PrEP Use, Sexual Behaviour, and PrEP Adherence Among Men who have Sex with Men Living in Wales Prior to and During the COVID-19 Pandemic

D Gillespie,C Knapper,R Ma,R Drayton,K Blee,Z Couzens,H S Bradshaw,D A Hughes,A Williams,A Jones,K Hood,F Wood,M De Bruin

doi:10.1007/s10461-022-03618-4

Abstract

We examined PrEP use, condomless anal sex (CAS), and PrEP adherence among men who have sex with men (MSM) attending sexual health clinics in Wales, UK. In addition, we explored the association between the introduction of measures to control transmission of SARS-CoV-2 on these outcomes. We conducted an ecological momentary assessment study of individuals in receipt of PrEP in Wales. Participants used an electronic medication cap to record PrEP use and completed weekly sexual behaviour surveys. We defined adherence to daily PrEP as the percentage of CAS episodes covered by daily PrEP (preceded by ≥ 3 days of PrEP and followed by ≥ 2 days). Sixty participants were recruited between September 2019 and January 2020. PrEP use data prior to the introduction of control measures were available over 5785 person-days (88%) and following their introduction 7537 person-days (80%). Data on CAS episodes were available for 5559 (85%) and 7354 (78%) person-days prior to and following control measures respectively. Prior to the introduction of control measures, PrEP was taken on 3791/5785 (66%) days, there were CAS episodes on 506/5559 (9%) days, and 207/406 (51%) of CAS episodes were covered by an adequate amount of daily PrEP. The introduction of pandemic-related control measures was associated with a reduction in PrEP use (OR 0.44, 95%CI 0.20–0.95), CAS (OR 0.35, 95%CI 0.17–0.69), and PrEP adherence (RR = 0.55, 95%CI 0.34–0.89) and this may have implications for the health and wellbeing of PrEP users and, in addition to disruption across sexual health services, may contribute to wider threats across the HIV prevention cascade.

Highlights

HIV pre-exposure prophylaxis (PrEP) involves the use of antiretroviral (ARV) medication for HIV-negative individuals to prevent HIV acquisition through high-risk sexual encounters [1]
We found some indication that the association between prior PrEP use and subsequent condomless anal sex (CAS) was higher following the introduction of control measures compared to the time prior to their introduction
While our study indicated that PrEP users tailor their PrEP use according to their risk exposure, we found that only 51 to 63% of CAS episodes were covered by an adequate supply of PrEP among daily PrEP users

Summary

Introduction

HIV pre-exposure prophylaxis (PrEP) involves the use of antiretroviral (ARV) medication for HIV-negative individuals to prevent HIV acquisition through high-risk sexual encounters [1]. Its use has been demonstrated to be highly effective in preventing HIV acquisition in several key populations in the context of large clinical trials [2,3,4] additional analysis of drug concentrations and medication use indicates that HIV-1 risk reduction was 96% and 99% for individuals taking PrEP four and seven days a week respectively, demonstrating its high levels of efficacy [5]. For PrEP to work as intended, it needs to be taken during periods where an individual is at-risk of acquiring HIV through condomless sexual contact [7]. Studying ‘PrEP implementation is complex as it requires careful assessment of both PrEP intake as well as people’s sexual activity

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Methods

Results

Conclusion