundação de apoio à Fiocruz (FIOTEC) Scholarship, Avenida, Brazil.
- Departamento Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brazil.
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Laio Magno
- Life Sciences Departament, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Gabriel Marinho Bahia Monteiro
- Fundação de apoio à Fiocruz (FIOTEC) Scholarship, Avenida, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Izabel Cristina Neves Ramos
- Fundação de apoio à Fiocruz (FIOTEC) Scholarship, Avenida, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Caroline Tianeze de Castro
- Faculdade Ciências Médicas de Minas Gerais, R. Basílio da Gama, Canela, Salvador, Bahia, 40110-040, Brazil
| | | | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:24-28. [PMID: 35810144 DOI: 10.1016/j.eimce.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Pre-Exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection in seronegative people at high risk of becoming infected. This strategy was endorsed in October 2019 by the Spanish Ministry of Health. OBJECTIVE To present the PrEP initial experience in the HIV Unit of the Hospital Clínic of Barcelona, paying special attention to the analysis of the vulnerability factors in the cohort. MATERIALS AND METHODS Retrospective, descriptive study. The epidemiological, sociodemographic, and clinical characteristics of the users included in the program during the first year are analyzed, paying particular attention to Infections, risky practices, and substance use. RESULTS 190 individuals were included, 177 men and 12 trans women with a mean age of 35 years (8 SD). 70% had higher education, and half had Spanish nationality. An average of 10 couples per trimester and 60% reported unprotected anal sex. 31% had at least one positive PCR for STIs, with N. gonorrhoeae being the most prevalent microorganism (51%) and the rectal sample the most affected (21%). 63% reported chemsex use, 19% polydrug use, and 8% "slamming". Half expressed concern about consumption and/or sexual practices and 25% the need for help. CONCLUSIONS The PrEP user profile attended in our Hospital Unit justifies the creation of multidisciplinary teams that allow us to provide holistic attention to the sexual life of these people.
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De La Mora L, Ugarte A, Martínez-Rebollar M, De Lazzari E, García-Hernández D, Font G, De Loredo N, Solbes E, Miquel L, Blanch J, Torres B, Riera J, Chivite I, Ambrosioni J, Inciarte A, González-Cordón A, Martínez E, Blanco JL, Mallolas J, Laguno M. Chemsex Practices in PrEP: Beyond Addiction and Risk Toward a Healthy Sex Life-Baseline Experiences from a Hospital-Based PrEP Program in Barcelona, Spain. AIDS Behav 2022; 26:4055-4062. [PMID: 35732910 DOI: 10.1007/s10461-022-03730-5] [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] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that has demonstrated efficacy in HIV prevention in individuals at high-risk, among them chemsex users. Out of 190 PrEP users followed at Hospital Clinic of Barcelona until October 2020, 89% reported drug use, and 63% disclosed that they had engaged in chemsex practices, initiated in 64% of cases within the past year. Twenty-one percent used 3 or more drugs simultaneously, being GHB/GBL, nitrites, sildenafil, and methamphetamine the most prevalent combination. Eight percent reported slamming. Forty-one percent described having had negative experiences and 8% did not remember the last time they had sober sex. Methamphetamine, mephedrone, GHB/GBL, and having had open relationships, group sex, double penetration, and fisting were significantly more prevalent. Forty-nine percent admitted being worried about chemsex use, and 18% said they needed help. A comprehensive, interdisciplinary approach is mandatory to enable the attainment of a healthy approach to one's sex life.
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Affiliation(s)
- Lorena De La Mora
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ainoa Ugarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maria Martínez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Elisa De Lazzari
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - David García-Hernández
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Guillermo Font
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Nicolás De Loredo
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Estela Solbes
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Laia Miquel
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Jordi Blanch
- Addiction Unit (GRAC). Psychiatry and Psychology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, Barcelona University, Barcelona, Spain
| | - Berta Torres
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Riera
- Dermatology Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Iván Chivite
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Ana González-Cordón
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esteban Martínez
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Luis Blanco
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Arnold-Forster D, Horne R, Nutland W, Wayal S, Rayment M, Rae C, Desai M, Clarke A, Sullivan A, McCormack S, Gafos M. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS Behav 2022; 26:2768-2782. [PMID: 35182281 PMCID: PMC9252952 DOI: 10.1007/s10461-022-03624-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
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Affiliation(s)
- Dora Arnold-Forster
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
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Guy D, Doran J, White TM, van Selm L, Noori T, Lazarus JV. The HIV pre-exposure prophylaxis continuum of care among women who inject drugs: A systematic review. Front Psychiatry 2022; 13:951682. [PMID: 36090369 PMCID: PMC9459118 DOI: 10.3389/fpsyt.2022.951682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION People who inject drugs have a substantial risk for HIV infection, especially women who inject drugs (WWID). HIV pre-exposure prophylaxis (PrEP), a highly-effective HIV prevention drug, is uncommonly studied among WWID, and we aimed to synthesize existing knowledge across the full PrEP continuum of care in this population. METHODS We systematically searched for peer-reviewed literature in three electronic databases, conference abstracts from three major HIV conferences, and gray literature from relevant sources.Eligibility criteria included quantitative, qualitative or mixed-methods studies with primary data collection reporting a PrEP-related finding among WWID, and published in English or Spanish between 2012 and 2021. The initial search identified 2,809 citations, and 32 were included. Data on study characteristics and PrEP continuum of care were extracted, then data were analyzed in a narrative review. RESULTS Our search identified 2,809 studies; 32 met eligibility requirements. Overall, awareness, knowledge, and use of PrEP was low among WWID, although acceptability was high. Homelessness, sexual violence, unpredictability of drug use, and access to the healthcare system challenged PrEP usage and adherence. WWID were willing to share information on PrEP with other WWID, especially those at high-risk of HIV, such as sex workers. CONCLUSIONS To improve PrEP usage and engagement in care among WWID, PrEP services could be integrated within gender-responsive harm reduction and drug treatment services. Peer-based interventions can be used to improve awareness and knowledge of PrEP within this population. Further studies are needed on transgender WWID as well as PrEP retention and adherence among all WWID.
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Affiliation(s)
- Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jason Doran
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,National Infection Service, UK Health Security Agency, London, United Kingdom.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 793] [Impact Index Per Article: 264.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Kiefer EM, Ross KS, Santos AC, Barney MR, McCormick TJ, Chow DC, Shikuma CM. Incident Cases of Sexually Transmitted Infections among Users of Pre-Exposure Prophylaxis for HIV Prevention in Honolulu, Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:148-154. [PMID: 34278321 PMCID: PMC8280359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Emtricitabine/tenofovir disoproxil fumarate [FTC-TDF] is a daily oral medication taken by HIV-negative individuals for pre-exposure prophylaxis (PrEP) to prevent human immunodeficiency virus (HIV) infection. A higher incidence of sexually transmitted infections (STIs) among PrEP users has been reported compared to STI incidence before PrEP use. Asymptomatic incident STI rates were investigated among 78 patients presenting for PrEP in Honolulu, Hawai'i, from April 2018 to May 2019. Testing for oropharyngeal gonorrhea, urethral gonorrhea and chlamydia, rectal gonorrhea and chlamydia, and syphilis was performed. Incident STI percentages were calculated at each follow-up visit. Ninety-seven percent of patients were men who have sex with men (MSM). Forty-seven percent of patients had follow-up data 6 months after initiation and 28% after 1 year. Thirty-two percent of patients self-reported an STI before initiating PrEP. More than half reported anonymous partners. There were 35 positive STI tests during the study period, and 25% of patients had one or more positive tests during this time. At initiation, 17% of patients were found to have an STI, followed by 16% at 3 months, 14% at 6 months, 8% at 9 months, and 5% at 12 months. At all visits, chlamydia was the most common STI detected; at 6 months, 18% of all rectal tests were positive for chlamydia. There were inconsistent condom use and high STI rates from screening during PrEP initiation and follow-up, offering an opportunity to identify asymptomatic STIs in this population. This study is the first report in Hawai'i of STI rates among PrEP users.
