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. 2023 May 25:15:100217.
doi: 10.1016/j.lansea.2023.100217. eCollection 2023 Aug.

High PrEP uptake, adherence, persistence and effectiveness outcomes among young Thai men and transgender women who sell sex in Bangkok and Pattaya, Thailand: findings from the open-label combination HIV prevention effectiveness (COPE) study

Brian W Weir  1   2 , Andrea L Wirtz  1 , Tareerat Chemnasiri  3   4 , Stefan D Baral  1 , Michele Decker  1   5 , Chen Dun  1   2 , Sandra Hsu Hnin Mon  1 , Chaiwat Ungsedhapand  3   4 , Eileen F Dunne  3   4 , Joseph Woodring  3   4 , Sarika Pattanasin  3   4 , Wichuda Sukwicha  3   4 , Michael C Thigpen  3   4 , Anchalee Varangrat  3   4 , Anchalee Warapornmongkholkul  3   4 , Siobhan O'Connor  3 , Julie P Ngo  1   6 , Noor Qaragholi  1 , Haley I Sisel  1   6 , Jasmine M Truong  1 , Surang Janyam  7 , Danai Linjongrat  8 , Somchai Sriplienchan  7 , Pachara Sirivongrangson  4 , James F Rooney  9 , Patrick Sullivan  10 , Boosbun Chua-Intra  4 , Andrew C Hickey  3   4 , Chris Beyrer  1   11 ; COPE Study Teamabcdefghijklmn; COPE Study Team
Collaborators, Affiliations

High PrEP uptake, adherence, persistence and effectiveness outcomes among young Thai men and transgender women who sell sex in Bangkok and Pattaya, Thailand: findings from the open-label combination HIV prevention effectiveness (COPE) study

Brian W Weir et al. Lancet Reg Health Southeast Asia. .

Abstract

Background: Daily oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection, but no study has evaluated combination prevention interventions with PrEP for transgender women (TGW) and men who have sex with men (MSM) who sell sex.

Methods: The Combination Prevention Effectiveness (COPE) study was a community-based, non-randomized implementation study in Bangkok and Pattaya, Thailand. Participants were HIV-negative MSM and TGW aged 18-26 years who reported exchanging sex with men in the prior 12 months and who met 2014 U.S. Public Health Service PrEP eligibility criteria. The intervention included quarterly HIV testing, semiannual testing for sexually transmitted infections, provision of condoms with lubricant, and the opportunity to initiate or end daily oral PrEP use at any time during study participation. Participants taking PrEP received monthly adherence counseling and short message service reminders. The primary outcome was HIV incidence rate ratio (IRR) on PrEP vs. not on PrEP. Secondary outcomes were PrEP initiation, PrEP use at 12 months, and PrEP adherence.

Findings: From October 2017 to August 2019, 846 participants were enrolled: 531 (62.8%) immediately initiated PrEP; 104 (12.3%) subsequently initiated PrEP, and 211 (24.9%) never initiated PrEP. Among those initiating PrEP within 30 days of enrollment; 85.9% were on PrEP at the 12-months. When taking PrEP, participants reported adherent PrEP use at 94.2% of quarterly assessments. Ten HIV seroconversions occurred without PrEP use (incidence rate [IR] = 3.42 per 100 person-years [PY]; 95% CI = 1.64-6.30), while zero cases occurred with PrEP use (IR = 0.0 per 100PY; 95% CI = 0.0-0.62), with IRR = 0.0 (95% CI = 0.0-0.22; p < 0.001).

Interpretation: Young Thai MSM and TGW who exchange sex can have high PrEP uptake, persistence and adherence, and low HIV incidence when offered in supportive community-based settings.

Funding: U.S. National Institute of Allergy and Infectious Diseases; Centers for Disease Control and Prevention.

Keywords: HIV; Men who have sex with men; Pre-exposure prophylaxis; Prevention; Sex work; Thailand; Transgender persons.

PubMed Disclaimer

Conflict of interest statement

The study was supported by an R01 from NIAID, NIH (1R01AI118505-01A1) and the CDC Division of HIV Prevention. The study drug, Truvada®, was manufactured and donated by Gilead Sciences, Inc. Gilead Sciences, Inc. had no role in the design of the study nor in the interpretation of study results. The findings and conclusions presented in this paper are those of the authors and do not necessarily represent the views of the NIH, the US CDC, or 10.13039/100007197U.S. Public Health Service. Patrick Sullivan reports support from NIH, CDC, Merck, Gilead Sciences, ViiV Healthcare, Molecular Testing Labs, and Elsevier. James F. Rooney reports support from Gilead Sciences. Rest of the authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Static images used in the social media campaign for the Combination Prevention Effectiveness (COPE) study for young men who have sex with men and transgender women who exchange sex, Thailand (2018–2020). The social media campaign included static imagery and short promotional videos. The campaign was promoted on local social media platforms (Facebook, Twitter, and LINE), project partner websites and newsletters, and gay networking applications and forums (Hornet, Blued, Postjung, GThai, Planet Romeo, and Palm Plaza).
Fig. 2
Fig. 2
Screening and enrollment in the COPE study for young men who have sex with men and transgender women who exchange sex, Thailand (2018–2020). PrEP, pre-exposure prophylaxis. Immediate PrEP initiation defined as starting PrEP on day of study enrollment. Delayed PrEP initiation defined as starting PrEP after study entry.
Fig. 3
Fig. 3
Patterns of PrEP use and HIV testing among participants with HIV seroconversion in the COPE study for young men who have sex with men and transgender women who exchange sex, Thailand (2018–2020). PrEP, pre-exposure prophylaxis.
See this image and copyright information in PMC

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