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Wang H, Zimmermann HML, van de Vijver D, Jonas KJ. Intention and preference to use long-acting injectable PrEP among MSM in the Netherlands: a diffusion of innovation approach. AIDS Care 2024:1-12. [PMID: 38713631 DOI: 10.1080/09540121.2024.2307378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/10/2024] [Indexed: 05/09/2024]
Abstract
Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) is efficacious in preventing HIV among men-who-have-sex-with-men (MSM) and will be soon available in Europe. This study investigated the intention and preference to use LAI-PrEP among MSM in the Netherlands by employing a diffusion of innovation approach. This study had a cross-sectional design nested within a cohort study established in 2017 to understand oral PrEP use among MSM. 309 MSM completed the survey on their awareness, interest, intention, and preference for LAI-PrEP in June 2022. Among them, 83% showed high/very-high interest in, and 63% showed high/very-high intention to use LAI-PrEP. A repeated innovator effect from the early adopters to LAI-PrEP was not observed. Early adopters did not show increased intention to use LAI-PrEP compared to other MSM subgroups, but neither did PrEP-naïve nor PrEP-discontinued MSM. However, among the 218 current oral PrEP users, suboptimal adherence was associated with preference for LAI-PrEP but not with intention to use it. In conclusion, our findings indicated that an effective, available, and affordable LAI-PrEP would be welcomed in the Netherlands, but that its introduction may not significantly expand PrEP coverage. However, the introduction of LAI-PrEP in the Netherlands could prove beneficial to MSM with suboptimal adherence to oral PrEP.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
- Viroscience Department, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Hanne M L Zimmermann
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | | | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
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Yeo TED. Reconciling intimacy and safety: a qualitative systematic review of HIV pre-exposure prophylaxis implementation among gay and bisexual men. CULTURE, HEALTH & SEXUALITY 2023:1-16. [PMID: 37860979 DOI: 10.1080/13691058.2023.2270004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
This review synthesises qualitative research on pre-exposure prophylaxis (PrEP) uptake by sexual minority men to provide an overarching conceptualisation of the implementation processes involved. Twenty-four studies-comprising 734 participants from USA, UK, France, Canada, and Taiwan-were synthesised using thematic synthesis. The synthesis elucidates the dual significance of PrEP uptake: (1) risk management: reinforcing relational circumstances, and rebalancing safety and risk; and (2) sexual empowerment: reclaiming health and sexuality and refocusing on sexual fulfillment and intimacy. Overall, the findings show how gay and bisexual men use PrEP to reconcile their antagonistic desires for intimacy and safety by recalibrating protection and reimagining intimacy. This review conceptualises the essence of users' experiences of PrEP implementation as reconciliation work-the labour and agency in making and remaking practices to manage discontinuities and incongruities-about the new HIV prevention modality. The concept of reconciliation work illustrates how using PrEP influences users' practices, which in turn, shape the meanings of PrEP use within the community. This work engenders contingent transformations and outcomes beyond HIV protection, encompassing the broader aspects of health and sexuality. Findings support the adoption of more holistic and empowering approaches to sexual health promotion and intervention.
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Affiliation(s)
- Tien Ee Dominic Yeo
- Department of Communication Studies, Hong Kong Baptist University, Hong Kong, China
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Zimmermann HML, Davidovich U, van Bilsen WPH, Coyer L, Matser A, Prins M, van Harreveld F. A psychosocial network approach studying biomedical HIV prevention uptake between 2017 and 2019. Sci Rep 2023; 13:16168. [PMID: 37758796 PMCID: PMC10533833 DOI: 10.1038/s41598-023-42762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Biomedical HIV-prevention strategies (BmPS) among men who have sex with men (MSM), such as pre-exposure prophylaxis (PrEP) and viral load sorting (VLS), are essential but relatively new and their uptake gradual. Using an extension of the causal attitude network approach, we investigated which beliefs are related to uptake of PrEP and VLS at each time-point. We included 632 HIV-negative MSM from the Amsterdam Cohort Studies from four data-waves between 2017 and 2019. We estimated weighted, undirected networks for each time-point, where we included pairwise interactions of PrEP and VLS uptake and related beliefs. PrEP use increased from 10 to 31% (p < 0.001), while VLS was reported by 7-10% at each time-point. Uptake of both BmPS was directly related to the perceived positive impact of the strategy on one's quality of sex life and perceived supportive social norms. Overall network structure differed between time points, specifically in regard to PrEP. At earlier time points, perceptions of efficacy and affordability played an important role for PrEP uptake, while more recently social and health-related concerns became increasingly important.The network structure differed across data-waves, suggesting specific time changes in uptake motives. These findings may be used in communication to increase prevention uptake.
