Anti-retroviral Therapy Based HIV Prevention Among a Sample of Men Who Have Sex with Men in Cape Town, South Africa: Use of Post-exposure Prophylaxis and Knowledge on Pre-exposure Prophylaxis.

Abstract

Men who have Sex with Men (MSM) have been affected disproportionately by the global HIV pandemic. Rates of consistent condom-use are low and there is a need for further biomedical prevention interventions to prevent new HIV infections. Post exposure prophylaxis (PEP) can reduce the risk of HIV, but uptake among MSM is low. Pre-exposure prophylaxis (PrEP), an innovative anti-retroviral-based HIV prevention tool might be an appropriate intervention for MSM who have recently accessed PEP that involves HIV negative individuals taking daily tenofovir+emtricitabine for HIV prevention. 44 MSM, attending a primary health-care level MSM-focused sexual health clinic in Cape Town, South Africa, who had initiated PEP were enrolled in this study. Participants were followed up after 2, 4 and 12weeks. Self-administered electronic surveys were completed at the initial, 4 and 12week visit. Barriers and facilitators to accessing PEP and remaining adherent were examined, as was knowledge about PrEP. Thirty-two participants (80%) were <40years of age (range 20-65years). 35% of the participants reported their reason for requiring PEP as condomless receptive anal intercourse. A further 20% required PEP following condomless penetrative anal intercourse; 27.5% required PEP due to a broken condom during receptive anal sex and 2 participants during insertive anal sex. Three participants did not complete 28days of PEPor were lost to follow up. Over half (58.5%) of the participants reported being completely adherent to their regime; under a third (31.7%) reported missing one PEP dose; and 9.8% reported missing more than one dose. 36/40 (90%) had heard of PrEP and 30/40 (75%) indicated that they would use PrEP if it were accessible to them. Thatwe enrolled 44 MSM who accessed PEP from a Department of Health affiliated clinic over 12months, speaks to the low uptake by MSM of PEP services in South Africa. Adherence was high and demonstrates that adherence support is feasible from a state health clinic. Reported risk behaviors in some high-risk participants did not change over time, demonstrating the need for additional longer-term HIV preventions such as PrEP. PEP users could conceivably be transitioned from PEP to PrEP.