Pre-exposure Prophylaxis Use Research Articles

Peer Influence on Motivation to Use Pre-Exposure Prophylaxis Among Latino Sexual Minority Men in Miami, Florida: A Network Autocorrelation Model.

Despite the availability of pre-exposure prophylaxis (PrEP), Latino sexual minority men (LSMM) continue to experience disparities in PrEP uptake and subsequently, HIV vulnerability. Social network norms are an underutilized solution to increase PrEP uptake. We used a peer influence model (network autocorrelation model) to examine the role of social network descriptive norms (i.e., actual behaviors) surrounding PrEP use. A total of 11 sociocentric networks of 13 friends (n = 143 LSMM) were recruited into our study from 2018 to 2019 in South Florida. Most participants were in PrEP pre-contemplation (n = 44), and almost one-third of our sample were using PrEP (n = 38). Three network autocorrelation models were estimated using an empirically informed Bayesian analysis. We found a positive association between participants' Motivational PrEP Cascade (MPC) position and their network members' (friends') cascade position based on three different measures of connection even when accounting for PrEP knowledge: friendship (ρ = 0.22; 95% CIa = 0.01-0.42), emotional closeness (ρ = 0.24; 95% CI = 0.03-0.44), and frequency of interaction (ρ = 0.22; CI = 0.03-0.42). Our findings highlight that an individual's progress in the MPC may be influenced by their network members' progress in the MPC, suggesting that LSMM using PrEP may serve as role models to their peers for PrEP use due to descriptive norms. Our findings further suggest that PrEP interventions for LSMM along the MPC can be implemented at the social network level.

The Impact of Stigma and Sexual Identity on PrEP Awareness and Use Among At-Risk Men Who Have Sex With Men in Four U.S. Cities (HPTN 078).

Persistent pre-exposure prophylaxis (PrEP) use reduces the risk of HIV infection, yet uptake lags among those with the greatest need. Sexual identity stigma may be a significant barrier to PrEP awareness and use among high-risk communities. The primary aim of this study was to determine whether sexual identity was related to PrEP awareness and use. This multi-site HIV Prevention Trials Network (HPTN) study (HPTN 078) focuses on men who have sex with men (MSM) (n=335) who were HIV-negative at screening. The majority of participants were non-white (62.1%), younger than 35 (57.9%), single (79.1%), and aware of PrEP, yet had never taken PrEP (52.5%). Participants completed questionnaires including sexual history and identity; lesbian, gay, bisexual, transgender, queer (LGBTQ) community engagement; PrEP awareness and use; and several measures of sexual identity stigma including family and friend stigma, general societal stigma, and anticipated healthcare stigma. Univariate and multinomial logistic regression models helped to determine factors associated with PrEP awareness and use. There were stark disparities in PrEP awareness comparing Black and White participants; 50% of Black participants reported being PrEP unaware vs 11.8% of White participants. In this sample, gay sexual identity (compared to bisexual identity) was associated with increased PrEP awareness (AOR 6.66) and use (AOR 16.9). Additionally, 29% of the association between sexual orientation and PrEP use was mediated through internalized stigma. Given low PrEP uptake among MSM, interventions that address sexual identity stigma may motivate greater PrEP uptake.

Barriers and Facilitators Along the PrEP Continuum of Care Among Latinx Sexual Minoritized Men and Transgender Women: A Systematic Review.

Latinx cisgender sexually minoritized men (SMM) and transgender women (TW) in the U.S. are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is a highly effective strategy for HIV prevention, rates of PrEP use among Latinx SMM and TW remain suboptimal. The main purpose of this systematic review was to (1) describe engagement in the various stages of the PrEP care continuum among Latinx SMM and TW, and (2) identify multilevel determinants that function as barriers or facilitators to engagement in the PrEP continuum of care for Latinx SMM and TW. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Five databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus) were searched to examine the available qualitative, quantitative, and mixed method studies relevant to the research question. A total of 56 studies were included, with the majority focusing on SMM and being cross-sectional in design. Barriers included PrEP knowledge, risk perception, intersecting stigma, and structural conditions. Community resources, social support, and PrEP navigation services facilitated engagement in the PrEP continuum of care. This review highlights the complex factors that influence PrEP care engagement among Latinx SMM and TW. These findings call for comprehensive, multilevel approaches to address inequities disparities in PrEP care engagement among these groups.