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Affiliation(s)
- Hanne M L Zimmermann
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Ward P H van Bilsen
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity Institute (AII), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity Institute (AII), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity Institute (AII), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Frenk van Harreveld
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Rugira E, Biracyaza E, Umubyeyi A. Uptake and Persistence on HIV Pre-Exposure Prophylaxis Among Female Sex Workers and Men Having Sex with Men in Kigali, Rwanda: A Retrospective Cross-Sectional Study Design. Patient Prefer Adherence 2023; 17:2353-2364. [PMID: 37790862 PMCID: PMC10542111 DOI: 10.2147/ppa.s427021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
Background Although HIV pre-exposure prophylaxis (PrEP) is known for its effectiveness in preventing HIV transmission; there is a global rise in HIV infection rates, particularly prominent in sub-Saharan Africa. This health concern is mostly evident among high-risk groups, namely Female Sex Workers (FSWs) and Men who have Sex with Men (MSMs), both of whom are more susceptible to sexually transmissible infections. This research examined the persistence, uptake, and associated predictors of PrEP utilization within the FSW and MSM populations. Methods A cross-sectional study design was conducted involving 4872 individuals from the FSW and MSM groups who were enrolled in a PrEP program across 10 health centers participating in a pilot initiative. The study population was subject to a year-long follow-up period commencing on March 1st, 2019. To evaluate the determinants of PrEP utilization within FSW and MSM groups, bivariate logistic analyses and multivariate logistic regression models were employed. Results The findings revealed that the occurrence of PrEP uptake was 45.55% (n=2219) among FSWs and 35.42% (n=17 participants) among MSM. Regarding PrEP persistence, MSM (88.24%, n=15 participants) presented higher PrEP proportion than FSWs (78.5%, n=1742 women). Our findings disclosed that individuals aged 25-34 years (aOR=0.82; 95% CI=0.72-0.93, p=0.002), 35-44 years (aOR=0.83; 95% CI=0.71-0.97, p=0.017), and 55 years and older (OR=0.14; 95% CI=0.04-0.48, p=0.002) exhibited lower likelihoods of having low PrEP uptake than those aged 15-19 years. Moreover, individuals residing with their families (aOR=0.71; 95% CI=0.58-0.87, p<0.001), living with roommates (aOR=0.7; 95% CI=0.5-0.97, p=0.032) displayed lower odds for experiencing low PrEP uptake than their counterparts living alone. Conclusion This study highlighted the low uptake of PrEP among participants when compared to previous studies. These results revealed significant influences of age and living conditions on PrEP usage.
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Affiliation(s)
- Eugene Rugira
- Department of Epidemiologuy and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Emmanuel Biracyaza
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montreal, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Aline Umubyeyi
- Department of Epidemiologuy and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
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Zimmermann HML, Gültzow T, Marcos TA, Wang H, Jonas KJ, Stutterheim SE. Mpox stigma among men who have sex with men in the Netherlands: Underlying beliefs and comparisons across other commonly stigmatized infections. J Med Virol 2023; 95:e29091. [PMID: 37752803 DOI: 10.1002/jmv.29091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023]
Abstract
People with or at risk for mpox are likely to be stigmatized because of analogies to other sexually transmitted infections. Stigma is driven by beliefs about the perceived severity of the condition and perceived responsibility for acquiring the condition, both in broader society and individual responsibility. We explored these beliefs and compared them across mpox, human immunodeficiency virus (HIV), syphilis, gonorrhoea, and chlamydia in an online survey, conducted in July 2022, with 394 men-who-have-sex-with-men in the Netherlands. We compared mean scores between infections using repeated measures analysis of variance and conducted hierarchical regression analyses to identify determinants of both mpox perceived responsibility endpoints. Results showed that participants expected that mpox would be seen as a "gay disease" and will be used to blame gay men. Compared to other infections, mpox was considered less severe than HIV, but more severe than syphilis, gonorrhoea, and chlamydia. Perceived responsibility was comparable across infections, but, for each infection, participants perceived attributed responsibility to be higher in society than individual responsibility. Both perceived responsibility endpoints were highly correlated with each other and with other stigma beliefs. These results provide insight on the underlying determinants of mpox stigma and demonstrate that anticipated mpox stigma is present in the Netherlands.