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Affiliation(s)
- Elizabeth M. Kiefer
- Hawai‘i Center for AIDS, Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (EMK, MRB, DCC, CMS)
| | - Kallan S. Ross
- Hawai‘i Island Family Medicine, Hilo Medical Center, Hilo, HI (KSR)
| | - Abigail C. Santos
- Combined Rush University Medical Center and Cook County Hospital, Chicago, IL (ACS)
| | - Maya R. Barney
- Hawai‘i Center for AIDS, Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (EMK, MRB, DCC, CMS)
| | - Timothy J. McCormick
- Harm Reduction Services Branch, Communicable Disease and Public Health Nursing Division, Hawai‘i State Department of Health (TJM)
| | - Dominic C. Chow
- Hawai‘i Center for AIDS, Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (EMK, MRB, DCC, CMS)
| | - Cecilia M. Shikuma
- Hawai‘i Center for AIDS, Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (EMK, MRB, DCC, CMS)
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Laguno M, Ugarte A, Martinez-Rebollar M, Sobrino Y, Font G, de Lazzari E, de la Mora L, Torres B, Chivite I, Riera J, Ambrosioni J, Inciarte A, González-Cordón A, Rojas J, Cordón E, Blanco JL, Martínez E, Mallolas J. PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement. Enferm Infecc Microbiol Clin 2021; 41:S0213-005X(21)00178-6. [PMID: 34045097 DOI: 10.1016/j.eimc.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pre-Exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection in seronegative people at high risk of becoming infected. This strategy was endorsed in October 2019 by the Spanish Ministry of Health. OBJECTIVE To present the PrEP initial experience in the HIV Unit of the Hospital Clínic of Barcelona, paying special attention to the analysis of the vulnerability factors in the cohort. MATERIALS AND METHODS Retrospective, descriptive study. The epidemiological, sociodemographic, and clinical characteristics of the users included in the program during the first year are analyzed, paying particular attention to Infections, risky practices, and substance use. RESULTS 190 individuals were included, 177 men and 12 trans women with a mean age of 35 years (8 SD). 70% had higher education, and half had Spanish nationality. An average of 10 couples per trimester and 60% reported unprotected anal sex. 31% had at least one positive PCR for STIs, with N. gonorrhoeae being the most prevalent microorganism (51%) and the rectal sample the most affected (21%). 63% reported chemsex use, 19% polydrug use, and 8% "slamming". Half expressed concern about consumption and/or sexual practices and 25% the need for help. CONCLUSIONS The PrEP user profile attended in our Hospital Unit justifies the creation of multidisciplinary teams that allow us to provide holistic attention to the sexual life of these people.
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Affiliation(s)
- Montserrat Laguno
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España.
| | - Ainoa Ugarte
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | | | - Yeray Sobrino
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Guillermo Font
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Elisa de Lazzari
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Lorena de la Mora
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Berta Torres
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Iván Chivite
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Josep Riera
- Servicio de Dermatología, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Juan Ambrosioni
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Alexy Inciarte
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Ana González-Cordón
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Jhon Rojas
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Encarna Cordón
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - José Luis Blanco
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Esteban Martínez
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Josep Mallolas
- Unidad de VIH, Hospital Clínic e IDIBAPS, Universidad de Barcelona, Barcelona, España
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10
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Chas J, Bauer R, Larabi IA, Peytavin G, Roux P, Cua E, Cotte L, Pasquet A, Capitant C, Meyer L, Raffi F, Spire B, Pialoux G, Molina JM, Alvarez JC. Evaluation of Drug Abuse by Hair Analysis and Self-Reported Use Among MSM Under PrEP: Results From a French Substudy of the ANRS-IPERGAY Trial. J Acquir Immune Defic Syndr 2021; 86:552-561. [PMID: 33394814 DOI: 10.1097/qai.0000000000002610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We used the Agence nationale de Recherches sur le sida et les hépatites virales (ANRS)-IPERGAY trial to qualitatively and quantitatively measure drug use among men who have sex with men under preexposure prophylaxis using 2 different methods, to better understand and collectively respond to risky practices. METHOD We included 69 volunteers of the ANRS-IPERGAY trial. We measured drug use by 2 methods: (1) drug detection by hair analysis and (2) reported drug use by self-reported drug consumption. RESULTS New psychoactive substances (NPS) and conventional drugs were detected in 53 of the 69 (77%) volunteers by hair analysis and in 39 of the 69 (57%) volunteers by questionnaires. On the 219 hair segments analyzed, the most commonly used drugs were cocaine in 47 of the 69 (68%), 3,4-methylenedioxymethamphetamine/ecstasy in 31 of the 69 (45%), and NPS in 27 of the 69 (39%). On the 1061 collected questionnaires, the most commonly used drugs were cocaine in 31 of the 69 (45%), 3,4-methylenedioxymethamphetamine/ecstasy in 29 of the 69 (42%), and NPS in 16 of the 69 (23%). Hair analysis detects more conventional drugs and/or NPS use (P < 0.05). Drug use identified by hair was significantly associated with a higher number of sexual partners in the past 2 months (P ≤ 0.001), more often casual partners (P ≤ 0.001), condomless anal sex (P ≤ 0.005), hardcore sexual practices (P ≤ 0.001), a higher number of sexually transmitted infections, and chemsex (P ≤ 0.05). CONCLUSIONS Self-report drug use by questionnaires remains the reference tool for harm reduction at the individual level because of its feasibility and low cost. However, hair analysis is more sensitive, objectively assessing consumption, and interesting to understand uses and to be able to collectively respond to risky practices with adapted messages.