How the Use of prep (Pre-exposure Prophylaxis) Helps to Prevent HIV Infection in Malaysia

Background: HIV remains a significant public health challenge in Malaysia, affecting key populations such as men who have sex with men (MSM), transgender individuals, sex workers, and people who inject drugs (PWID). Despite advancements in prevention and treatment, HIV continues to be a leading cause of morbidity and mortality. Pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical intervention, utilizing antiretroviral tablets (ARVs) to significantly reduce the risk of HIV infection in HIV-negative individuals. Methods and Materials: This study investigates the effectiveness of PrEP in preventing HIV transmission among high-risk groups in Malaysia. The research examines the mechanism of action of the two primary drugs used in PrEP—tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC)—and analyzes data from various studies, including the iPrEx, Partners PrEP, PROUD, and IPERGAY studies. Additionally, it addresses the challenges of implementing PrEP in Malaysia, such as stigma, adherence issues, and integration with existing HIV services. Results: PrEP has shown to reduce the risk of HIV infection by more than 90% when used consistently. The iPrEx study demonstrated a 44% reduction in HIV risk, increasing to 92% with consistent use. The Partners PrEP study indicated a 75% reduction, with a potential 90% decrease with strict adherence. The PROUD and IPERGAY studies reinforced these findings, showing 86% reductions in HIV risk. Despite its proven efficacy, the implementation of PrEP in Malaysia faces barriers such as stigma, prejudice, and adherence challenges. Conclusion: PrEP is a highly effective strategy for reducing HIV transmission among high-risk populations in Malaysia. To maximize its potential impact, it is crucial to address barriers to implementation, including stigma, adherence issues, and integration with existing healthcare services. Mathematical modeling suggests that widespread PrEP use could lead to a significant decrease in new HIV infections, potentially reducing cases among MSM by 30% over a decade. Learning from successful PrEP programs in other countries, Malaysia should focus on supportive policies, community engagement, affordability, and adherence support to effectively combat the HIV epidemic.

Examining the Effects of PrEP Use on Sexual Behaviors and Sexually Transmitted Infections Among Chinese Men who have Sex with Men: A Cross-Sectional Study

Men who have sex with men (MSM) is a high-risk population for HIV and sexually transmitted infections (STIs). Pre-exposure prophylaxis (PrEP) is effective in HIV prevention. This study aims to examine the differences in sexual behaviors, STI prevalence and HIV/STI testing across subgroups of MSM with various PrEP use. Data were collected via a cross-sectional survey in an MSM community in Xi’an, Shaanxi, from 2022.01 to 2022.09. Participants were categorized as ‘PrEP-naïve and unwilling to use’, ‘PrEP-naïve but willing to use’, and ‘current or former PrEP users’. Shannon index was used to assess sexual act diversity and multivariate logistic regression analyzed factors associated with PrEP use. Of the 1,131 MSM participants, 23.52% were PrEP-naïve and unwilling, 64.98% were PrEP-naïve but willing, and 11.49% were current or former PrEP users. The PrEP-naïve but willing group had the highest recent STI testing rates at 73.06% and showed greater sexual act diversity (Shannon index 1.61). This group also had the highest syphilis rates (7.49% vs. 6.47% and2.54%, p < 0.01). Younger age (18–30: OR = 0.39 (0.18–0.85); 31–40: OR = 0.43 (0.20–0.96)) and lower education (high school/vocational: OR = 0.15 (0.04–0.58); associate degree: OR = 0.21 (0.06–0.71)) were factors that negatively influenced PrEP use. Current or former PrEP users had the highest oropharyngeal gonorrhea (14.39% vs. 9.68% and 5.80%, p < 0.01) and overall gonorrhea rates (20.86% vs. 17.17% and 8.37%, p < 0.001). ‘PrEP-naïve but willing’ participants consistently demonstrated high-risk sexual behavior, increased STI testing, and more diverse sexual acts, whereas PrEP users had the highest STI prevalence.

Awareness, Intention to Use Pre-Exposure Prophylaxis, and Factors Associated with Awareness among Men Who Have Sex with Men in the Republic of Korea.