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Affiliation(s)
- Hanne M L Zimmermann
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Thomas Gültzow
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- Department of Theory, Methods and Statistics, Open University of the Netherlands, Heerlen, The Netherlands
| | - Tamika A Marcos
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- Viroscience Department, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Mizushima D, Nagai Y, Mezzio D, Harada K, Piao Y, Barnieh L, El Moustaid F, Cawson M, Taniguchi T. Cost-effectiveness analysis of HIV pre-exposure prophylaxis in Japan. J Med Econ 2023:1-14. [PMID: 37421417 DOI: 10.1080/13696998.2023.2233824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND While global efforts have been made to prevent transmission of HIV, the epidemic persists. Men who have sex with men (MSM) are at high risk of infection. Despite evidence of its cost-effectiveness in other jurisdictions, pre-exposure prophylaxis (PrEP) for MSM is neither approved nor reimbursed in Japan. METHOD The cost-effectiveness analysis compared the use of once daily PrEP versus no PrEP among MSM over a 30-year time horizon from a national healthcare perspective. Epidemiological estimates for each of the 47 prefectures informed the model. Costs included HIV/AIDS treatment, HIV and testing for sexually transmitted infections, monitoring tests and consults, and hospitalization costs. Analyses included health and cost outcomes, as well as the incremental cost-effectiveness ratio (ICER) reported as the cost per quality-adjusted life year (QALY) for all of Japan and each prefecture. Sensitivity analyses were performed. FINDINGS The estimated proportion of HIV infections prevented with the use of PrEP ranged from 48% to 69% across Japan, over the time horizon. Cost savings due to lower monitoring costs and general medical costs were observed. Assuming 100% coverage, for Japan overall, daily use of PrEP costs less and was more effective; daily use of PrEP was cost-effective at a willingness to pay threshold of ¥5,000,000 per QALY in 32 of the 47 prefectures. Sensitivity analyses found that the ICER was most sensitive to the cost of PrEP. INTERPRETATION Compared to no PrEP use, once daily PrEP is a cost-effective strategy in Japanese MSM, reducing the clinical and economic burden associated with HIV.
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Affiliation(s)
- Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | - Yi Piao
- Gilead Sciences, Tokyo, Japan
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Evers YJ, Goense CJD, Hoebe CJPA, Dukers-Muijrers NHTM. Newly diagnosed HIV and use of HIV-PrEP among non-western born MSM attending STI clinics in the Netherlands: a large retrospective cohort study. Front Public Health 2023; 11:1196958. [PMID: 37404283 PMCID: PMC10315834 DOI: 10.3389/fpubh.2023.1196958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction The World Health Organization recommends HIV-PrEP for all people at risk for HIV infection, which includes men who have sex with men (MSM). Substantial part of new HIV diagnoses in the Netherlands are in non-western born MSM. This study evaluated new HIV diagnoses and reported PrEP use among non-western born MSM and compared it to western-born MSM. To inform public health efforts in the context of equitable PrEP access, we further assessed sociodemographic factors related to higher HIV risk and lower PrEP use among non-western born MSM. Methods Surveillance data of consultations among MSM in all Dutch STI-clinics (2016-2021) were analyzed. STI-clinics provide PrEP via the national pilot-program since August 2019. In non-western born MSM (born in Eastern-Europe/Latin-America/Asia/Africa/Dutch-Antilles/Suriname), sociodemographic factors were evaluated for association with HIV (by multivariable generalized estimating equations) and reported PrEP use in the past 3 months (by multivariable logistic regression; restricted to an at-risk for HIV person-level data-subset from August 2019). Results New HIV infections were diagnosed among 1.1% (493/44,394) of non-western born MSM-consultations (vs. 0.4% among western-born MSM, 742/210,450). Low education (aOR: 2.2, 95%CI: 1.7-2.7, vs. high education) and age under 25 years (aOR: 1.4, 95%CI: 1.1-1.8, vs. age above 35 years) were associated with new HIV diagnoses. PrEP use in the past 3 months was 40.7% in non-western born MSM (1,711/4,207; 34.9% among western-born MSM, 6,089/17,458). PrEP use was lower among non-western born MSM aged under 25 years (aOR: 0.3, 95%CI: 0.2-0.4), living in less urban areas (aOR: 0.7, 95%CI: 0.6-0.8), and having low education level (aOR: 0.6, 95%CI: 0.5-0.7). Conclusion Our study confirmed that non-western born MSM are an important key population in HIV prevention. Access to HIV prevention, including HIV-PrEP, should be further optimized to all non-western born MSM at risk for HIV, and specifically to those who are younger, live in less urban areas, and have a low education level.