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Affiliation(s)
- Julie Chas
- Département des Maladies Infectieuses, Hôpital Tenon, AP-HP, Paris, France
| | | | - Islam Amine Larabi
- Département de Pharmacologie-Toxicologie, Hôpital Raymond Poincaré, AP-HP, et MassSpecLab, Plateforme de Spectrométrie de Masse, Inserm U-1173, UFR des Sciences de la Santé Simone Veil, Université Paris-Saclay (Versailles Saint-Quentin-en-Yvelines), Garches, France
| | - Gilles Peytavin
- Département de Pharmacologie-Toxicologie, Hôpital Bichat Claude Bernard, AP-HP, et IAME, INSERM, UMRS1137, Université de Paris, Paris, France
| | - Perrine Roux
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Eric Cua
- Département des Maladies Infectieuses, Hôpital de l'Archet, Nice, France
| | - Laurent Cotte
- Département des Maladies Infectieuses, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Armelle Pasquet
- Département des Maladies Infectieuses, Hôpital G Dron, Centre Hospitalier Universitaire de Tourcoing, Tourcoing, France
| | | | - Laurence Meyer
- INSERM SC10 US19, Villejuif, France
- Université Paris Sud, Paris, France
| | - Francois Raffi
- Département des Maladies Infectieuses, Hôtel-Dieu, Nantes, France
| | - Bruno Spire
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gilles Pialoux
- Département des Maladies Infectieuses, Hôpital Tenon, AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Jean-Michel Molina
- Département de Maladies Infectieuses, Hôpital Lariboisière Saint-Louis, Paris, France
- Université de Paris, Paris, France; and
- INSERM U944, Paris, France
| | - Jean-Claude Alvarez
- Département de Pharmacologie-Toxicologie, Hôpital Raymond Poincaré, AP-HP, et MassSpecLab, Plateforme de Spectrométrie de Masse, Inserm U-1173, UFR des Sciences de la Santé Simone Veil, Université Paris-Saclay (Versailles Saint-Quentin-en-Yvelines), Garches, France
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11
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Jolley D, Jaspal R. Discrimination, HIV conspiracy theories and pre-exposure prophylaxis acceptability in gay men. Sex Health 2020; 17:525-533. [PMID: 33341121 DOI: 10.1071/sh20154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
Abstract
Background Combination prevention, which includes pre-exposure prophylaxis (PrEP), is essential for achieving the zero HIV infections target in the UK by 2030. It is important to assess attitudes towards PrEP in at-risk populations. This study focuses on the effect of discrimination and HIV conspiracy theorising on attitudes towards PrEP in gay men in the UK. METHODS In total, 244 White British gay men completed a survey that included demographic questions and measures of sexual health screening, hypervigilance, sexual orientation discrimination, quality of contact with healthcare professionals, belief in conspiracy theories and attitudes towards PrEP. Data were analysed using multiple linear regression and mediation analysis. RESULTS Discrimination was positively correlated with HIV conspiracy beliefs and negatively correlated with PrEP acceptance. Mediation analyses demonstrated that the relationship between discrimination and attitudes towards PrEP was explained by HIV conspiracy theorising. Gay men who had attended a sexual health screening (vs never attended) reported higher belief in HIV conspiracy theories. A further mediation analysis showed that reported poor contact with a healthcare professional was associated with an increased belief in HIV conspiracy theories, which was associated with negative attitudes towards PrEP. Both perceived discrimination and poor contact with a healthcare professional were exacerbated by hypervigilance. CONCLUSIONS HIV conspiracy theorising is an important variable in understanding attitudes towards PrEP among gay men. Its roots are in adverse social experiences (e.g. discrimination, poor contact with healthcare professionals) and its consequences may be the rejection of PrEP. HIV prevention and PrEP campaigns must focus on prejudice reduction and on challenging conspiracy beliefs.
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Affiliation(s)
- Daniel Jolley
- Department of Psychology, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK; and Corresponding author.
| | - Rusi Jaspal
- School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4FQ, UK
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12
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Brady M, Rodger A, Asboe D, Cambiano V, Clutterbuck D, Desai M, Field N, Harbottle J, Jamal Z, McCormack S, Palfreeman A, Portman M, Quinn K, Tenant-Flowers M, Wilkins E, Young I. BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018. HIV Med 2020; 20 Suppl 2:s2-s80. [PMID: 30869189 DOI: 10.1111/hiv.12718] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Michael Brady
- Consultant in Sexual Health and HIV, King's College Hospital, London
| | - Alison Rodger
- Reader and Honorary Consultant Infectious Diseases and HIV, University College London
| | - David Asboe
- Consultant HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Valentina Cambiano
- Lecturer in Infectious Disease Modelling and Biostatistics, University College London
| | | | - Monica Desai
- Consultant Epidemiologist, Public Health England
| | - Nigel Field
- Senior Lecturer, Consultant Clinical Epidemiologist, University College London
| | | | | | - Sheena McCormack
- Professor of Clinical Epidemiology, MRC Clinical Trials Unit at University College London
| | - Adrian Palfreeman
- Consultant HIV and Sexual Health, University Hospitals of Leicester NHS Trust
| | - Mags Portman
- Consultant HIV and Sexual Health, Mortimer Market Centre, London
| | - Killian Quinn
- Consultant HIV and Sexual Health, King's College Hospital, London
| | | | - Ed Wilkins
- Consultant in Infectious Diseases, North Manchester General Hospital
| | - Ingrid Young
- Chancellor's Fellow, Usher Institute, University of Edinburgh
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13
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Olansky E, Mansergh G, Pitts N, Mimiaga MJ, Denson DJ, Landers S, Holman J, Herbst JH. PrEP Awareness in the Context of HIV/AIDS Conspiracy Beliefs Among Black/African American and Hispanic/Latino MSM in Three Urban US Cities. JOURNAL OF HOMOSEXUALITY 2020; 67:833-843. [PMID: 30633661 DOI: 10.1080/00918369.2018.1557953] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We examined HIV conspiracy beliefs and PrEP awareness in a convenience sample of minority MSM. Participants in three cities completed a behavioral self-assessment on sociodemographics, PrEP awareness, and HIV/AIDS conspiracy beliefs. HIV/AIDS conspiracy beliefs were more common among Black than Latino MSM (58% vs. 42%, p < .05), and among younger men than older men (age 18-29 (50%), 30-39 (22%), 40+ (28%); p < .05). PrEP awareness co-occurred with conspiracy belief less (37%) than with non-belief (63%, p < .05), persisting in multivariable regression (aOR = 0.52, 95% CI = 0.38-0.71). This relationship suggests that current HIV care and prevention messaging is either inaccessible or not credible to some minority subpopulations.
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Affiliation(s)
| | | | | | - Matthew J Mimiaga
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | | | - Jeremy Holman
- Health Resources in Action, Boston, Massachusetts, USA
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14
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Gafos M, South A, Hanley B, Brodnicki E, Hodson M, McCormack S, Witzel TC, Harbottle J, Vale C. "PROUD to have been involved": an evaluation of participant and community involvement in the PROUD HIV prevention trial. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:13. [PMID: 32322408 PMCID: PMC7164163 DOI: 10.1186/s40900-020-00189-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND The PROUD trial, a HIV prevention trial in men who have sex with men and trans women, set out to involve community representatives and trial participants in several ways. PROUD also aimed to evaluate participant involvement, to learn lessons and make recommendations for future clinical trials. METHODS Two structured surveys, one of participant and community representatives involved in the PROUD study, and the other of researchers from the PROUD team, were carried out in 2017. The results from the surveys were reviewed quantitatively and qualitatively, and themes emerging from the data identified and synthesised. RESULTS Survey invitations were sent to 88 involved participants, 11 community representatives and 10 researchers. The overall response rate was 55% (60/109). Overall, participants were younger than community representatives, and the majority were from Greater London. As expected, participants were predominantly involved in participant involvement meetings and community representatives in management committees.Participants and community representatives cited different motivations for getting involved in PROUD. Overall, participants were positive about their involvement; only two participants rated their experience unfavourably. Community representatives were also broadly positive. Most participants and all community representatives felt their involvement made a difference to the trial, themselves and / or the organisations they represented. However, some participant answers reflected the impact of participation in the trial rather than involvement in PPI activities.Researchers felt that PPI had positive impact across the entire trial cycle. Half felt they would have liked there to have been more PPI activity in PROUD. Researchers noted some challenges and recommendations for the future, including need for adequate funding, more engagement in PPI by all researchers, the need for PPI expertise to facilitate involvement activities and training and mentoring in PPI. CONCLUSIONS Involving clinical trial participants and wider community representatives as active partners in PPI is feasible and valuable in trials. Researchers are encouraged to consider and appropriately resource participant involvement and prospectively evaluate all PPI within their trials.