This study assessed pre-exposure prophylaxis (PrEP) awareness, knowledge, and attitudes in a sample of 1389 men who have sex with men (MSM). Using a self-report survey, we measured PrEP knowledge mean scores, attitudes toward PrEP, and awareness rates to identify the key influences on PrEP uptake. PrEP awareness among participants was 66.3%, with 33.7% having never heard of PrEP. Approximately 4.5% had previous experience with PrEP but were not current users, while only 2.7% reported that they were currently taking it. Logistic regression analysis revealed that the significant predictors of PrEP awareness were educational attainment, marital status, prior HIV testing knowledge, and attitudes toward PrEP. Several demographic factors were not significant predictors of intention to use PrEP; however, using the internet to meet partners, number of partners, HIV testing, positive attitudes, and reduced perceived barriers played a critical role in shaping PrEP use intentions. These findings highlight the critical role of targeted educational strategies and tailored public health messaging in enhancing the awareness and intention to use PrEP among MSM.

Social, economic, and physical side effects impact PrEP uptake and persistence among transgender women in Peru

IntroductionOral pre-exposure prophylaxis (PrEP) for HIV-1 infection is over 99% effective in protecting against HIV acquisition when used consistently and appropriately. However, PrEP uptake and persistent use remains suboptimal, with a substantial gap in utilization among key populations who could most benefit from PrEP. In Latin America specifically, there is poor understanding of barriers to PrEP uptake and persistence among transgender (trans) women.MethodsIn April-May 2018, we conducted qualitative interviews lasting 25–45 min as part of an end-of-project evaluation of TransPrEP, a pilot RCT that examined the impact of a social network-based peer support intervention on PrEP adherence among trans women in Lima, Peru. Participants in the qualitative evaluation, all adult trans women, included individuals who either (1) screened eligible to participate in the TransPrEP pilot, but opted not to enroll (n = 8), (2) enrolled, but later withdrew (n = 6), (3) were still actively enrolled at the time of interview and/or successfully completed the study (n = 16), or (4) were study staff (n = 4). Interviews were audio recorded and transcribed verbatim. Codebook development followed an immersion/crystallization approach, and coding was completed using Dedoose.ResultsEvaluation participants had a mean age of 28.2 years (range 19–47). When describing experiences taking PrEP, participant narratives highlighted side effects that spanned three domains: physical side effects, such as prolonged symptoms of gastrointestinal distress or somnolence; economic challenges, including lost income due to inability to work; and social concerns, including interpersonal conflicts due to HIV-related stigma. Participants described PrEP use within a broader context of social and economic marginalization, with a focus on daily survival, and how PrEP side effects negatively contributed to these stressors. Persistence was, in some cases, supported through the intervention’s educational workshops.ConclusionThis research highlights the ways that physical, economic, and social side effects of PrEP can impact acceptability and persistence among trans women in Peru, amplifying and layering onto existing stressors including economic precarity. Understanding the unique experiences of trans women taking PrEP is crucial to informing tailored interventions to improve uptake and persistence.

Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women.

There are gaps in uptake of, adherence to, and persistence in the use of preexposure prophylaxis for human immunodeficiency virus (HIV) prevention among cisgender women. We conducted a phase 3, double-blind, randomized, controlled trial involving adolescent girls and young women in South Africa and Uganda. Participants were assigned in a 2:2:1 ratio to receive subcutaneous lenacapavir every 26 weeks, daily oral emtricitabine-tenofovir alafenamide (F/TAF), or daily oral emtricitabine-tenofovir disoproxil fumarate (F/TDF; active control); all participants also received the alternate subcutaneous or oral placebo. We assessed the efficacy of lenacapavir and F/TAF by comparing the incidence of HIV infection with the estimated background incidence in the screened population and evaluated relative efficacy as compared with F/TDF. Among 5338 participants who were initially HIV-negative, 55 incident HIV infections were observed: 0 infections among 2134 participants in the lenacapavir group (0 per 100 person-years; 95% confidence interval [CI], 0.00 to 0.19), 39 infections among 2136 participants in the F/TAF group (2.02 per 100 person-years; 95% CI, 1.44 to 2.76), and 16 infections among 1068 participants in the F/TDF group (1.69 per 100 person-years; 95% CI, 0.96 to 2.74). Background HIV incidence in the screened population (8094 participants) was 2.41 per 100 person-years (95% CI, 1.82 to 3.19). HIV incidence with lenacapavir was significantly lower than background HIV incidence (incidence rate ratio, 0.00; 95% CI, 0.00 to 0.04; P<0.001) and than HIV incidence with F/TDF (incidence rate ratio, 0.00; 95% CI, 0.00 to 0.10; P<0.001). HIV incidence with F/TAF did not differ significantly from background HIV incidence (incidence rate ratio, 0.84; 95% CI, 0.55 to 1.28; P = 0.21), and no evidence of a meaningful difference in HIV incidence was observed between F/TAF and F/TDF (incidence rate ratio, 1.20; 95% CI, 0.67 to 2.14). Adherence to F/TAF and F/TDF was low. No safety concerns were found. Injection-site reactions were more common in the lenacapavir group (68.8%) than in the placebo injection group (F/TAF and F/TDF combined) (34.9%); 4 participants in the lenacapavir group (0.2%) discontinued the trial regimen owing to injection-site reactions. No participants receiving twice-yearly lenacapavir acquired HIV infection. HIV incidence with lenacapavir was significantly lower than background HIV incidence and HIV incidence with F/TDF. (Funded by Gilead Sciences; PURPOSE 1 ClinicalTrials.gov number, NCT04994509.).