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Affiliation(s)
- Ymke J. Evers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Cornelia J. D. Goense
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht, Limburg, Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Morgan E, Dyar C, Feinstein BA, Ricks J. PrEP use and stigma among a sample of older adults in Columbus, Ohio. Int J STD AIDS 2023; 34:122-129. [PMID: 36424190 PMCID: PMC10113038 DOI: 10.1177/09564624221140967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite older adults (age ≥50 years) continuing to account for 1 in 6 new HIV diagnoses, the majority of research has focused on young adults. Assessing PrEP use and stigma among this understudied population is key to achieving the U.S.'s goals of Ending the HIV Epidemic, a federal initiative focusing on reducing new HIV infections by at least 90% by 2030. METHODS Data for this analysis came from the Columbus Health Aging Project (N = 794). This study was designed to assess several domains of health among adults aged 50 years and older in Columbus, Ohio. Multiple logistic and linear regression models were used to examine the associations between sociodemographic factors and past 6-month PrEP use, PrEP stigma, and concurrent use of PrEP and other prevention methods, adjusting for known confounders. RESULTS Overall, 93 (11.7%) participants reported past 6-month PrEP use. Transgender women (aOR = 6.90; 95% CI: 2.19, 21.72), cisgender gay men (aOR = 5.58; 95% CI: 2.49, 12.50), cisgender lesbians (aOR = 2.24; 95% CI: 1.05, 4.80), and those living with family members or roommates (aOR = 6.59; 95% CI: 3.49, 12.45) were each more likely to report past 6-month PrEP use relative to cisgender women, heterosexuals, and those living with a spouse/partner, respectively. Relative to cisgender women, PrEP-related stigma was lower among transgender women (β = -5.05; 95% CI: -8.44, -1.66) and higher among cisgender men (β = 1.96; 95% CI: 0.46, 3.46). CONCLUSION Future research should aim to continue developing a firm understanding of PrEP use and stigma among older adults to reduce HIV risk among this population and to understand unique needs of sub-populations of older adults.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH
- Infectious Disease Institute, The Ohio State University, Columbus, OH
- College of Public Health, The Ohio State University, Columbus, OH
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, OH
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - JaNelle Ricks
- College of Public Health, The Ohio State University, Columbus, OH
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Gokengin D, Bursa D, Skrzat-Klapaczynska A, Alexiev I, Arsikj E, Balayan T, Begovac J, Cicic A, Dragovic G, Harxhi A, Aimla K, Lakatos B, Matulionyte R, Mulabdic V, Oprea C, Papadopoulos A, Rukhadze N, Sedlacek D, Sojak L, Tomazic J, Vassilenko A, Vasylyev M, Verhaz A, Yancheva N, Yurin O, Kowalska J. PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future. Vaccines (Basel) 2023; 11:vaccines11010122. [PMID: 36679967 PMCID: PMC9867039 DOI: 10.3390/vaccines11010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1−80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.
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Affiliation(s)
- Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, Izmir 35100, Türkiye
- HIV/AIDS Research and Practice Center, Ege University, Izmir 35100, Türkiye
- Correspondence: or
| | - Dominik Bursa
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Agata Skrzat-Klapaczynska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Ivailo Alexiev
- Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria
| | - Elena Arsikj
- University Clinic for Infectious Diseases and Febrile Conditions Skopje, Faculty of Medicine Skopje, Ss.Cyril and Methodius University, 1010 Skopje, North Macedonia
| | - Tatevik Balayan
- National Center for Disease Control and Prevention, Yerevan 0025, Armenia
| | - Josip Begovac
- Department of Infectious Diseases, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Alma Cicic
- Center for Communicable Disease Control and Prevention, Institute for Public Health of Montenegro, 81000 Podgorica, Montenegro
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, 1001 Tirana, Albania
| | - Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Botond Lakatos
- Department of HIV and Tropical Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Vilnius University Hospital Santaros Klinikos, Vilnius University, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, Clinical Center University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Cristiana Oprea
- Victor Babes Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, 030303 Bucharest, Romania
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, University General Hospital “ATTIKON”, 12462 Athens, Greece
| | - Nino Rukhadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - Dalibor Sedlacek
- HIV Center University Hospital, Charles University, 11000 Pilsen, Czech Republic
| | - Lubomir Sojak
- Center for Treatment of HIV/AIDS Patients, Department of Infectology and Geographical Medicine, Academic L. Derer’s University Hospital, 2412 Bratislava, Slovakia
| | - Janez Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia
| | - Anna Vassilenko
- Global Fund Grant Management Department, Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RNPT MT), 220013 Minsk, Belarus
| | - Marta Vasylyev
- Astar Medical Center, 79054 Lviv, Ukraine
- Internal Medicine Department, Erasmus MC, 2040 3000 Rotterdam, The Netherlands
| | - Antonija Verhaz
- Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases—Sofia, Medical University Sofia, 1431 Sofia, Bulgaria
| | - Oleg Yurin
- Department of AIDS, Epidemiology and Prevention, Central Research Institute of Epidemiology, Federal AIDS Centre, 111123 Moscow, Russia
| | - Justyna Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
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10
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Edinger A, Valdez D, Walsh-Buhi E, Bollen J. Deep learning for topical trend discovery in online discourse about Pre-Exposure Prophylaxis (PrEP). AIDS Behav 2023; 27:443-453. [PMID: 35916950 PMCID: PMC9344253 DOI: 10.1007/s10461-022-03779-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/16/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) interventions are increasingly prevalent on social media. These data can be mined for insights about PrEP that may not be as apparent in surveys including personal musings about PrEP and barriers/facilitators to PrEP uptake. This study explores online discourse about PrEP using an interdisciplinary public health and computational informatics approach. We collected (N = 4,020) tweets using Twitter's Application Programming Interface (API). These data underwent a three-step neural network/deep learning process to identify clusters within these tweets and relative similarity/dissimilarity between clusters. We identified 25 distinct clusters from our original collection of tweets. These clusters represent general information about PrEP, how PrEP is communicated among diverse groups, and potential pockets of misinformation and disinformation regarding PrEP. Specific clusters of interest include discussions of medication side effects, social perception of PrEP usage, and concerns with costs and barriers to access of PrEP interventions. Our approach revealed diverse ways PrEP is contextualized online. Importantly this information can be leveraged to identify points of possible intervention for disinformation and misinformation about PrEP.