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Affiliation(s)
- Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SN UK
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Annabelle South
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Bec Hanley
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | | | - Matthew Hodson
- NAM / aidsmap, Unit 19, St Mark’s Studios, 14 Chillingworth Road, London, N7 8QJ UK
| | - Sheena McCormack
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - T. Charles Witzel
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Claire Vale
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
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15
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Maxwell S, Gafos M, Moncrieff M, Shahmanesh M, Stirrup O. Pre-exposure prophylaxis use among men who have sex with men who have experienced problematic chemsex. Int J STD AIDS 2020; 31:474-480. [PMID: 32075538 PMCID: PMC7814093 DOI: 10.1177/0956462420906927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
Men who have sex with men (MSM) who experience problematic chemsex are at high risk of acquiring HIV due to combined drug use and sexual behaviours. Pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV transmission in this group of men. The aim of this study was to examine the biopsychosocial characteristics associated with PrEP use among HIV-negative MSM who have experienced problematic chemsex. This was a cross-sectional analysis of secondary data collected during client assessments at a specialist alcohol and drug service based within the United Kingdom. We compared the socio-demographics, substance use, sexual behaviours and mental health of MSM who reported ever using PrEP to those who reported never using PrEP. Statistical analysis was conducted using the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Between August 2016 and July 2018, 165 HIV-negative MSM who engaged in chemsex had an assessment completed. Thirty-four per cent (n = 50/145) had ever used PrEP. The median age was 36 years (IQR: 30–42), 92% identified as gay (n = 152/165) and 79% were of white ethnicity (n = 130/164). The use of crystal methamphetamine was associated with higher levels of men ever using PrEP (40% versus 21%) (p= 0.047). Men who had ever used PrEP had a higher median number of sexual partners in the previous three months (20 versus 10) (p= 0.004) and had lower level of condom use in their sex lives (median reported 5% versus 50%) (p= 0.010) in comparison to men who had never used PrEP. It is encouraging that men having higher-risk sex had been accessing PrEP. However, further research is required to explore PrEP uptake, retention and adherence in this high-risk group.
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Affiliation(s)
- Steven Maxwell
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK
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16
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Mudzviti T, Dhliwayo A, Chingombe B, Ngara B, Monera-Penduka TG, Maponga CC, Morse GD. Perspectives on oral pre-exposure prophylaxis use amongst female sex workers in Harare, Zimbabwe. South Afr J HIV Med 2020; 21:1039. [PMID: 32158559 PMCID: PMC7059237 DOI: 10.4102/sajhivmed.v21i1.1039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) could provide protection from human immunodeficiency virus (HIV) infection in sexually active persons at risk. Limited data are available in Zimbabwe with regard to the perceptions about PrEP amongst female sex workers (FSWs). OBJECTIVES The aim of this study was to evaluate the knowledge levels of oral PrEP and the likelihood of its use amongst FSWs. METHOD This was a cross-sectional study in the peri-urban areas of Harare, Zimbabwe. Human immunodeficiency virus-negative FSWs were interviewed to assess their awareness of and likelihood to use PrEP. The relative importance index was used to evaluate the levels of knowledge and the likelihood of, and barriers to, PrEP use. A set of 10 questions was designed and validated that evaluated participants' understanding of PrEP. A bivariate logistic regression model was utilised to identify predictors of PrEP use. RESULTS A total of 131 FSWs with a median age of 25 years (interquartile range: 21-31) participated in this study. Of the 71 (54%) FSWs who had heard about PrEP, 46 (35%) participants had adequate knowledge of its use. A total of 102 (78%) participants revealed that they would be willing to continuously use PrEP if it was provided free of cost. Increasing age of the participants was associated with an increase in the likelihood of using PrEP (r = 0.0033, p = 0.038). More knowledge about PrEP increased the likelihood of its use (r = 0.21, p = 0.0153). This likelihood increased amongst participants with an unprotected sexual intercourse encounter in the preceding 3 months (r = 0.0448, p = 0.026). CONCLUSION Knowledge of PrEP amongst FSWs was low. To increase the uptake of PrEP, there is a need to further sensitise FSWs about this intervention. Programmes should also promote awareness training in FSW subgroups that are less likely to use PrEP.
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Affiliation(s)
- Tinashe Mudzviti
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
- Newlands Clinic, Harare, Zimbabwe
| | - Anesu Dhliwayo
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
| | | | - Bernard Ngara
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Charles C. Maponga
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
- Population Services International, Harare, Zimbabwe
- Center for Integrated Global Biomedical Sciences, University at Buffalo, New York, United States
| | - Gene D. Morse
- Center for Integrated Global Biomedical Sciences, University at Buffalo, New York, United States
- Translational Pharmacology Research Core, University at Buffalo, New York, United States
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17
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O'Halloran C, Rice B, White E, Desai M, Dunn DT, McCormack S, Sullivan AK, White D, McOwan A, Gafos M. Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:246-254. [PMID: 31739177 PMCID: PMC6913514 DOI: 10.1016/j.drugpo.2019.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants. METHODS The PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI). RESULTS 1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90-1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline. CONCLUSIONS These analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.
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Affiliation(s)
- Charlotte O'Halloran
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Brian Rice
- LSHTM, Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Ellen White
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Monica Desai
- University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - David T Dunn
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
| | - David White
- Department of Infection, Hawthorn house, Heartlands Hospital, University of Birmingham Hospitals NHS Trust, Birmingham B9 5SS, United Kingdom.
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, 56 Dean Street, London W1D 6AE, United Kingdom.
| | - Mitzy Gafos
- LSHTM, Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
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18
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White E, Dunn DT, Desai M, Gafos M, Kirwan P, Sullivan AK, Clarke A, McCormack S. Predictive factors for HIV infection among men who have sex with men and who are seeking PrEP: a secondary analysis of the PROUD trial. Sex Transm Infect 2019; 95:449-454. [PMID: 30918121 PMCID: PMC6824743 DOI: 10.1136/sextrans-2018-053808] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/12/2018] [Accepted: 01/03/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) is a highly effective method of HIV prevention for men who have sex with men (MSM). However, uncertainty remains around the optimal eligibility criteria for PrEP, specifically whether there are subgroups at low risk of HIV for whom PrEP might not be warranted. METHODS PROUD was an open-label waitlist trial design that randomised MSM attending participating sexual health centres in England to receive PrEP immediately (IMM) or after a deferral period of 1 year (DEF). This analysis is based on participants who were randomised to the deferred arm, when they did not have access to PrEP. HIV incidence was compared between subgroups defined by baseline characteristics. RESULTS Overall, 21 participants acquired HIV infection over 239.3 person-years (PY) follow-up, yielding an incidence rate of 8.8/100 PY (95% CI 5.4 to 13.4). Two highly significant predictors for HIV acquisition were identified. Men with a self-reported diagnosis of syphilis, rectal chlamydia (CT) or rectal gonorrhoea (GC) in the previous 12 months had an incidence of 17.2/100 PY (95% CI 9.7 to 28.5); those reporting receptive anal intercourse without a condom (ncRAI) with two or more partners in the previous 3 months had an incidence of 13.6/100 PY (95% CI 7.9 to 21.7). The incidence rate among participants lacking both of these risk factors was 1.1/100 PY (1/87.6, 95% CI 0.03 to 6.4). CONCLUSIONS The high HIV incidence in PROUD suggests that most participants appropriately judged their need for PrEP. Eligibility criteria for a PrEP programme can therefore be broad, as in the current guidelines. However, a recent history of syphilis or rectal CT/GC, or multiple ncRAI partners indicates a high imminent risk of HIV infection. MSM with any of these characteristics should be offered PrEP as a matter of urgency.
