PG-8 Characterization of pre exposure prophylaxis (PrEP) cascade among Nigerian MSM

Abstract

Introduction: With an estimated HIV incidence of 15.4/100 person years, Nigerian men who have sex with men (MSM) account for one of the highest HIV incidence among members of key populations. Proven HIV biomedical intervention such as Pre exposure Prophylaxis (PrEP) will potentially decrease new HIV infections and likely benefit MSM in this setting. Here we characterize engagement in the HIV PrEP cascade and assess factors associated with PrEP initiation among Nigerian MSM. Methods: The TRUST/RV368 cohort employs respondent-driven-sampling (RDS) to recruit MSM into HIV/STI prevention and treatment services in Abuja and Lagos, Nigeria. HIV negative MSM at the Abuja site who completed a survey instrument on awareness and willingness to use PrEP were approached by telephone for PrEP initiation. Follow-up visits were one month after enrollment and quarterly thereafter. Bivariate logistic regression models were used to assess factors associated with PrEP initiation. Results: Between March 2013 and July 2018, 428 HIV negative MSM completed the survey instrument on awareness and willingness to use PrEP. Of these, 13 (3%) seroconverted during their initial follow up prior to PrEP initiation and were excluded, and the remaining 415 were included in these analyses. Participants had a median age of 25 (interquartile range [IQR]: 22–29) years. Among 415 HIV negative, 250 (60%) were successfully contacted, 144 (35%) screened and 133 (32%) initiated PrEP (Figure 1). Younger MSM, [≤19 years vs ≥ 25 years (OR 0.6; 95% CI 0.4 to 0.9)] and religion, (Muslims vs. Christians, (OR 0.5; 95% CI 0.3 to 0.9) were associated with decreased odds of PrEP initiation. Exposure to HIV education such as receiving information on HIV prevention in the past 12-months was associated with increased odds of PrEP initiation, (OR 1.7; 95% CI 1.1 to 2.7). Conclusions: Engagement in PrEP in this population is relatively low with younger individuals less likely to engage in PrEP. Reinforcing HIV prevention education and facilitating young MSM to engage in PrEP programs is critical in order to prevent onward HIV transmission.