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Affiliation(s)
- Andy Edinger
- grid.411377.70000 0001 0790 959XDepartment of Applied Health Science, Indiana University School of Public Health, 47405 Bloomington, IN USA
| | - Danny Valdez
- Luddy School of Informatics and Computer Engineering, Indiana University, 47405, Bloomington, IN, USA.
| | - Eric Walsh-Buhi
- grid.411377.70000 0001 0790 959XDepartment of Applied Health Science, Indiana University School of Public Health, 47405 Bloomington, IN USA
| | - Johan Bollen
- grid.411377.70000 0001 0790 959XLuddy School of Informatics and Computer Engineering, Indiana University, 47405 Bloomington, IN USA ,grid.411377.70000 0001 0790 959XDepartment of Psychological and Brain Sciences, Indiana University, 47405 Bloomington, IN USA
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11
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Bekker LG, Giovenco D, Baral S, Dominguez K, Valencia R, Sanchez T, McNaghten A, Zahn R, Yah CS, Sokhela Z, Kaplan R, Phaswana-Mafuya RN, Beyrer C, Sullivan PS. Oral pre-exposure prophylaxis uptake, adherence, and adverse events among South African men who have sex with men and transgender women. South Afr J HIV Med 2022; 23:1405. [PMID: 36479416 PMCID: PMC9724083 DOI: 10.4102/sajhivmed.v23i1.1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women (TGW) in South Africa have not been widely implemented. Objectives The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility. Method In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP, and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations. Results Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305 days (interquartile range: 232-325 days). Across the follow-up time points, 57% - 72% of participants self-reported taking protective levels of PrEP and 59% - 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation. Conclusion Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP.
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Affiliation(s)
- Linda-Gail Bekker
- Desmond Tutu HIV Centre, Cape Town, South Africa
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Danielle Giovenco
- Desmond Tutu HIV Centre, Cape Town, South Africa
- International Health Institute, Brown University, Providence, United States of America
| | - Stefan Baral
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Karen Dominguez
- Desmond Tutu HIV Centre, Cape Town, South Africa
- Contraceptive Research and Development (CONRAD), Eastern Virginia Medical School, Norfolk, United States of America
| | - Rachel Valencia
- Department of Epidemiology, Emory University, Atlanta, United States of America
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, United States of America
| | - A.D. McNaghten
- Department of Epidemiology, Emory University, Atlanta, United States of America
| | - Ryan Zahn
- Department of Epidemiology, Emory University, Atlanta, United States of America
| | - Clarence S. Yah
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, School of Health System and Public Health, University of Pretoria, Pretoria, South Africa
| | - Zinhle Sokhela
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Refliwe N. Phaswana-Mafuya
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Chris Beyrer
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Patrick S. Sullivan
- Department of Epidemiology, Emory University, Atlanta, United States of America
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12
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Li G, Park LS, Lodi S, Logan RW, Cartwright EJ, Aoun-Barakat L, Casas JP, Dickerman BA, Rentsch CT, Justice AC, Hernán MA. Tenofovir disoproxil fumarate and coronavirus disease 2019 outcomes in men with HIV. AIDS 2022; 36:1689-1696. [PMID: 35848570 PMCID: PMC9444875 DOI: 10.1097/qad.0000000000003314] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare the risk of coronavirus disease 2019 (COVID-19) outcomes by antiretroviral therapy (ART) regimens among men with HIV. DESIGN We included men with HIV on ART in the Veterans Aging Cohort Study who, between February 2020 and October 2021, were 18 years or older and had adequate virological control, CD4 + cell count, and HIV viral load measured in the previous 12 months, and no previous COVID-19 diagnosis or vaccination. METHODS We compared the adjusted risks of documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19-related hospitalization, and intensive care unit (ICU) admission by baseline ART regimen: tenofovir alafenamide (TAF)/emtricitabine (FTC), tenofovir disoproxil fumarate (TDF)/FTC, abacavir (ABC)/lamivudine (3TC), and other. We fit pooled logistic regressions to estimate the 18-month risks standardized by demographic and clinical factors. RESULTS Among 20 494 eligible individuals, the baseline characteristics were similar across regimens, except that TDF/FTC and TAF/FTC had lower prevalences of chronic kidney disease and estimated glomerular filtration rate <60 ml/min. Compared with TAF/FTC, the estimated 18-month risk ratio (95% confidence interval) of documented SARS-CoV-2 infection was 0.65 (0.43, 0.89) for TDF/FTC, 1.00 (0.85, 1.18) for ABC/3TC, and 0.87 (0.70, 1.04) for others. The corresponding risk ratios for COVID-19 hospitalization were 0.43 (0.07, 0.87), 1.09 (0.79, 1.48), and 1.21 (0.88, 1.62). The risk of COVID-19 ICU admission was lowest for TDF/FTC, but the estimates were imprecise. CONCLUSION Our study suggests that, in men living with HIV, TDF/FTC may protect against COVID-19-related events. Randomized trials are needed to investigate the effectiveness of TDF as prophylaxis for, and early treatment of, COVID-19 in the general population.