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Affiliation(s)
- Ellen White
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - David T Dunn
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, Manchester, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Kirwan
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - Ann K Sullivan
- St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Department of HIV, Sexual Health and Contraception, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit at University College London, London, UK
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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19
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Gafos M, Horne R, Nutland W, Bell G, Rae C, Wayal S, Rayment M, Clarke A, Schembri G, Gilson R, McOwan A, Sullivan A, Fox J, Apea V, Dewsnap C, Dolling D, White E, Brodnicki E, Wood G, Dunn D, McCormack S. The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour. AIDS Behav 2019; 23:1708-1720. [PMID: 30306439 PMCID: PMC6570678 DOI: 10.1007/s10461-018-2300-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There are still important gaps in our understanding of how people will incorporate PrEP into their existing HIV prevention strategies. In this paper, we explore how PrEP use impacted existing sexual risk behaviours and risk reduction strategies using qualitative data from the PROUD study. From February 2014 to January 2016, we conducted 41 in-depth interviews with gay, bisexual and other men who have sex with men (GBMSM) enrolled in the PROUD PrEP study at sexual health clinics in England. The interviews were conducted in English and were audio-recorded. The recordings were transcribed, coded and analysed using framework analysis. In the interviews, we explored participants' sexual behaviour before joining the study and among those using or who had used PrEP, changes to sexual behaviour after starting PrEP. Participants described the risk behaviour and management strategies before using PrEP, which included irregular condom use, sero-sorting, and strategic positioning. Participants described their sexual risk taking before initiating PrEP in the context of the sexualised use of drugs, geographical spaces linked with higher risk sexual norms, and digitised sexual networking, as well as problematic psychological factors that exacerbated risk taking. The findings highlight that in the main, individuals who were already having frequent condomless sex, added PrEP to the existing range of risk management strategies, influencing the boundaries of the 'rules' for some but not all. While approximately half the participants reduced other risk reduction strategies after starting PrEP, the other half did not alter their behaviours. PrEP provided an additional HIV prevention option to a cohort of GBMSM at high risk of HIV due to inconsistent use of other prevention options. In summary, PrEP provides a critical and necessary additional HIV prevention option that individuals can add to existing strategies in order to enhance protection, at least from HIV. As a daily pill, PrEP offers protection in the context of the sex cultures associated with sexualised drug use, digitised sexual applications and shifting social norms around sexual fulfilment and risk taking. PrEP can offer short or longer-term options for individuals as their sexual desires change over their life course offering protection from HIV during periods of heightened risk. PrEP should not be perceived or positioned in opposition to the existing HIV prevention toolkit, but rather as additive and as a tool that can and is having a substantial impact on HIV.
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Affiliation(s)
- Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Rob Horne
- School of Pharmacy, University College London, London, UK
| | | | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Mortimer Market Centre, Institute for Global Health, UCL, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Richard Gilson
- The Mortimer Market Centre, Institute for Global Health, University College London, London, UK
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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20
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Hoornenborg E, Achterbergh RC, van der Loeff MFS, Davidovich U, van der Helm JJ, Hogewoning A, van Duijnhoven YT, Sonder GJ, de Vries HJ, Prins M. Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: baseline analysis of a demonstration study in Amsterdam. J Int AIDS Soc 2019; 21:e25105. [PMID: 29603900 PMCID: PMC5878413 DOI: 10.1002/jia2.25105] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/08/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The Amsterdam PrEP project is a prospective, open-label demonstration study at a large sexually transmitted infection (STI) clinic. We examined the uptake of PrEP; the baseline characteristics of men who have sex with men (MSM) and transgender persons initiating PrEP; their choices of daily versus event-driven PrEP and the determinants of these choices. METHODS From August 2015 through May 2016, enrolment took place at the STI clinic of the Public Health Service of Amsterdam, the Netherlands. MSM or transgender persons were eligible if they had at least one risk factor for HIV infection within the preceding six months. Participants were offered a choice between daily or event-driven use of tenofovir/emtricitabine. Baseline data were analysed using descriptive statistics and multivariable analysis was employed to determine variables associated with daily versus event-driven PrEP. RESULTS Online applications were submitted by 870 persons, of whom 587 were invited for a screening visit. Of them, 415 were screened for eligibility and 376 initiated PrEP. One quarter (103/376, 27%) chose event-driven PrEP. Prevalence of bacterial STI was 19.0% and mean condomless anal sex (CAS) episodes in the preceding three months were 11. In multivariable analysis, older age (≥45 vs. ≤34, aOR 2.1, 95% CI 1.2 to 3.9), being involved in a steady relationship (aOR 1.7, 95% CI 1.0 to 2.7), no other daily medication use (aOR 0.6, 95% CI 0.3 to 0.9), and fewer episodes of CAS (per log increase aOR 0.7, 95% CI 0.6 to 0.9) were determinants for choosing event-driven PrEP. DISCUSSION PrEP programmes are becoming one of the more important intervention strategies with the goal of reducing incident HIV-infection and we were unable to accommodate many of the persons applying for this study. Offering a choice of dosing regimen to PrEP users may enable further personalization of HIV prevention strategies and enhance up-take, adherence and cost-effectiveness. CONCLUSIONS The majority of participants preferred daily versus event-driven use. Within this majority, a high number of CAS episodes before PrEP initiation was reported and we observed a high prevalence of STI. Determinants of choosing event-driven PrEP were older age, fewer CAS episodes, no other daily medication use, and involved in a steady relationship.
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Affiliation(s)
- Elske Hoornenborg
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, STI Outpatient Clinic, Amsterdam, the Netherlands
| | - Roel Ca Achterbergh
- Department of Infectious Diseases, Public Health Service of Amsterdam, STI Outpatient Clinic, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Academic Medical Center, Center for Immunity and Infection Amsterdam (CINIMA), University of Amsterdam, Amsterdam, the Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Academic Medical Center, Center for Immunity and Infection Amsterdam (CINIMA), University of Amsterdam, Amsterdam, the Netherlands
| | - Jannie J van der Helm
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Arjan Hogewoning
- Department of Infectious Diseases, Public Health Service of Amsterdam, STI Outpatient Clinic, Amsterdam, the Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Gerard Jb Sonder
- Department of Infectious Diseases, Communicable Diseases Control, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Henry Jc de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, STI Outpatient Clinic, Amsterdam, the Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.,Department of Infectious Diseases, Academic Medical Center, Center for Immunity and Infection Amsterdam (CINIMA), University of Amsterdam, Amsterdam, the Netherlands
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21
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Miltz AR, Lampe FC, Bacchus LJ, McCormack S, Dunn D, White E, Rodger A, Phillips AN, Sherr L, Clarke A, McOwan A, Sullivan A, Gafos M. Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial. BMC Public Health 2019; 19:431. [PMID: 31023281 PMCID: PMC6482482 DOI: 10.1186/s12889-019-6757-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP). Methods PROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points. Results At month-12 (N = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 (N = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p < 0.001 for all); IPV was not consistently associated with measures of condomless anal sex or high partner numbers. Conclusions GBMSM at high-risk of HIV who are seeking/taking PrEP may experience a high burden of IPV, which may be linked to depression. Training on awareness of and enquiry for IPV among GBMSM in sexual health clinics is recommended. Trial registration ClinicalTrials.gov identifier: NCT02065986. Registered 19 February 2014 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-019-6757-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ada R Miltz
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK.
