Loss to Follow-Up from HIV Pre-Exposure Prophylaxis Care in Men Who Have Sex with Men in West Africa

Abstract

Loss to follow-up (LTFU) from HIV pre-exposure prophylaxis (PrEP) care compromises the goal of HIV elimination. We investigated the proportion of LTFU and associated risk factors among men who have sex with men (MSM) enrolled in a PrEP demonstration project in Burkina Faso, Côte d'Ivoire, Mali, and Togo. CohMSM-PrEP, a prospective cohort study, was conducted between November 2017 and June 2021 in community-based clinics. MSM aged 18 years or older at substantial risk of HIV infection received a comprehensive prevention package, including PrEP and peer education. LTFU was defined as not returning to the clinic for six months. Associated risk factors were investigated using a time-varying Cox's model. Of 647 participants followed up for a median time of 15 months, 372 were LTFU (57.5%). LTFU was associated with younger age (adjusted hazard ratio [95% Confidence Interval]; 1.50 [1.17-1.94]), unemployment (1.33 [1.03-1.71]), depression (1.63 [1.12-2.38]), and perceiving no HIV risk with stable male partners (1.61 [1.23-2.10]). Contacting peer educators outside of scheduled visits was protective (0.74 [0.56-0.97]). Our findings show that LTFU from PrEP care in West African MSM is a major challenge to achieving HIV elimination, but that the involvement of peer educators in PrEP delivery helps to limit LTFU by providing users with adequate support.

Keywords: HIV/AIDS; MSM; PrEP; West Africa; community-based research; key populations; pre-exposure prophylaxis.

Figure 1

CohMSM-PrEP study population flowchart with median follow-up time in months (IQR) (Follow-up from 20 November 2017–30 June 2021; 647 participants contributed to 4831 visits from baseline to M42).

Figure 2

Kaplan–Meier curves with log-rank test p-value comparing LTFU by: (a) age group, (b) country, (c) employment status, (d) recruitment type, (e) chosen PrEP regimen, (f) PrEP adherence, (g) contact with peer educators outside of scheduled visits, (h) self-defined sexual orientation, (i) self-defined gender identity, (j) depression score, (k) had a casual male sexual partner in the previous three months, (l) had a casual female sexual partner in the previous three months, (m) number of male sexual partners in the previous three months, (n) Combined prevention use during most recent anal intercourse, (o) HIV risk perception with stable male partner, and (p) HIV risk perception with casual male partners (n = 647 participants, 4831 visits).

Figure 2

Kaplan–Meier curves with log-rank test p-value comparing LTFU by: (a) age group, (b) country, (c) employment status, (d) recruitment type, (e) chosen PrEP regimen, (f) PrEP adherence, (g) contact with peer educators outside of scheduled visits, (h) self-defined sexual orientation, (i) self-defined gender identity, (j) depression score, (k) had a casual male sexual partner in the previous three months, (l) had a casual female sexual partner in the previous three months, (m) number of male sexual partners in the previous three months, (n) Combined prevention use during most recent anal intercourse, (o) HIV risk perception with stable male partner, and (p) HIV risk perception with casual male partners (n = 647 participants, 4831 visits).

Figure 2

Kaplan–Meier curves with log-rank test p-value comparing LTFU by: (a) age group, (b) country, (c) employment status, (d) recruitment type, (e) chosen PrEP regimen, (f) PrEP adherence, (g) contact with peer educators outside of scheduled visits, (h) self-defined sexual orientation, (i) self-defined gender identity, (j) depression score, (k) had a casual male sexual partner in the previous three months, (l) had a casual female sexual partner in the previous three months, (m) number of male sexual partners in the previous three months, (n) Combined prevention use during most recent anal intercourse, (o) HIV risk perception with stable male partner, and (p) HIV risk perception with casual male partners (n = 647 participants, 4831 visits).