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Affiliation(s)
- Guilin Li
- CAUSALab
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lesley S Park
- Stanford Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Sara Lodi
- CAUSALab
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Roger W Logan
- CAUSALab
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily J Cartwright
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta
- Atlanta VA Medical Center, North Druid Hills, Georgia
| | - Lydia Aoun-Barakat
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut
| | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System
- Department of Medicine, Division of Aging, Brigham & Women's Hospital
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Barbra A Dickerman
- CAUSALab
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher T Rentsch
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, US Department of Veterans Affairs, Washington, DC, USA
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Amy C Justice
- VA Connecticut Healthcare System, US Department of Veterans Affairs, Washington, DC, USA
- Department of Medicine, Yale School of Medicine
- Division of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Miguel A Hernán
- CAUSALab
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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13
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Wang H, Shobowale O, den Daas C, Op de Coul E, Bakker B, Radyowijati A, Vermey K, van Bijnen A, Zuilhof W, Jonas KJ. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148829. [PMID: 35886681 PMCID: PMC9315833 DOI: 10.3390/ijerph19148829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called “Randstad”, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0–10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04–4.4). Lower education (aOR = 0.4, 95% CI 0.2–0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7–2.0) and high education. We showed that regional differences—MSM in non-urban regions—and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
| | - Oladipupo Shobowale
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
| | - Chantal den Daas
- Health Psychology, University of Aberdeen, Aberdeen AB24 3 FX, UK;
| | - Eline Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands;
| | | | | | - Koenraad Vermey
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Arjan van Bijnen
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Wim Zuilhof
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
- Correspondence: ; Tel.: +31-43-38-84068
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14
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Krist LC, Zimmermann HML, van Dijk M, Stutterheim SE, Jonas KJ. PrEP Use in Times of COVID-19 in the Netherlands: Men Who Have Sex With Men (MSM) on PrEP Test Less for HIV and Renal Functioning During a COVID-19 Related Lockdown. AIDS Behav 2022; 26:3656-3666. [PMID: 35578141 PMCID: PMC9109746 DOI: 10.1007/s10461-022-03693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
As a result of the COVID-19 pandemic, HIV care and prevention efforts have been disrupted. We investigated pre-exposure prophylaxis (PrEP) use and testing behaviors among MSM in the Netherlands, and the factors that influenced testing behaviors during the COVID-19 pandemic. A cohort of 766 MSM, established in 2017, was asked in August 2020 to report on their experiences during the COVID-19 pandemic via an online survey. Participants (n = 319) reported increased PrEP use and, among PrEP users (n = 211), significantly lower rates of having tested in the last 3 months for HIV and renal functioning compared to before the pandemic. Daily PrEP use and a higher number of sexual partners during the pandemic was significantly associated with continued HIV testing. Continued renal functioning testing was associated with older age. Correcting for pandemic-related disruptions in PrEP use and care will require sustained effort to understand and address missed opportunities.
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Affiliation(s)
- Lizette C Krist
- Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Hanne M L Zimmermann
- Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Mart van Dijk
- Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Sarah E Stutterheim
- Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Kai J Jonas
- Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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15
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Hulstein SH, Zimmermann HM, de la Court F, Matser AA, Schim van der Loeff MF, Hoornenborg E, Davidovich U, Prins M, de Vries HJ. Factors Associated With the Intention to Use HIV Preexposure Prophylaxis for Young and Older Men Who Have Sex With Men. Sex Transm Dis 2022; 49:343-352. [PMID: 35001016 PMCID: PMC8994038 DOI: 10.1097/olq.0000000000001599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The uptake of preexposure prophylaxis (PrEP) against HIV is low among young men who have sex with men (MSM) in the Netherlands. Studying the intention to use PrEP among non-PrEP using young and older MSM can guide health authorities in developing new prevention campaigns to optimize PrEP uptake. METHODS We investigated the sociodemographic, behavioral, and psychosocial factors associated with a high PrEP use intention in the coming 6 months among 93 young MSM (aged ≤25 years), participating in an online survey, and 290 older MSM (aged ≥26 years), participating in an open, prospective cohort in 2019 to 2020. RESULTS Perceiving PrEP as an important prevention tool was associated with a high PrEP use intention among young and older MSM. Among young MSM, a high level of PrEP knowledge and believing that PrEP users take good care of themselves and others were associated with a high PrEP use intention. Among older MSM, 2 or more anal sex partners, chemsex, high HIV risk perception, and believing PrEP increases sexual pleasure were associated with a high PrEP use intention. Believing PrEP leads to adverse effects was associated with a low intention to use PrEP among older MSM. CONCLUSIONS To conclude, we showed that both behavioral and psychosocial factors were associated with a high PrEP use intention among young and older MSM. In addition to focusing on sexual behavior and HIV risk, future prevention campaigns and counseling on PrEP could incorporate education, endorsing positive beliefs, and disarming negative beliefs to improve the uptake of PrEP in young and older MSM.
