Boutet Clément, Di Ciaccio Marion, Spire Bruno, Velter Annie, Sagaon-Teyssier Luis
Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
Laboratoire de Recherche Communautaire, Coalition PLUS, Pantin, France.
AIDS Behav. 2025 Apr 30. doi: 10.1007/s10461-025-04729-4.
Although PrEP prevents HIV among at-risk populations, high discontinuation rates hinder its effectiveness. We investigated three reasons for PrEP discontinuation in real-life settings in France and associated factors, in order to assess weariness taking PrEP. We used data from the French online survey Enquête Rapport au Sexe 2023 which targeted gay and bisexual men having sex with men (GBMSM). First, we constructed the outcome 'PrEP duration'. Second, we created a three-category 'reason for PrEP discontinuation' variable as follows: changes in sexual behaviors, a desire to discontinue PrEP, and clinical reasons. Third, we calculated PrEP survival probability. We then performed a Weibull accelerated failure time model with competing risks to assess how the duration of time on PrEP influenced discontinuation, and whether specific factors were associated with different discontinuation reasons. The analysis included 4819 GBMSM. Median PrEP duration was 19 months. Discontinuation because of changes in sexual behaviors was less likely among GBMSM who initiated PrEP prescription in a sexual health structure (AF = 0.604 [0.424-0.858]). A desire to stop PrEP was more likely among those living in regions with the lowest reported seropositivity rates (AF = 2.320 [1.054-5.107]). Discontinuing PrEP for clinical reasons was more likely among participants coming from smaller municipalities (AF = 2.312 [1.099-4.868]). PrEP duration dependence was negative for all three reasons, implying that the longer the time taking PrEP, the lower the probability of discontinuation. We found no weariness with PrEP use among GBMSM; this highlights the need to detail specific factors associated with PrEP discontinuation.
尽管暴露前预防（PrEP）可预防高危人群感染艾滋病毒，但高停药率阻碍了其有效性。我们调查了法国现实环境中PrEP停药的三个原因及相关因素，以评估服用PrEP的倦怠情况。我们使用了法国在线调查“2023年性报告调查”的数据，该调查针对与男性发生性关系的男同性恋者和双性恋者（GBMSM）。首先，我们构建了“PrEP持续时间”这一结果变量。其次，我们创建了一个三类“PrEP停药原因”变量，如下：性行为改变、希望停止服用PrEP以及临床原因。第三，我们计算了PrEP生存概率。然后，我们进行了具有竞争风险的威布尔加速失效时间模型分析，以评估服用PrEP的时间长短如何影响停药，以及特定因素是否与不同的停药原因相关。该分析纳入了4819名GBMSM。PrEP的中位持续时间为19个月。在性健康机构开始PrEP处方的GBMSM中，因性行为改变而停药的可能性较小（调整因子[AF]=0.604[0.424 - 0.858]）。在报告血清阳性率最低地区生活的人更有可能希望停止服用PrEP（AF = 2.320[1.054 - 5.107]）。来自较小市镇的参与者因临床原因停止服用PrEP的可能性更大（AF = 2.312[1.099 - 4.868]）。对于所有三个原因，PrEP持续时间依赖性均为负，这意味着服用PrEP的时间越长，停药的概率越低。我们发现GBMSM中不存在对使用PrEP的倦怠；这凸显了详细说明与PrEP停药相关的特定因素的必要性。
