Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
J Int AIDS Soc. 2023 Jul;26(7):e26133. doi: 10.1002/jia2.26133.
Daily and event-driven oral pre-exposure prophylaxis (PrEP) reduce the risk of HIV acquisition. PrEP use can vary over time, yet little is known about the trajectories of PrEP use irrespective of the chosen PrEP regimens among men who have sex with men (MSM).
Using data from a mobile, web-based diary application collected daily from 17 August 2015 until 6 May 2018, we analysed PrEP use and sexual behaviour in two large cohorts, AMPrEP (Amsterdam, the Netherlands) and Be-PrEP-ared (Antwerp, Belgium). In both cohorts, participants could choose between daily and event-driven oral PrEP every 3 months. We used group-based trajectory modelling to identify trajectories of PrEP use over time and their determinants. In addition, we estimated the incidence rate of chlamydia, gonorrhoea and syphilis within these trajectories.
We included 516 MSM (n = 322 AMPrEP; n = 194 Be-PrEP-ared), of whom 24% chose event-driven PrEP at PrEP initiation. Participants contributed 225,015 days of follow-up (median = 508 days [IQR = 429-511]). Four distinct PrEP use trajectories were identified: ≤2 tablets per week ("low frequency," 12% of the total population), 4 tablets per week ("variable," 17%), "almost daily" (31%) and "always daily" (41%). Compared to participants with "low frequency" PrEP use, participants with "variable" (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.04-4.60) and "almost daily" PrEP use were more often AMPrEP participants (OR = 2.64, 95% CI = 1.27-5.49). "Almost daily" PrEP users were more often employed (OR = 6.76, 95% CI = 2.10-21.75) and were younger compared to participants with "low frequency" PrEP use. In addition, the number of days on which anal sex occurred was lower among participants with "low frequency" PrEP use compared to the other groups (all p<0.001). Compared to "low frequency" PrEP users, the incidence rates of chlamydia and gonorrhoea were higher for participants with "almost daily" and "always daily" PrEP use.
We uncovered four distinct PrEP use trajectories, pointing to different patterns of PrEP use in practice beyond the two-regimen dichotomy. These trajectories were related to sexual behaviour and rates of sexually transmitted infection. Tailoring PrEP care according to different PrEP use patterns could be an important strategy to improve efficient PrEP delivery.
每日和事件驱动的口服暴露前预防（PrEP）可降低 HIV 感染风险。PrEP 的使用可能随时间而变化，但我们对男男性行为者（MSM）中无论选择哪种 PrEP 方案，PrEP 使用的轨迹知之甚少。
使用 2015 年 8 月 17 日至 2018 年 5 月 6 日期间通过移动、基于网络的日记应用程序每日收集的数据，我们在两个大型队列（阿姆斯特丹的 AMPrEP 和安特卫普的 Be-PrEP-ared）中分析了 PrEP 的使用和性行为。在两个队列中，参与者可以每 3 个月选择每日或事件驱动的口服 PrEP。我们使用基于群组的轨迹建模来确定随时间推移的 PrEP 使用轨迹及其决定因素。此外，我们还估计了这些轨迹内衣原体、淋病和梅毒的发病率。
我们纳入了 516 名 MSM（n = 322 名 AMPrEP；n = 194 名 Be-PrEP-ared），其中 24%的参与者在开始 PrEP 时选择了事件驱动的 PrEP。参与者提供了 225015 天的随访（中位数 = 508 天[IQR = 429-511]）。确定了四种不同的 PrEP 使用轨迹：每周≤2 片（“低频率”，占总人群的 12%）、每周 4 片（“可变”，占 17%）、“几乎每天”（31%）和“每天”（41%）。与“低频率”PrEP 使用者相比，“可变”（比值比[OR] = 2.18，95%置信区间[CI] = 1.04-4.60）和“几乎每天”PrEP 使用者更常是 AMPrEP 参与者（OR = 2.64，95%CI = 1.27-5.49）。“几乎每天”PrEP 使用者更常从事有薪工作（OR = 6.76，95%CI = 2.10-21.75），且比“低频率”PrEP 使用者年轻。此外，与其他组相比，“低频率”PrEP 使用者进行肛交的天数较少（均<0.001）。与“低频率”PrEP 使用者相比，“几乎每天”和“每天”PrEP 使用者的衣原体和淋病发病率更高。
我们发现了四种不同的 PrEP 使用轨迹，这表明实践中的 PrEP 使用模式存在两种方案之外的不同模式。这些轨迹与性行为和性传播感染率有关。根据不同的 PrEP 使用模式定制 PrEP 护理可能是提高高效 PrEP 提供的重要策略。
