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. 2021 May;24(5):e25708.
doi: 10.1002/jia2.25708.

Adherence to event-driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: analysis based on online diary data, 3-monthly questionnaires and intracellular TFV-DP

Vita W Jongen  1 , Elske Hoornenborg  1 , Mark Am van den Elshout  1 , Anders Boyd  1   2 , Hanne Ml Zimmermann  1 , Liza Coyer  1 , Udi Davidovich  1   3 , Peter L Anderson  4 , Henry Jc de Vries  1   5 , M Prins  1   6 , Maarten F Schim van der Loeff  1   6 ; Amsterdam PrEP Project team in the HIV Transmission Elimination Amsterdam (H-TEAM) Initiative
Affiliations

Adherence to event-driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: analysis based on online diary data, 3-monthly questionnaires and intracellular TFV-DP

Vita W Jongen et al. J Int AIDS Soc. 2021 May.

Abstract

Introduction: Event-driven pre-exposure prophylaxis (edPrEP) with oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective for preventing HIV acquisition in men who have sex with men (MSM) and is preferred over daily PrEP by some MSM. However, it is largely unknown how well MSM adhere to edPrEP. We then aimed to assess PrEP protection during CAS among MSM using edPrEP and participating in the Amsterdam PrEP demonstration project (AMPrEP).

Methods: We analysed data from participants enrolled in AMPrEP who were taking edPrEP. We measured adherence through (1) a mobile application in which sexual behaviour and PrEP-use were recorded daily, (2) three-monthly self-completed questionnaires and (3) dried blood spot (DBS) samples collected around six, twelve and twenty-four months after PrEP initiation. We assessed the proportion of days with condomless anal sex (CAS) acts that were protected by PrEP, per partner type (i.e. steady partners, known casual partners, unknown casual partners), and the proportion of three-month periods during which PrEP was correctly used. Intracellular TFV-diphosphate (TFV-DP) concentrations were determined from DBS. Good adherence was defined as at least one tablet before and one tablet within 48 hours after a CAS act.

Results: Between 11 September 2015 and 6 October 2019, 182 of 376 MSM (48.4%) used edPrEP for at least one three-month period. Of the 8224 CAS days that were reported in the app during edPrEP-use, we observed good protection for most CAS days involving steady partners (n = 1625/2455, 66.9%), known casual partners (n = 3216/3472, 92.6%) and unknown casual partners (n = 2074/2297, 90.3%). Men reported consistently correct PrEP-use in 851 (81.4%) of the 1046 three-month periods of edPrEP-use. The median TFV-DP concentration was 591 fmol/sample (interquartile range = 270 to 896).

Conclusions: Adherence to edPrEP was high as determined from the online app and questionnaire. DBS measurements were consistent with two to three tablets per week on average.

Keywords: HIV; HIV prevention and control; On-demand PrEP; Pre-exposure prophylaxis; medication adherence; men who have sex with men.

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Figures

Figure 1
Figure 1
Flowchart of inclusion of participants into the analyses of questionnaire data, app data and DBS, AMPrEP observational cohort study, September 2015 to October 2019, Amsterdam, the Netherlands. app, application; DBS, dried blood spots; edPrEP, event‐driven PrEP.
Figure 2
Figure 2
PrEP protection of condomless anal sex acts (CAS) per partner type, as reported in the AMPrEP mobile diary app, AMPrEP observational cohort study, September 2015 to October 2019, Amsterdam, the Netherlands.
Figure 3
Figure 3
Association between log‐transformed TFV‐DP from dried blood spots (DBS) and log‐transformed condomless anal sex (CAS) days or pill use reported in the AMPrEP mobile diary app, AMPrEP observational cohort study, September 2015 to October 2019, Amsterdam, the Netherlands. Pill use and condomless anal sex days were transformed as follows: ln(number of days on which a pill was taken + 1) and ln(number of CAS days + 1).
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