Examining physical and virtual sexual and drug risk venue co-attendance among PrEP-eligible Latinx sexual minority men

Disparities in Latinx sexual minority men (LSMM) pre-exposure prophylaxis (PrEP) initiation and adherence demonstrate the need for innovative strategies to improve outcomes along the PrEP Care Continuum. The purpose of this study was to examine physical and virtual risk venue co-attendance among LSMM of varying stages of PrEP use living in South Florida, an Ending the HIV Epidemic (EHE) priority jurisdiction. Venue co-attendance may be leveraged to support equitable dissemination and implementation (D&I) of HIV and drug use preventive interventions to LSMM. Ninety-four LSMM completed surveys on PrEP use and identified physical and virtual sexual and drug risk venues (where men seek sex partners and/or have sex or access or use drugs). Bivariate analyses examined differences in demographics and venue endorsement by PrEP status. Exponential random graph models examined endorsement of venues by PrEP status. One-mode projection visualizations portray the structure of venue co-attendance networks by PrEP status. Participants identified 49 physical and virtual sexual and drug risk venues. A homophily effect of PrEP status on venue endorsement was identified for both sexual and drug risk venues. Network size and density differed by PrEP status and whether the venue was identified as a sexual or drug risk location. Online dating apps, bars, and saunas had the highest centrality in each network type suggesting their potential role in implementing preventive programming. This study identified specific sexual and drug risk venues that may be leveraged to both disseminate targeted PrEP and harm reduction information and to implement interventions to improve PrEP uptake and adherence among LSMM living in EHE priority jurisdictions.

Enhanced Oral Pre-exposure Prophylaxis (PrEP) Implementation for Ugandan Fisherfolk: Pilot Intervention Outcomes

Mobile populations such as fisherfolk show high HIV incidence and prevalence. We pilot-tested implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake and adherence in the context of healthcare outreach events in two mainland fisherfolk communities on Lake Victoria, Uganda from September 2021 to February 2022. The implementation strategies included PrEP adherence supporters (selected from PrEP users’ social networks), community workshops (to address misconceptions and stigma, and empower PrEP advocacy), and check-in calls (including refill reminders). PrEP medical records data were collected from 6-months pre-intervention to 6-months post-intervention. Qualitative interviews with 20 PrEP users (10 who continued, 10 who discontinued), 9 adherence supporters, and 7 key partners (providers, community leaders) explored acceptability. Percentages of PrEP initiators (of those eligible) were significantly higher during the intervention (96.5%) than 6-months before the intervention (84.5%), p < 0.0001; percentages of PrEP users who persisted (i.e., possessed a refill) 6-months post-initiation (47.9% vs. 6.7%) and had at least 80% PrEP coverage (based on their medication possession ratio) from the initiation date to 6-months later (35.9% vs. 0%) were higher during versus pre-intervention, p < 0.0001. A comparison fisherfolk community with better healthcare access had lower uptake (78.3%; p < 0.0001) and persistence at 6-months (34.0%; p < 0.001), but higher coverage during the intervention period (70.4%; p < 0.0001). Qualitative data suggested the strategies promoted PrEP use through reduced stigma and misconceptions. The intervention bundle cost was $223.95, $172.98, and $94.66 for each additional person for PrEP initiation, persistence, and coverage, respectively. Enhanced community-based PrEP implementation that fosters a supportive community environment can improve PrEP use in mobile populations without easy access to healthcare. (NCT05084716).