| | - Fiona C Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - David Dunn
- MRC Clinical Trials Unit, University College London, London, UK
| | - Ellen White
- MRC Clinical Trials Unit, University College London, London, UK
| | - Alison Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Andrew N Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | | | - Ann Sullivan
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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22
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Orser L, O'Byrne P. The role of public health units in the delivery of HIV pre-exposure prophylaxis (PrEP). CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:72-75. [PMID: 30341481 PMCID: PMC6964540 DOI: 10.17269/s41997-018-0141-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/21/2018] [Indexed: 02/07/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy involving the use of once daily antiretroviral medications to prevent HIV infection. Available research supports that PrEP, when used as prescribed, can prevent HIV transmission by upwards of 96%. Such findings have led to the development of research publications and guidelines supporting PrEP for individuals at high risk for HIV acquisition, such as men who have sex with men (MSM). Despite its benefit, current use of PrEP in clinical settings has been undermined by false impressions of poor efficacy of PrEP and concerns about increased risk-taking among MSM should PrEP be readily available. Furthermore, guidance for the role of public health units in PrEP access has not been well defined. While we maintain that PrEP should be available to any person who requests it, we feel that public health units should focus on those at highest risk for HIV acquisition, and, in doing so, possibly reduce local HIV rates.
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Affiliation(s)
- Lauren Orser
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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23
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Expanding the Menu of HIV Prevention Options: A Qualitative Study of Experiences with Long-Acting Injectable Cabotegravir as PrEP in the Context of a Phase II Trial in the United States. AIDS Behav 2018; 22:3540-3549. [PMID: 29290075 DOI: 10.1007/s10461-017-2017-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adherence challenges with oral pre-exposure prophylaxis have stimulated interest in alternate modes of administration including long-acting injections. We conducted 30 in-depth interviews with 26 male trial participants and 4 clinical providers in a Phase IIa study (ÉCLAIR) evaluating the use of long-acting cabotegravir (CAB-LA) injections in New York and San Francisco. Interviews exploring attitudes and experiences with CAB-LA were audiotaped, transcribed, and analyzed using thematic content analysis. Despite a high frequency of some level of side effects, almost all participants reported being interested in continuing with CAB-LA, versus a daily oral, due to its convenience and the perceived advantage of not worrying about adhering to pills. Providers reinforced the importance of CAB-LA as a prevention option and the need for guidelines to assist patient decision-making. Further research is needed on the acceptability of CAB-LA among men and women at higher risk for HIV in different settings.
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24
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Edmundson C, Heinsbroek E, Glass R, Hope V, Mohammed H, White M, Desai M. Sexualised drug use in the United Kingdom (UK): A review of the literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:131-148. [PMID: 29625796 DOI: 10.1016/j.drugpo.2018.02.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/22/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Sexualised drug use (SDU) refers to the use of drugs in a sexual context. This includes 'Chemsex'- the use of drugs (specifically crystal methamphetamine, GHB/GBL and mephedrone) before or during planned sexual activity to sustain, enhance, disinhibit or facilitate the experience. Here we aimed to synthesise available UK prevalence data for Chemsex, SDU and the use of Chemsex drugs in an undefined context (CDU) in men who have sex with men (MSM). METHODS Papers published between January 2007 and August 2017 reporting Chemsex, SDU and/or Chemsex drug use (CDU) prevalence in MSM were identified through PubMed. Citations were searched for further eligible publications. We also conducted a review of national surveillance data, extracting prevalence data for Chemsex, SDU or CDU. Synthesized data were then assessed to determine the time at which these drugs were taken, in this case just prior to or during sexual activity (event-level). RESULTS Our search identified 136 publications, of which 28 were included in the final data synthesis. Three of the four surveillance systems assessed provided SDU or CDU data in MSM. Few publications included event-level data for Chemsex (n = 4), with prevalence estimates ranging from 17% among MSM attending sexual health clinics (SHC) to 31% in HIV-positive MSM inpatients. Prevalence estimates for SDU (n = 7 publications) also varied considerably between 4% in MSM receiving HIV care to 41% among MSM attending SHC for HIV post-exposure prophylaxis (PEP). Eighteen publications provided data for CDU. CONCLUSION Prevalence estimates varied considerably due to differences in the definition used and population assessed. Standardised definitions and studies with representative national samples of MSM are required to improve our understanding of the extent of Chemsex and its associated risks. Longitudinal event-level data for SDU and Chemsex are needed to monitor impact of interventions.
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Affiliation(s)
- Claire Edmundson
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Ellen Heinsbroek
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Rachel Glass
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Vivian Hope
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Public Health Institute, Liverpool John Moores University, 2nd Floor Henry Cotton Campus, 15-21 Webster Street, Liverpool L3 2ET, United Kingdom
| | - Hamish Mohammed
- HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Martin White
- Alcohol, Drugs and Tobacco, Health Improvement, Public Health England, Skipton House, 80 London Road, London SE1 6LH, United Kingdom
| | - Monica Desai
- National Institute for Health and Care Excellence, Level 1A, City Tower, Picadilly Plaza, Manchester M1 4BT, United Kingdom
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25
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Wilton J, Noor SW, Schnubb A, Lawless J, Hart TA, Grennan T, Fowler S, Maxwell J, Tan DHS. High HIV risk and syndemic burden regardless of referral source among MSM screening for a PrEP demonstration project in Toronto, Canada. BMC Public Health 2018; 18:292. [PMID: 29486737 PMCID: PMC5830065 DOI: 10.1186/s12889-018-5180-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/19/2018] [Indexed: 11/24/2022] Open
Abstract
Background To maximize public health impact and cost-effectiveness, HIV pre-exposure prophylaxis (PrEP) must reach individuals at high HIV risk. Referrals for PrEP can be self- or provider-initiated, but there are several challenges to both. We assessed whether HIV risk differed by referral source among gay, bisexual and other men who have sex (gbMSM) screening for an HIV PrEP demonstration project. Methods PREPARATORY-5 was an open-label PrEP demonstration project enrolling gbMSM at high risk of HIV acquisition in Toronto, Canada. Study eligibility criteria related to high risk was defined as scoring ≥10 on the HIV Incidence Risk Index for MSM (HIRI-MSM) and engaging in at least 1 act of condomless receptive anal sex within the past 6 months. Recruitment was promoted through self-referrals (ads in a sexual networking app and gay newspaper/website) and provider-referrals (10 community-based organizations, CBOs). HIV risk score (HIRI-MSM) and syndemic health burden were measured among gbMSM screened for study participation and compared according to referral source. Results Between October 16 and December 30, 2014, online ads generated 1518 click-throughs and CBOs referred 115 individuals. Overall, 165 men inquired about the trial, of which 86 underwent screening. The majority of screened men were self-referrals (60.5%), scored ≥10 on HIRI-MSM (96.5%), and reported condomless receptive anal sex in the past 6 months (74.2%). Self- and provider-referrals had similarly high HIV risk profiles, with a median (IQR) HIRI-MSM score of 26.0 (19.0–32.5) and 28.5 (20.0–34.0) (p = 0.3), and 75.0% and 73.5% reporting condomless receptive anal sex (p = 0.9), respectively. The overall burden of syndemic health problems was also high, with approximately one-third overall identified as having depressive symptoms (39.5%), alcohol-related problems (39.5%), multiple drug use (31.4%), or sexual compulsivity (31.4%). There were no significant differences in syndemic health problems by referral source. Conclusions HIV risk and syndemic burden were high among gbMSM presenting for this PrEP demonstration project regardless of referral source. Self-referral may be a useful and efficient strategy for identifying individuals suitable for PrEP use. Online strategies and CBOs working in gay men’s health may play important roles in connecting individuals at high HIV risk to PrEP services. Trial registration ClinicalTrials.gov NCT02149888. Registered May 12th 2014.