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Affiliation(s)
| | | | - Feline de la Court
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Amy A. Matser
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Maarten F. Schim van der Loeff
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Elske Hoornenborg
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Udi Davidovich
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Maria Prins
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Henry J.C. de Vries
- Department of Dermatology, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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16
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Rathakrishnan D, Purpura LJ, Salcuni PM, Myers JE, Wahnich A, Daskalakis DC, Edelstein ZR. PrEP Use and Correlates of Use Among a Large, Urban Sample of Men and Transgender Persons Who Have Sex with Men. AIDS Behav 2022; 26:1017-1025. [PMID: 34599419 DOI: 10.1007/s10461-021-03456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
We examined recent pre-exposure prophylaxis (PrEP) use (past 6 months) and its correlates among a large sample of men who have sex with men and transgender and gender non-conforming persons participating in a home HIV self-testing program conducted by the New York City Health Department between 11/2016 and 1/2017. Correlates examined included demographic characteristics and HIV-related behaviors in the past 6 months. Associations with recent PrEP use were assessed using log-binomial regression. 400 (22.5%) of 1776 participants reported recent PrEP use. In adjusted models, recent PrEP use was associated with Manhattan residence [adjusted prevalence ratio (aPR) 1.26; 95% confidence interval (CI) (1.04, 1.53)], higher income [aPR 1.29; 95% CI (1.03, 1.62)], and having insurance [aPR 1.89; 95% CI (1.33, 2.69)]. All HIV-related behaviors, except for injection drug use, were individually associated with PrEP use. More research is needed to better understand barriers to PrEP use among patients who are low income and/or uninsured as this may help improve current public health efforts to increase PrEP uptake among disproportionately impacted populations.
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Affiliation(s)
- Dinesh Rathakrishnan
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence J Purpura
- New York City Department of Health and Mental Hygiene, Queens, NY, USA.
- Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA.
- ICAP, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Paul M Salcuni
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Julie E Myers
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - Amanda Wahnich
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | | | - Zoe R Edelstein
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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17
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Van Dijk M, De Wit JBF, Guadamuz TE, Martinez JE, Jonas KJ. Quality of Sex Life and Perceived Sexual Pleasure of PrEP Users in the Netherlands. JOURNAL OF SEX RESEARCH 2022; 59:303-308. [PMID: 34128741 DOI: 10.1080/00224499.2021.1931653] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Next to its benefits for HIV prevention, PrEP may have psychosocial benefits relating to improved quality of sex life. The aim of the current study was to investigate the onset of changes in the quality of sex life and sexual pleasure of PrEP users in the first months of commencing PrEP use. Moreover, we investigated what factors were related to the quality of sex life of PrEP users. We recruited 145 participants via the Dutch PrEP-advocacy website PrEPnu.nl, and they received follow-up questionnaires after three and six months. We found that PrEP users reported an increase in the quality of their sex life, which was related to reduced fear of HIV since they started using PrEP but not to decreased condom use. PrEP users were more interested in experimenting with sex practices, but they did not always feel more desirable as a sex partner because of PrEP use. Health-care providers and health promotion campaigns could emphasize the positive effects of PrEP on the quality of sex life, in addition to the HIV-preventive effects of PrEP, to decrease PrEP stigma and increase PrEP uptake.
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Affiliation(s)
- Mart Van Dijk
- Department of Work & Social Psychology, Maastricht University
| | - John B F De Wit
- Department of Interdisciplinary Social Science, Utrecht University
| | | | | | - Kai J Jonas
- Department of Work & Social Psychology, Maastricht University
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18
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Eustaquio PC, Figuracion R, Izumi K, Morin MJ, Samaco K, Flores SM, Brink A, Diones ML. Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study. BMC Public Health 2022; 22:366. [PMID: 35189850 PMCID: PMC8860324 DOI: 10.1186/s12889-022-12705-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. Methods We did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits. Results HIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01–4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46–7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15–2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32–0.62]). Conclusions HIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.