Interest in and Willingness to Use PrEP: A Cross-Sectional Study of Individuals with Problematic Substance Use Residing in a High HIV Prevalence Jurisdiction

Although it is an effective HIV prevention method, pre-exposure prophylaxis (PrEP) is underutilized in the Southern US. Many people who use drugs (PWUD) have increased susceptibility to HIV which could be lessened by using PrEP. Potential barriers to PrEP use include lack of awareness of PrEP, low knowledge about HIV prevention, low self-efficacy for HIV prevention, inaccurate risk perceptions, and anticipated stigma. The current study examined predisposing, enabling, and reinforcing factors that may predict interest in PrEP. The purpose of the current study was to explore factors associated with interest in and willingness to use daily oral and long acting injectable PrEP among sexually active adult PWUD. The data were collected from adult participants (n = 270) residing in Harris County, TX, who self-reported problematic substance use and who reported oral, anal, or vaginal sex in the six months prior to completing the survey. The survey was distributed and completed online via Qualtrics Panels in March of 2022 and included measures of PrEP and HIV knowledge, PrEP stigma, sexual health self-efficacy, experiences of discrimination, health literacy, and medical mistrust. The majority of participants reported circumstances or behaviors that increased their susceptibility to HIV. Findings indicated that PrEP user stereotypes and PrEP anticipated disapproval by others were associated with interest in using daily oral PrEP and willingness to use long acting injectable PrEP. These results provide insight into reasons for low PrEP uptake among PWUD who live in a high HIV prevalence jurisdiction. Implications for HIV prevention intervention are discussed.

HIV pre-exposure prophylaxis use during periods of unprotected sex among female sex workers in Tanga city, Tanzania: a control arm analysis of the pragmatic quasi-experimental trial.

Pre-exposure prophylaxis (PrEP) prevention-effective adherence is of critical importance but challenging particularly among key populations where periods of high HIV risk are frequent. We assessed the use of PrEP with reference to periods of unprotected sex among female sex workers in the city of Tanga. This was part of the pragmatic quasi-experimental trial for HIV PrEP rollout in Tanzania involving a control cohort of 313 female sex workers aged ≥18 years recruited by respondent-driven sampling and followed for 12 months. PrEP use and periods of condomless or unprotected sex were assessed at the 6th and 12th month of follow-up. Prevention-effective adherence was defined as PrEP use of ≥2 pills/week and ≥6 pills/week for anal and vaginal condomless sex. Multivariable modified Poisson regression was conducted to determine factors influencing PrEP use (≥2 pills/week). Overall, 59.2 and 45.9% of participants had unprotected anal and vaginal sex with a client, respectively. The prevention-effective adherence for anal sex ranged from 8.0% (months 6) to 10.0% (months 12) while that of vaginal sex was from 10.1% (month 6) to 3.8% (month 12). Participants who lived with friends were 25.5 times more likely to use ≥2 PrEP doses per week than those who lived alone (aPR = 25.5; 95%CI: 2.55-255.42, p = 0.006). Compared to self-reporting poor health status, self-reporting good health status significantly increased the use of ≥2 PrEP doses per week (aPR = 17.4; 95%CI: 3.01-101.02, p = 0.001). Refusing condomless sex with a steady partner increased the likelihood of using ≥2 PrEP doses per week than accepting condomless sex with a steady partner (aPR = 11.2; 95%CI: 1.55-80.48, p = 0.017). The prevalence of using ≥2 PrEP doses per week was less among participants accepting condomless sex at high pay than those who refused (aPR = 0.1; 95%CI: 0.03-0.26, p = 0.000). Use of PrEP during periods of unprotected sex was rare among female sex workers. Living with friends, self-reporting good health status, and refusing condomless sex with steady partners were associated with increased use of ≥2 PrEP doses per week. However, accepting condomless sex for increased payment was associated with reduced use of ≥2 PrEP doses per week. This calls for an in-depth study to understand the perspectives and circumstances shaping poor adherence during periods of unprotected sex among female sex workers.

