Sunday, February 21, 2016

Uptake of PrEP and Condom and Sexual Risk Behavior among MSM During the ANRS IPERGAY Trial

The double-blind phase of the randomized ANRS IPERGAY trial, evaluating sexual activity-based oral HIV pre-exposure prophylaxis (PrEP), was conducted among high-risk men who have sex with men (MSM). 

Results showed an 86% (95% CI: 40-98) relative reduction in HIV incidence among participants with tenofovir disoproxil fumarate-emtricitabine vs. placebo. The present pooled analysis aimed to analyze (i) participants' adherence to the prescribed treatment and/or condom use during sexual intercourse and (ii) sexual behavior during the double-blind phase of the study. Four hundred MSM were enrolled in the trial. Every 2 months they completed online questionnaires collecting sexual behavior and PrEP adherence data regarding their most recent sexual intercourse. A total of 2232 questionnaires (M0-M24) were analyzed. Changes over time were evaluated using a mixed model accounting for multiple measures. 

Irrespective of sexual partner and practice type, on average, 
  • 42.6% (min: 32.1-max: 45.8%) reported PrEP use only during their most recent episode of sexual intercourse; 
  • 29% (22.9 - 35.6%) reported both PrEP and condom use; 
  • 11.7% (7.2 - 18.9%) reported condom-use only, and 
  • 16.7% (10.8 - 29.6%) reported no PrEP or condom use with no significant change during the study. 
  • Scheduled (i.e., correct) PrEP use was reported on average by 59.0% (47.2  -68.5%) of those reporting PrEP use during their most recent sexual intercourse. 
  • Overall, 70.3% (65.3 - 79.4%) and 69.3% (58.3 - 75.4%) of participants reported, respectively, condomless anal and condomless receptive anal intercourse during their most recent sexual encounter without significant change during follow-up. 
Overall, on average 83.3% (min: 70.4-max: 89.2%) of participants protected themselves by PrEP intake or condom use or both during the trial, and no increase in at-risk sexual practices was observed. 

None of these indicators showed significant trend during the follow-up, although we found a tendency toward decrease (p = .19) of the median number of sexual partners strengthening the absence of behavioral disinhibition. 

On-demand PrEP within a comprehensive HIV prevention package could improve prevention in MSM.

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  • 1 INSERM, UMR912 (SESSTIM) , Marseille , France.
  • 2 Aix Marseille Université, UMR_S912, IRD , Marseille , France.
  • 3 ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France.
  • 4 Inserm SC10 , Villejuif , France.
  • 5 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC) , Badalona , Spain.
  • 6 GRePS Lyon 2 Université , Bron , France.
  • 7 AIDES (Mission Innovation Recherche Expérimentation) , Pantin , France.
  • 8 Department of Infectious Diseases , Hôpital de la Croix Rousse, INSERM U1052 , Lyon , France.
  • 9 Department of Infectious Diseases , Hôpital Tenon , Paris , France.
  • 10 Department of Infectious Disease , Assistance Publique Hôpitaux de Paris, University of Paris Diderot Paris 7, INSERM U941 , Paris , France.
  •  2016 Feb 17:1-8. 

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