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Affiliation(s)
- Patrick C Eustaquio
- LoveYourself, Inc, 715 Anglo Bldg., Shaw Blvd, 1550, Mandaluyong City, Philippines.
| | - Roberto Figuracion
- Family Planning Organization of the Philippines, Inc, Iloilo Chapter - Rajah Community Center, 2F Dulalia Building, Rizal St, 5000, Iloilo City, Iloilo City Proper, Philippines
| | - Kiyohiko Izumi
- World Health Organization, Philippines, Ground Floor Building 3 San Lazaro Compound, C. S. Gatmaitan Ave, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | - Mary Joy Morin
- Department of Health, Philippines, Compound San Lazaro St, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | - Kenneth Samaco
- World Health Organization, Philippines, Ground Floor Building 3 San Lazaro Compound, C. S. Gatmaitan Ave, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | - Sarah May Flores
- Department of Health, Philippines, Compound San Lazaro St, Santa Cruz, 1000, Manila, Metro Manila, Philippines
| | | | - Mona Liza Diones
- Family Planning Organization of the Philippines, Inc, Iloilo Chapter - Rajah Community Center, 2F Dulalia Building, Rizal St, 5000, Iloilo City, Iloilo City Proper, Philippines
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Jijón S, Molina JM, Costagliola D, Supervie V, Breban R. Can HIV epidemics among MSM be eliminated through participation in preexposure prophylaxis rollouts? AIDS 2021; 35:2347-2354. [PMID: 34224442 DOI: 10.1097/qad.0000000000003012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the conditions under which preexposure prophylaxis (PrEP) coverage can eliminate HIV among MSM in the Paris region. DESIGN Mathematical modeling. METHODS We propose an innovative approach, combining a transmission model with a game-theoretic model, for decision-making about PrEP use. Individuals at high risk of HIV infection decide to use PrEP, depending on their perceived risk of infection and the relative cost of using PrEP versus antiretroviral treatment (ART), which includes monetary and/or nonmonetary aspects, such as price and access model of PrEP, consequences of being infected and lifelong ART. RESULTS If individuals assessed correctly their infection risk, and the cost of using PrEP were sufficiently low, then the PrEP rollout could lead to elimination. Specifically, assuming 86% PrEP effectiveness, as observed in two clinical trials, a minimum PrEP coverage of 55% [95% confidence interval (CI) 43-64%] among high-risk MSM would achieve elimination in the Paris region. A complete condom drop by MSM using PrEP slightly increases the minimum PrEP coverage required for elimination, by ∼1%, whereas underestimation of their own HIV infection risk would require PrEP programs reduce the cost of using PrEP by a factor ∼2 to achieve elimination. CONCLUSION Elimination conditions are not yet met in the Paris region, where at most 47% of high-risk MSM were using PrEP as of mid-2019. Further lowering the cost of PrEP and promoting a fair perception of HIV risk are required and should be maintained in the long-run, to maintain elimination status.
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Affiliation(s)
- Sofía Jijón
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP)
| | - Jean-Michel Molina
- University of Paris, Department of Infectious Diseases, St-Louis and Lariboisiére Hospitals, APHP, Inserm U944
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP)
| | - Virginie Supervie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP)
| | - Romulus Breban
- Institut Pasteur, Unité d'Épidémiologie des Maladies Émergentes, Paris, France
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Van Dijk M, De Wit JBF, Guadamuz TE, Martinez JE, Jonas KJ. Bridging the serodivide: attitudes of PrEP users towards sex partners living with HIV. AIDS Care 2021; 34:349-352. [PMID: 34280060 DOI: 10.1080/09540121.2021.1954588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The introduction of biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), holds the potential to overcome the serodivide. We investigated the attitudes of PrEP users towards having sex with partners living with HIV. PrEP users in the Netherlands were recruited online and completed three questionnaires over a period of six months. We investigated changes over time in feelings of fear of HIV, comfort, and attitudes towards condom use when having sex with men living with HIV (MLHIV). A majority of PrEP users in our sample (up to 71.6%) had sex with MLHIV. Feeling comfortable to have sex with MLHIV did not change over time, but was already at a high level at T1. Most importantly, feeling safe not to use condoms with HIV-positive partners significantly increased, and did so in a rather short period of time after the onset of PrEP use (3-6 months). Taken together, the findings suggest that that PrEP may contribute to decreasing the serodivide between MSM rather quickly after the onset of PrEP use.
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Affiliation(s)
- Mart Van Dijk
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - John B F De Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Thomas E Guadamuz
- Department of Society and Health, Mahidol University, Bangkok, Thailand
| | - Joel E Martinez
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Kai J Jonas
- Department of Work & Social Psychology, Maastricht University, Maastricht, the Netherlands
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