Hepatitis E in men who have sex with men: a systematic review

BackgroundThe transmission dynamics of hepatitis E in men who have sex with men (MSM) are poorly understood. We aimed to explore any factors observed in MSM with hepatitis E by...

Transactional Sex, HIV, and Bacterial STIs Among U.S. Men Who have Sex with Men

Men who have sex with men (MSM) and are engaged in transactional sex (MSM-TS) experience complex social and structural vulnerabilities that increase their HIV risk. This study aimed to estimate the prevalence of TS and associations between TS and sexually transmitted infection (STI) outcomes among cisgender MSM in the U.S. Using 2017-2021 data from an online survey of U.S. MSM, characteristics of MSM-TS were summarized, and adjusted prevalence ratios (aPRs) calculated for the associations between past-year TS and bacterial STI diagnosis, HIV status, and either antiretroviral or pre-exposure prophylaxis use. Analyses were conducted in 2023. TS prevalence was 3.7% (n=1,848/49,539). Compared to other MSM, MSM-TS more commonly reported homelessness, being uninsured, condomless anal sex with partners of any HIV status and condomless anal sex with serodifferent partners, and illicit drug use. TS was associated with increased HIV (aPR 1.44, 95% CI 1.25-1.66) and bacterial STI prevalence (aPR 2.40, 95% CI=2.09-2.52) and lower antiretroviral therapy use (among MSM living with HIV; PR 0.92, 95% CI=0.87-0.97). Structural and behavioral risks converged among U.S. MSM engaging in TS leading to greater HIV and bacterial STI prevalence in this group. HIV interventions for U.S. MSM-TS should address individual as well as structural risks, including poverty and housing instability.

Prepare Romania: study protocol for a randomized controlled trial of an intervention to promote pre-exposure prophylaxis adherence and persistence among gay, bisexual, and other men who have sex with men

BackgroundGay, bisexual, and other men who have sex with men (GBMSM) represent a high-risk group for HIV transmission in Romania, yet they possess few resources for prevention. Despite having no formal access to pre-exposure prophylaxis (PrEP) through the health system, GBMSM in Romania demonstrate a high need for and interest in this medication. In anticipation of a national rollout of PrEP, this study tests the efficacy of a novel strategy, Prepare Romania, that combines two evidence-based PrEP promotion interventions for GBMSM living in Romania.MethodsThis study uses a randomized controlled trial design to examine whether GBMSM living in Romania receiving Prepare Romania, a culturally adapted counseling and mobile health intervention (expected n = 60), demonstrate greater PrEP adherence and persistence than those assigned to a PrEP education control arm (expected n = 60). Participants from two main cities in Romania are prescribed PrEP and followed-up at 3 and 6 months post-randomization. PrEP adherence data are obtained through weekly self-report surveys and dried blood spot testing at follow-up visits. Potential mediators (e.g., PrEP use motivation) of intervention efficacy are also assessed. Furthermore, Prepare Romania’s implementation (e.g., proportion of enrolled participants attending medical visits, intervention experience) will be examined through interviews with participants, study implementers, and healthcare officials.DiscussionThe knowledge gained from this study will be utilized for further refinement and scale-up of Prepare Romania for a future multi-city effectiveness trial. By studying the efficacy of tools to support PrEP adherence and persistence, this research has the potential to lay the groundwork for PrEP rollout in Romania and similar contexts.Trial registrationThis study was registered on ClinicalTrials.gov, identifier NCT05323123, on March 25, 2022.

Evaluating the performance of a risk assessment score tool to predict HIV acquisition among pregnant and postpartum women in Kenya.