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Affiliation(s)
- James Wilton
- Applied Epidemiology Unit, Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Alexandre Schnubb
- Division of Infectious Diseases, St. Michael's Hospital, 30 Bond St, 4CC - Room 4-179, Toronto, ON, M5B 1W8, Canada
| | - James Lawless
- Division of Infectious Diseases, St. Michael's Hospital, 30 Bond St, 4CC - Room 4-179, Toronto, ON, M5B 1W8, Canada
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - John Maxwell
- ACT (AIDS Committee of Toronto), Toronto, Ontario, Canada
| | - Darrell H S Tan
- Division of Infectious Diseases, St. Michael's Hospital, 30 Bond St, 4CC - Room 4-179, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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26
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Response to the Hammoud et al paper on 'the new MTV generation'. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:205-206. [PMID: 29395698 DOI: 10.1016/j.drugpo.2018.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/03/2018] [Accepted: 01/17/2018] [Indexed: 11/21/2022]
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27
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Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG, Furegato M, Hughes G, Connor N, Delpech VC, Gill ON. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? ACTA ACUST UNITED AC 2017; 22:30553. [PMID: 28662762 PMCID: PMC5490453 DOI: 10.2807/1560-7917.es.2017.22.25.30553] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 11/27/2022]
Abstract
Since October 2015 up to September 2016, HIV diagnoses fell by 32% compared with October 2014–September 2015 among men who have sex with men (MSM) attending selected London sexual health clinics. This coincided with high HIV testing volumes and rapid initiation of treatment on diagnosis. The fall was most apparent in new HIV testers. Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable.
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Affiliation(s)
- Alison E Brown
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom.,These authors contributed equally to this work and share first authorship
| | - Hamish Mohammed
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom.,These authors contributed equally to this work and share first authorship
| | - Dana Ogaz
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Peter D Kirwan
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Mandy Yung
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Sophie G Nash
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Martina Furegato
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Nicky Connor
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Valerie C Delpech
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - O Noel Gill
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
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Abstract
Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.
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Affiliation(s)
- Monica Desai
- HIV and STI Department, Public Health England, London NW9 5EQ, UK
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, University College London, London WC1E 6BT, UK
| | - Robert Grant
- University of California School of Medicine; Gladstone Institutes; San Francisco AIDS Foundation, San Francisco, CA 94115, USA
| | - Sheena McCormack
- MRC Clinical Trials Unit, University College London, London
- Chelsea and Westminster Hospital, London SW10 9BH
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Vaccher SJ, Grulich AE, Haire BG, Conway DP, Poynten IM, Ooi C, Foster R, Templeton DJ, Zablotska IB. Validation of participant eligibility for pre-exposure prophylaxis: Baseline data from the PRELUDE demonstration project. PLoS One 2017; 12:e0185398. [PMID: 28950022 PMCID: PMC5614574 DOI: 10.1371/journal.pone.0185398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/10/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In Australia, pre-exposure prophylaxis (PrEP) is targeted to individuals at high risk for HIV infection. We describe the HIV risk profile and characteristics of PRELUDE participants, and evaluate the population validity of the sample in representing high-risk gay and bisexual men (GBM) eligible for PrEP. METHODS PRELUDE is an on-going, open-label, single-arm observational study. Participants were identified in clinics and screened for eligibility using a paper-based risk assessment tool which followed the New South Wales (NSW) PrEP guidelines. Selection was validated using an independent online behavioural survey, completed by study participants upon enrolment. Demographic information was analysed using descriptive statistics, and kappa tests were used to determine agreement between reporting of high-risk practices in the risk assessment and behavioural survey. RESULTS During 2014-15, 471 individuals were targeted for enrolment; 341 were assessed for PrEP eligibility and 313 were enrolled. Of these, 303 (97%) identified as GBM. Overall, 85% of GBM met at least one high-risk criterion; 68% reported receptive intercourse with an HIV-positive or unknown status casual male partner, and 37% reported methamphetamine use in the three months preceding enrolment. The remaining 15% were enrolled based on medium-risk behaviours, or at the clinicians' discretion. We found an 82% total agreement between self-reported high-risk behaviour and clinicians' categorisation of GBM as being at high risk for HIV based on PrEP eligibility criteria. CONCLUSIONS Behavioural eligibility criteria used by clinicians successfully identified individuals at high risk for HIV infection. This targeted approach ensures that the greatest public health and HIV prevention benefits can be derived in a setting without universal access to PrEP.
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Affiliation(s)
- Stefanie J. Vaccher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail: (SJV); (IBZ)
| | - Andrew E. Grulich
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Bridget G. Haire
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Damian P. Conway
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Isobel M. Poynten
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia
| | - Rosalind Foster
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- Clinic 16, Northern Sydney Sexual Health, St Leonards, New South Wales, Australia
| | - David J. Templeton
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- RPA Sexual Health, Sydney Local Health District and Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Iryna B. Zablotska
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail: (SJV); (IBZ)
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Bull L, Dimitrijevic P, Beverley S, Scarborough A, Mandalia S, Dosekun O, Barber T, Reeves I, McCormack S, Rayment M. Perceived need of, and interest in, HIV pre-exposure prophylaxis amongst men who have sex with men attending three sexual health clinics in London, UK. Int J STD AIDS 2017; 29:435-442. [PMID: 28927341 DOI: 10.1177/0956462417730259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) has proven efficacy in reducing the risk of HIV infection in men who have sex with men (MSM), but has not yet been commissioned in the UK. The aim of this study was to investigate perceived need and benefit (or experience of) PrEP among HIV-negative MSM attending sexual health clinics. HIV-negative MSM attending three sexual health centres in London, UK were opportunistically invited to complete a questionnaire. Data collected comprised demographic data and sexual and drug use behaviours as well as questions regarding perceptions of risk and need for PrEP. Logistic regression analysis was undertaken to identify variables predicting acceptability of, and intention to use, PrEP. In addition, data were gathered in respondents already taking PrEP. Eight hundred and thirty-nine questionnaires were analysed. The median age of respondents was 35 years (IQR 28-41, range 18-78), 650 (77%) were of white ethnicity and 649 (77%) had a university education. Four hundred and fifty-six (54%) reported at least one episode of condomless anal sex in the preceding three months, 437 (52%) reported recreational drug use in the preceding three months and 311 (37%) had been diagnosed with a sexually transmitted infection within the preceding six months. Four hundred and sixty-three (64%) of 726 strongly agreed with the statement 'I think I would benefit from PrEP'. Multivariate logistic regression analysis demonstrated that having receptive anal intercourse (RAI) without condoms, having an awareness of the risk of unprotected RAI and having belief in the effectiveness of PrEP were independent predictors for someone thinking they would benefit from taking PrEP. Eight percent of respondents (59/724) had already taken or were currently taking PrEP. The results suggest that individuals at risk are likely to perceive themselves as benefiting from PrEP. The majority perceived their risk of acquiring HIV and benefit from PrEP accurately. Overall they appeared to have little concern over the use of PrEP and generally positive attitudes. Further investigation is warranted to understand why those at risk do not perceive benefit from PrEP.
