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Choosing Between Daily and Event-Driven Pre-exposure Prophylaxis

Results of a Belgian PrEP Demonstration Project

Reyniers, Thijs, PhD*; Nöstlinger, Christiana, PhD*,†; Laga, Marie, PhD*; De Baetselier, Irith, MSc; Crucitti, Tania, PhD; Wouters, Kristien, MD; Smekens, Bart, MSc; Buyze, Jozefien, PhD; Vuylsteke, Bea, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2018 - Volume 79 - Issue 2 - p 186–194
doi: 10.1097/QAI.0000000000001791
Prevention Research
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Background: Daily pre-exposure prophylaxis and event-driven pre-exposure prophylaxis (PrEP) are efficacious in reducing HIV transmission among men who have sex with men (MSM). We analyzed baseline data from a PrEP demonstration project “Be-PrEP-ared” in Antwerp, Belgium, to understand preferences for daily PrEP or event-driven PrEP among MSM at high risk of HIV and factors influencing their initial choice.

Methods: Cross-sectional data from an open-label prospective cohort study, using mixed methods. Participants who preregistered online were screened for eligibility and tested for sexually transmitted infections (STIs). Eligible participants chose between daily PrEP and event-driven PrEP and reported on behavioral data through an electronic questionnaire. In-depth interviews were conducted with a selected subsample. Bivariate associations were examined between preferred PrEP regimens and sociodemographic factors, sexual behavior, and STIs at screening.

Results: In total, 200 participants were enrolled between October 2015 and December 2016. Self-reported levels of sexual risk-taking before enrollment were high. STI screening revealed that 39.5% had at least 1 bacterial STI. At baseline, 76.5% of participants preferred daily PrEP and 23.5% event-driven PrEP. Feeling able to anticipate HIV risk was the most frequent reason for preferring event-driven PrEP. Regimen choice was associated with sexual risk-taking behavior in the past 3 months. Almost all participants (95.7%) considered it likely that they would change their dosing regimen the following year.

Conclusion: Event-driven PrEP was preferred by 23.5% of the participants, which better suits their preventive needs. Event-driven PrEP should be included in PrEP provision as a valuable alternative to daily PrEP for MSM at high risk of HIV.

*Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;

Department of Applied Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria; and

Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.

Correspondence to: Thijs Reyniers, PhD, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium (e-mail: treyniers@itg.be).

Supported by a grant obtained from the Flemish Agency for Innovation and Entrepreneurship. Gilead Sciences donated the drugs (Truvada) for the study.

The study medication of Be-PrEP-ared was donated by Gilead Sciences.

Members of the Be-PrEP-ared study team are listed in the Appendix 1.

Received March 16, 2018

Accepted June 18, 2018

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