Clinical risk score tools require validation in diverse settings and populations before they are widely implemented. We aimed to externally validate an HIV risk assessment tool for predicting HIV acquisition among pregnant and postpartum women. In the context of prevention of mother-to-child transmission programs, risk score tools could be used to prioritize retesting efforts and delivery of pre-exposure prophylaxis (PrEP) to pregnant and postpartum women most at risk for HIV acquisition while minimizing unnecessary perinatal exposure. Data from women enrolled in a cross-sectional study of programmatic HIV retesting and/or receiving maternal and child health care services at five facilities in Western Kenya were used to validate the predictive ability of a simplified risk score previously developed for pregnant/postpartum women. Incident HIV infections were defined as new HIV diagnoses following confirmed negative or unknown status during pregnancy. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC) and Brier score. Among 1266 women with 35 incident HIV infections, we found an AUC for predicting HIV acquisition of 0.60 (95% CI, 0.51, 0.69), with a Brier score of 0.27. A risk score >6 was associated with a 2.9-fold increase in the odds of HIV acquisition (95% CI, 1.48, 5.70; p = 0.002) vs scores ≤6. Women with risk scores >6 were 27% (346/1266) of the population but accounted for 52% of HIV acquisitions. Syphilis, age at sexual debut, and unknown partner HIV status were significantly associated with increased risk of HIV in this cohort. The simplified risk score performed moderately at predicting risk of HIV acquisition in this population of pregnant and postpartum women and may be useful to guide PrEP use or counseling.

Long-Term HIV Pre-Exposure Prophylaxis Persistence and Reinitiation in Connecticut from 2012 to 2018.

HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention for HIV infections. PrEP persistence is critical to achieving optimal protection against HIV infection. However, little is known about PrEP persistence in the United States. This study utilized the Connecticut All-Payer Claims Database (APCD) to identify PrEP persistence among patients who filled their PrEP prescriptions in the state. The authors identified 1,576 PrEP patients who picked up PrEP prescriptions and extracted medical and pharmacy claims to evaluate a longitudinal cohort during 2012-2018 based on the Connecticut APCD. Patients who did not pick up medication for one consecutive month (ie, 30 days) were defined as discontinuing PrEP. Kaplan-Meier Survival Curve and proportional hazard regression were used to describe PrEP persistence. Of the 1,576 patients who picked up PrEP prescriptions, the median age was 32.0 (interquartile range [IQR]: 22.0-44.0). The majority were male individuals (93%). Of 1,040 patients who discontinued PrEP, 702 (67.5%) restarted PrEP at least once. The median time of PrEP persistence was 3 months (IQR: 1-6 months) for initial PrEP use. The median time on PrEP was also around 3 months in the following episodes of PrEP use. Being female, being on parent's insurance, and having high co-pays were associated with shorter periods of PrEP persistence. PrEP persistence was low among patients who picked up PrEP prescriptions. Although many patients restarted PrEP, persistence remained low during follow-up PrEP use and possibly led to periods of increased HIV risk. Effective interventions are needed to improve PrEP persistence and reduce HIV incidence.

Incidence and risk factors associated with acquired syphilis in HIV pre-exposure prophylaxis users.

Acquired syphilis continues to affect millions of people around the world. It is crucial to study it in the context of HIV Pre-Exposure Prophylaxis (PrEP) to achieve the goals set out in the 2030 Agenda since the literature suggests increased risk behaviors for sexually transmitted infections. This study aimed to investigate the incidence and factors associated with acquired syphilis among PrEP users. This retrospective cohort included data on PrEP users from all over Brazil from 2018 to 2020, retrieved from the national antiretroviral logistics system. We calculated the proportion of syphilis before PrEP, the incidence during the user's follow-up, reinfections, and their possible associated factors. We conducted descriptive, bivariate, and multivariate analysis, estimating the crude Relative Risk, adjusted Odds Ratio (aOR), and their respective confidence intervals (95%CI). Most of the 34,000 individuals who started PrEP were male (89.0%), white (53.7%), self-identified as male (85.2%), homosexual, gay, or lesbian (72.2%), and had 12 schooling years or more (67.8%). Of these, 8.3% had syphilis in the six months before starting PrEP, and 4% had it in the first 30 days of using the prophylaxis. We identified a loss-to-follow-up rate of 41.7%, although the loss and the cohort shared similar characteristics. The proportion of missed syphilis tests was high: 33.4% in the 30 days and 38.8% in the follow-up period. In the 19,820 individuals effectively monitored, the incidence of acquired syphilis was 19.1 cases per 100 person-years, and 1.9% of users had reinfection. The rate of missed syphilis tests at the 30-day follow-up was 33.4%, and the total follow-up test period was 38.8%. The multivariate analysis identified female gender (aOR 0.3; 95%CI 0.2-0.5), being white or Black (aOR 0.9; 95%CI 0.7-0.9 and aOR 0.7; 95%CI 0.7-0.99, respectively) as protective factors for syphilis. Being homosexual, gay, lesbian (aOR 2.7; 95%CI 2.0-3.7), or having a history of syphilis in the six months before PrEP (aOR 2.2; 95%CI 1.9-2.5) were risk factors for syphilis during PrEP use. Behaviors related to the risk of syphilis included accepting something in exchange for sex (aOR 1.6; 95%CI 1.3-1.9), irregular condom use (use in less than half of sexual intercourse sessions; aOR 1.7; 95%CI 1.53-2.1) and recreational drug use (poppers; aOR 1.5; 95%CI 1.53-2.1). Syphilis in the context of PrEP has high rates and is associated with sociodemographic and behavioral factors. We recommend additional studies targeting prevention in this population to curb these figures.