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Affiliation(s)
- Lauren Bull
- 1 Chelsea and Westminster Hospital, London, UK
| | | | | | | | | | | | | | - Iain Reeves
- 3 Homerton University Hospital foundation trust, London, UK
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31
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Gourlay A, Fox J, Gafos M, Fidler S, Nwokolo N, Clarke A, Gilson R, Orkin C, Collins S, Porter K, Hart G. A qualitative study exploring the social and environmental context of recently acquired HIV infection among men who have sex with men in South-East England. BMJ Open 2017; 7:e016494. [PMID: 28851787 PMCID: PMC5629694 DOI: 10.1136/bmjopen-2017-016494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES A key UK public health priority is to reduce HIV incidence among gay and other men who have sex with men (MSM). This study aimed to explore the social and environmental context in which new HIV infections occurred among MSM in London and Brighton in 2015. DESIGN A qualitative descriptive study, comprising in-depth interviews, was carried out as a substudy to the UK Register of HIV Seroconverters cohort: an observational cohort of individuals whose date of HIV seroconversion was well estimated. An inductive thematic analysis was conducted in NVivo, guided by a socio-ecological framework. SETTING Participants were recruited from six HIV clinics in London and Brighton. Fieldwork was conducted between January and April 2015. PARTICIPANTS All MSM eligible for the UK Register Seroconverter cohort (an HIV-positive antibody test result within 12 months of their last documented HIV-negative test or other laboratory evidence of HIV seroconversion) diagnosed within the past 12 months and aged ≥18 were eligible for the qualitative substudy. 21 MSM participated, aged 22-61 years and predominantly white. RESULTS A complex interplay of factors, operating at different levels, influenced risk behaviours and HIV acquisition. Participants saw risk as multi-factorial, but the relative importance of factors varied for each person. Individual psycho-social factors, including personal history, recent life stressors and mental health, enhanced vulnerability towards higher risk situations, while features of the social environment, such as chemsex and social media, and prevalent community beliefs regarding treatment and HIV normalisation, encouraged risk taking. CONCLUSIONS Recently acquired HIV infection among MSM reflects a complex web of factors operating at different levels. These findings point to the need for multi-level interventions to reduce the risk of HIV acquisition among high-risk MSM in the UK and similar settings.
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Affiliation(s)
- Annabelle Gourlay
- Faculty of Population Health Sciences, University College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, London, UK
| | - Julie Fox
- Guys and St Thomas’ NHS Trust/ King’s College London, London, UK
| | - Mitzy Gafos
- Faculty of Population Health Sciences, University College London, London, UK
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Nneka Nwokolo
- 56 Dean Street, Department of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Elton John Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospital, Brighton, UK
| | - Richard Gilson
- Faculty of Population Health Sciences, University College London, London, UK
| | - Chloe Orkin
- Ambrose King Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Kholoud Porter
- Faculty of Population Health Sciences, University College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, London, UK
| | - Graham Hart
- Faculty of Population Health Sciences, University College London, London, UK
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Abstract
OBJECTIVES AND DESIGN Hepatitis C virus (HCV) has been recognized as an emerging sexually transmitted infection (STI) among HIV-positive MSM. However, HIV-negative MSM at high risk for HIV might also be at increased risk for HCV. We studied the HCV prevalence in HIV-negative MSM who start preexposure prophylaxis (PrEP) in Amsterdam. Phylogenetic analysis was used to compare HCV strains obtained from HIV-negative and HIV-positive MSM. METHODS At enrolment in the Amsterdam PrEP demonstration project, HIV-negative MSM were tested for the presence of HCV antibodies and HCV RNA. If positive for HCV RNA, an HCV NS5B gene fragment (709 bp) was sequenced and compared with HCV isolates from HIV-positive MSM (n = 223) and risk groups other than MSM (n = 153), using phylogenetic analysis. RESULTS Of 375 HIV-negative MSM enrolled in Amsterdam PrEP, 18 (4.8%, 95% confidence interval 2.9-7.5%) of participants were anti-HCV and/or HCV RNA positive at enrolment; 15 of 18 (83%) had detectable HCV RNA. HCV genotyping showed genotype 1a (73%), 4d (20%), and 2b (7%). All HCV-positive MSM starting PrEP were part of MSM-specific HCV clusters containing MSM with and without HIV. CONCLUSION HCV prevalence among HIV-negative MSM who started PrEP was higher than previously reported. All HIV-negative HCV-positive MSM were infected with HCV strains already circulating among HIV-positive MSM. The increasing overlap between sexual networks of HIV-positive and HIV-negative MSM might result in an expanding HCV-epidemic irrespective of HIV-status. Hence, routine HCV testing should be offered to MSM at high risk for HIV, especially for those enrolling in PrEP programs.
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Gafos M, Brodnicki E, Desai M, McCormack S, Nutland W, Wayal S, White E, Wood G, Barber T, Bell G, Clarke A, Dolling D, Dunn D, Fox J, Haddow L, Lacey C, Nardone A, Quinn K, Rae C, Reeves I, Rayment M, White D, Apea V, Ayap W, Dewsnap C, Collaco-Moraes Y, Schembri G, Sowunmi Y, Horne R. Acceptability of an open-label wait-listed trial design: Experiences from the PROUD PrEP study. PLoS One 2017; 12:e0175596. [PMID: 28426834 PMCID: PMC5398545 DOI: 10.1371/journal.pone.0175596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND PROUD participants were randomly assigned to receive pre-exposure prophylaxis (PrEP) immediately or after a deferred period of one-year. We report on the acceptability of this open-label wait-listed trial design. METHODS Participants completed an acceptability questionnaire, which included categorical study acceptability data and free-text data on most and least liked aspects of the study. We also conducted in-depth interviews (IDI) with a purposely selected sub-sample of participants. RESULTS Acceptability questionnaires were completed by 76% (415/544) of participants. After controlling for age, immediate-group participants were almost twice as likely as deferred-group participants to complete the questionnaire (AOR:1.86;95%CI:1.24,2.81). In quantitative data, the majority of participants in both groups found the wait-listed design acceptable when measured by satisfaction of joining the study, intention to remain in the study, and interest in joining a subsequent study. However, three-quarters thought that the chance of being in the deferred-group might put other volunteers off joining the study. In free-text responses, data collection tools were the most frequently reported least liked aspect of the study. A fifth of deferred participants reported 'being deferred' as the thing they least liked about the study. However, more deferred participants disliked the data collection tools than the fact that they had to wait a year to access PrEP. Participants in the IDIs had a good understanding of the rationale for the open-label wait-listed study design. Most accepted the design but acknowledged they were, or would have been, disappointed to be randomised to the deferred group. Five of the 25 participants interviewed reported some objection to the wait-listed design. CONCLUSION The quantitative and qualitative findings suggest that in an environment where PrEP was not available, the rationale for the wait-listed trial design was well understood and generally acceptable to most participants in this study.
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Affiliation(s)
- Mitzy Gafos
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Monica Desai
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Will Nutland
- Sigma research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Tristan Barber
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amanda Clarke
- Claude Nichol Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Julie Fox
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lewis Haddow
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Charles Lacey
- York Hospitals NHS Foundation Trust, York, United Kingdom
| | - Anthony Nardone
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Killian Quinn
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Rae
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Iain Reeves
- Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Rayment
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - David White
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wilbert Ayap
- St Mary’s Hospital, Imperial College NHS Foundation Trust, London, United Kingdom
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Yolanda Collaco-Moraes
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Yinka Sowunmi
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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