TY - JOUR
T1 - Adherence to event-driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands
T2 - analysis based on online diary data, 3-monthly questionnaires and intracellular TFV-DP
AU - Jongen, Vita W
AU - Hoornenborg, Elske
AU - van den Elshout, Mark Am
AU - Boyd, Anders
AU - Zimmermann, Hanne Ml
AU - Coyer, Liza
AU - Davidovich, Udi
AU - Anderson, Peter L
AU - de Vries, Henry Jc
AU - Prins, M
AU - Schim van der Loeff, Maarten F
AU - Amsterdam PrEP Project team in the HIV Transmission Elimination Amsterdam (H-TEAM) Initiative
N1 - © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
PY - 2021/5
Y1 - 2021/5
N2 - INTRODUCTION: Event-driven pre-exposure prophylaxis (edPrEP) with oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective for preventing HIV acquisition in men who have sex with men (MSM) and is preferred over daily PrEP by some MSM. However, it is largely unknown how well MSM adhere to edPrEP. We then aimed to assess PrEP protection during CAS among MSM using edPrEP and participating in the Amsterdam PrEP demonstration project (AMPrEP).METHODS: We analysed data from participants enrolled in AMPrEP who were taking edPrEP. We measured adherence through (1) a mobile application in which sexual behaviour and PrEP-use were recorded daily, (2) three-monthly self-completed questionnaires and (3) dried blood spot (DBS) samples collected around six, twelve and twenty-four months after PrEP initiation. We assessed the proportion of days with condomless anal sex (CAS) acts that were protected by PrEP, per partner type (i.e. steady partners, known casual partners, unknown casual partners), and the proportion of three-month periods during which PrEP was correctly used. Intracellular TFV-diphosphate (TFV-DP) concentrations were determined from DBS. Good adherence was defined as at least one tablet before and one tablet within 48 hours after a CAS act.RESULTS: Between 11 September 2015 and 6 October 2019, 182 of 376 MSM (48.4%) used edPrEP for at least one three-month period. Of the 8224 CAS days that were reported in the app during edPrEP-use, we observed good protection for most CAS days involving steady partners (n = 1625/2455, 66.9%), known casual partners (n = 3216/3472, 92.6%) and unknown casual partners (n = 2074/2297, 90.3%). Men reported consistently correct PrEP-use in 851 (81.4%) of the 1046 three-month periods of edPrEP-use. The median TFV-DP concentration was 591 fmol/sample (interquartile range = 270 to 896).CONCLUSIONS: Adherence to edPrEP was high as determined from the online app and questionnaire. DBS measurements were consistent with two to three tablets per week on average.
AB - INTRODUCTION: Event-driven pre-exposure prophylaxis (edPrEP) with oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective for preventing HIV acquisition in men who have sex with men (MSM) and is preferred over daily PrEP by some MSM. However, it is largely unknown how well MSM adhere to edPrEP. We then aimed to assess PrEP protection during CAS among MSM using edPrEP and participating in the Amsterdam PrEP demonstration project (AMPrEP).METHODS: We analysed data from participants enrolled in AMPrEP who were taking edPrEP. We measured adherence through (1) a mobile application in which sexual behaviour and PrEP-use were recorded daily, (2) three-monthly self-completed questionnaires and (3) dried blood spot (DBS) samples collected around six, twelve and twenty-four months after PrEP initiation. We assessed the proportion of days with condomless anal sex (CAS) acts that were protected by PrEP, per partner type (i.e. steady partners, known casual partners, unknown casual partners), and the proportion of three-month periods during which PrEP was correctly used. Intracellular TFV-diphosphate (TFV-DP) concentrations were determined from DBS. Good adherence was defined as at least one tablet before and one tablet within 48 hours after a CAS act.RESULTS: Between 11 September 2015 and 6 October 2019, 182 of 376 MSM (48.4%) used edPrEP for at least one three-month period. Of the 8224 CAS days that were reported in the app during edPrEP-use, we observed good protection for most CAS days involving steady partners (n = 1625/2455, 66.9%), known casual partners (n = 3216/3472, 92.6%) and unknown casual partners (n = 2074/2297, 90.3%). Men reported consistently correct PrEP-use in 851 (81.4%) of the 1046 three-month periods of edPrEP-use. The median TFV-DP concentration was 591 fmol/sample (interquartile range = 270 to 896).CONCLUSIONS: Adherence to edPrEP was high as determined from the online app and questionnaire. DBS measurements were consistent with two to three tablets per week on average.
KW - Anti-HIV Agents/therapeutic use
KW - Diphosphates/therapeutic use
KW - Emtricitabine/therapeutic use
KW - HIV Infections/drug therapy
KW - Homosexuality, Male
KW - Humans
KW - Male
KW - Medication Adherence
KW - Netherlands
KW - Pre-Exposure Prophylaxis
KW - Sexual Behavior
KW - Sexual and Gender Minorities
KW - Surveys and Questionnaires
KW - Transgender Persons
KW - COST-EFFECTIVENESS
KW - On-demand PrEP
KW - DRUG-USE
KW - medication adherence
KW - men who have sex with men
KW - HIV prevention and control
KW - HIV
KW - PREEXPOSURE PROPHYLAXIS
KW - Pre-exposure prophylaxis
U2 - 10.1002/jia2.25708
DO - 10.1002/jia2.25708
M3 - Article
C2 - 33973373
SN - 1758-2652
VL - 24
SP - 1
EP - 10
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 5
M1 - e25708
ER -