Blood safety markers in Dutch donors after relaxation of deferral for men who have sex with men: re-emergence of syphilis and HIV pre-exposure prophylaxis use.

Less discriminatory donor selection policies for men who have sex with men (MSM) may impact transfusion safety in terms of higher residual risks for known transfusion-transmitted infections (TTIs), increased vulnerability toward new TTIs that are also transmitted via sex, and HIV infections masked by pre-exposure prophylaxis (PrEP). TTI trends in Dutch donors were studied over a 13-year period (2011-2023), characterized by successive relaxations of MSM deferral criteria. Structured posttest counseling was performed to determine risk factors in TTI-positive donors. PrEP drug levels were measured in 9977 donations from male donors living in urban areas and in 67 donors with active or resolved syphilis. HIV incidence (from 5.8 to 1.5 per 1,000,000 donor years (DY)) and HBV incidence (from 12.4 to 4.5 per 1,000,000 DY) in Dutch donors decreased with less stringent MSM deferral criteria, while syphilis prevalence (from 26.4 to 44.1 per 100,000 new donors) and syphilis incidence (from 18.3 to 46.3 per 1,000,000 DY) increased over time. The proportion of MSM-related syphilis rose from 2% to 32% in new donors and from 12% to 27% in repeat donors. PrEP was detected in 2 of 9977 (0.02%) donations from male donors living in urban areas, and in 1 of 39 (2.6%) male donors with syphilis. To date, phasing out donor deferral for MSM had no significant impact on transfusion safety in the Netherlands. However, rising syphilis rates and (recent) PrEP use in the blood donor population, albeit rare, suggest an influx of donors with higher sexual risk profiles and requires intensified TTI surveillance in donors.

The effects of regular home delivery of HIV self-testing and follow-up counselling on HIV testing and prevention outcomes in men who have sex with men who test infrequently in the United States: a pragmatic, virtual randomized controlled trial.

Past research shows that HIV self-testing (HIVST) can increase testing and facilitate more HIV diagnoses relative to clinic testing. However, in the United States, the use of HIVSTs is limited due to concerns that those who use HIVST could be less likely to be linked to care. From January 2019 to April 2022, we recruited 811 men who have sex with men (MSM) in the United States who tested infrequently using an online marketing campaign and randomized them 1:1:1 to receive one of the following every 3 months for a year: (1) text message reminders to get tested at a local clinic (control); (2) mailed HIVST kits with access to a free helpline (standard HIVST); and (3) mailed HIVST kits with counselling provided within 24 hours of opening a kit (eTest). Quarterly follow-up surveys assessed HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) use and sexual risk behaviour. Eight participants were diagnosed with HIV, and all but one were through HIVST. Participants in either HIVST condition, standard or eTest, had significantly higher odds of any testing (OR = 7.9, 95% CI = 4.9-12.9 and OR = 6.6, 95% CI = 4.2-10.5) and repeat testing (>1 test; OR = 8.5, 95% CI = 5.7-12.6; OR = 8.9, 95% CI = 6.1-13.4) over 12 months relative to the control group. Rates of STI testing and PrEP uptake did not differ across study condition, but those in the eTest condition reported 27% fewer sexual risk events across the study period relative to other groups. HIVST vastly increased testing, encouraged more regular testing among MSM, and identified nearly all new cases, suggesting that HIVST could diagnose HIV acquisition earlier. Providing timely follow-up counselling after HIVST did not increase rates of STI testing or PrEP use, but some evidence suggested that counselling may have reduced sexual risk behaviour. To encourage more optimal testing, programmes should incorporate HIVST and ship kits directly to recipients at regular intervals.