Department of Pediatrics, Faculty of Medicine, 65103Chulalongkorn University, Bangkok, Thailand.
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, 65103Chulalongkorn University, Bangkok, Thailand.
Int J STD AIDS. 2022 Jul;33(8):799-805. doi: 10.1177/09564624221106527. Epub 2022 Jun 2.
Daily pre-exposure prophylaxis (PrEP) regimen of tenofovir/emtricitabine (TDF/FTC) tablet is the standard of care for HIV prevention in Thailand. Event-driven PrEP (ED-PrEP), taking two loading pills 2-24 h prior to sex and two doses afterward, is considered an alternative regimen. This pilot study aimed to describe accuracy of and retention in ED-PrEP use among Thai young men who have sex with men (YMSM). A cohort of YMSM aged 15-19 years at risk of HIV infection, defined as reporting irregular condom use or having an HIV-positive sexual partner, was enrolled. All participants were provided oral TDF/FTC, condoms, and the "Raincoat" mobile application, which reminds users when to administer ED-PrEP. Participants attended clinic visits at Months 1, 3, and 6 and followed up by phone at Months 2, 4, and 5. Proper use of ED-PrEP was reported in person-months. From August 2020 to July 2021, 36 YMSM with a median age of 18.7 (IQR, 17.5-19.4) years were enrolled. Thirty-two participants (88.9%, 95% CI: 73.9-96.9%) were retained at 6 months. No HIV incidence occurred during this study period. Of 197 person-months of follow-up, 69 (35%) involved sexual activity. In this group, 61% used ED-PrEP correctly. "Unplanned sexual activity" was the most commonly cited reason for incorrect use. YMSM who have infrequent sex had very high retention in ED-PrEP. However, about one-third of the sexually active period, ED-PrEP was not used correctly due to not taking the loading dose, suggesting that this regimen may not be suitable for unanticipated sexual activity.
每日暴露前预防（PrEP）方案，即替诺福韦/恩曲他滨（TDF/FTC）片剂，是泰国预防 HIV 的标准方案。事件驱动的 PrEP（ED-PrEP）方案，即性行为前 2-24 小时服用两片负荷剂量，之后再服用两片，被认为是替代方案。本研究旨在描述接受 HIV 感染风险较高的泰国男男性行为者（MSM）中 ED-PrEP 使用的准确性和保留率。研究招募了一组年龄在 15-19 岁、报告不规则使用避孕套或有 HIV 阳性性伴侣的 MSM。所有参与者均提供 TDF/FTC 口服片剂、避孕套和“Raincoat”移动应用程序，该应用程序会提醒用户何时服用 ED-PrEP。参与者在第 1、3 和 6 个月接受门诊随访，并在第 2、4 和 5 个月通过电话进行随访。ED-PrEP 的正确使用以人月报告。从 2020 年 8 月至 2021 年 7 月，共招募了 36 名中位年龄为 18.7（IQR，17.5-19.4）岁的 MSM。32 名参与者（88.9%，95%CI：73.9-96.9%）在第 6 个月时仍保留。在研究期间，未发生 HIV 感染。在 197 个人月的随访中，有 69 人（35%）发生了性行为。在这组人群中，有 61%的人正确使用了 ED-PrEP。“无计划的性行为”是不正确使用的最常见原因。性活动较少的 MSM 对 ED-PrEP 的保留率非常高。然而，在大约三分之一的有性行为的时期，由于未服用负荷剂量，ED-PrEP 并未正确使用，这表明该方案可能不适合意外的性行为。
