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  IAS 2017: Conference on HIV Pathogenesis
Treatment and Prevention
Paris, France
July 23-26 2017
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Pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in the Netherlands: motives to choose for, switch to, or stop with daily or event-driven PrEP


IAS: HIV Prevention at IAS 2017 - Jared Baeten, MD PhD Connie Celum, MD MPH University of Washington(08/14/17)
PrEP remains primarily oral tenofovir-based pills (mostly tenfovir disoproxil fumarate in combination with emtricitabine [FTC/TDF]), the only approach to date to have received regulatory approval in any country, although new PrEP agents are marching through clinical trials......New PrEP agents. Long-acting injectable agents - that would work for a month, two, or more - offer substantial promise for becoming a PrEP option. Injectable agents have great appeal - they could be used discretely and could remove some adherence challenges (e.g., taking a daily pill, but not returning to a clinic to get HIV testing and a PrEP refill).
.....The dapivirine vaginal ring.... PrEP agent that is furthest along towards becoming an alternative to oral TDF-based pills, after the results of the two trials last year.In 2016, two phase III trials among women in Africa demonstrated that an antiretroviral-containing vaginal ring (the dapivirine vaginal ring) was effective and safe for HIV prevention, and phase I-III studies of other potential options are ongoing....A second dapivirine abstract assessed vaginal microbiota in women using investigational dapivirine vaginal films or gels (abstract TUAC0104, Hillier).
http://natap.org/2017/IAS/IAS_70.htm ....Long-acting injectable agents ..... injectable, the integrase strand transfer inhibitor cabotegravir, was tested in the HPTN 077 trial a phase II safety and tolerability trial among 199 HIV uninfected men and women in Brazil, South Africa, Malawi, and the US assigned 3:1 to cabotegravir or placebo. (abstract Landovitz, TUAC0106LB - http://www.natap.org/2017/IAS/IAS_33.htm ). .....IAS: Safety and Efficacy of Long-Acting CAB and RPV as Two Drug IM Maintenance Therapy: LATTE-2 Week 96 Results - (07/24/17)
a new medication (MK-8591), a nucleoside reverse transcriptase translocation inhibitor, formulated as a weekly pill was found to be completely protective against low-dose rectal SHIV challenge in macaques (abstract MOAX0203LB, Markowitz).
http://natap.org/2017/IAS/IAS_03.htm Weekly or other less-frequent oral dosing approaches may be in the future for PrEP.
Long-Acting & Nanoparticle ARTs - Future of HIV Medication??? Long acting Cabotegravir for PrEP is in Phase 3- (03/22/17)
IAS: Is on-demand PrEP with TDF/FTC effective among MSM with infrequent sexual intercourse? - (08/03/17)
IAS: Is on-demand PrEP a suitable tool for MSM who practice chemsex? Results from a sub-study of the ANRS-IPERGAY trial - Chemsex Users in IPERGAY Twice as Likely to Use As-Needed PrEP - (07/28/17)
IAS: Long term follow up of PROUD Evidence for high continued HIV exposure and durable effectiveness of PrEP - (07/31/17)
IAS: No HIV Transmissions in Gay Couples if HIV+ Partner Has Undetectable Virus - (08/04/17)
IAS: Reasons for not using PrEP in a national on-line sample of U.S. men who have sex with men (MSM) - Cost, Side Effects, Access Lead Reasons for PrEP Nonuse by US MSM - (07/31/17)
IAS: Experiences and perceptions of PrEP among gay, MSM, and TGW in the PROUD study in England: 'Rules' of Sex, Psychological, Psychosocial Benefits - (07/31/17)
IAS: Impact of risk perception trajectory on PrEP and condom use among Men who have Sex with Men during the Open-Label-Extension of the ANRS-IPERGAY trial - (07/27/17)
IAS: Potential for HIV transmission among adolescents and young adults receiving antiretroviral therapy - 'PrEP missed opportunities' - (08/03/17)
IAS: Changes in Truvada® for HIV Pre-exposure Prophylaxis Utilization in the USA: 2012-2016 - Disparities - (08/02/17)
IAS: Limited implementation of HIV pre-exposure prophylaxis among public health departments in North Carolina, United States - (08/02/17)
IAS: PrEP at IAS 2017 / IAS Coverage: New HIV & HCV Drugs, Fatty Liver in HIV - (08/11/17)
Pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in the Netherlands: motives to choose for, switch to, or stop with daily or event-driven PrEP
Reported by Jules Levin
9th IAS Conference on HIV Science (IAS 2017), July 23-26, 2017, Paris
H. Zimmermann1, S. Eekman1, R. Achterbergh1,2, M. Prins1,3, M. Schim van der Loeff1, H. de Vries2,3, E. Hoornenborg1,2, U. Davidovich1,3, HIV Transmission Elimination Amsterdam (H-Team)
1Public Health Service Amsterdam, Infectious Diseases - Research & Prevention, Amsterdam, Netherlands, 2Public Health Service Amsterdam, Infectious Diseases - STI Outpatient Clinic, Amsterdam, Netherlands, 3Academic Medical Center of Amsterdam, Amsterdam, Netherlands
Background: Proper implementation of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) requires a clear understanding of the reasons why MSM choose one PrEP-dosing regimen over another in real-life settings. Therefore, we aimed to gain insight into the motives for choosing or switching between daily and event-driven PrEP or (temporarily) stopping PrEP use.

Methods: We used data from the Amsterdam PrEP (AmPrEP) demonstration study (June 2015-February 2017), where both daily and event-driven PrEP (dPrEP and edPrEP, respectively) are offered. MSM''s motives to choose a regimen were measured at baseline among 376 participants of whom 273 chose dPrEP and 103 chose edPrEP. Motives to switch or stop were recorded at every 3-monthly follow-up visit. Standardized closed- and open-end items were used. Open answers were coded and analyzed following qualitative research methods.

Results: Among the reasons to use dPrEP were the convenience of daily routine (n=133), perceived higher dPrEP efficacy (n=34), and fear of side-effects relating to edPrEP re-initiation (n=5). Perceived toxicity and burden of daily medication were reasons to choose edPrEP (n=38). Infection risk was also considered: dPrEP was preferred for unplanned and/or frequent sexual risk behavior (n=79), while edPrEP was chosen when risk was more predictable (n=57).
Some chose for, or switched to, edPrEP to inhibit sexual risk behavior (n=4), while others chose for, or switched to, dPrEP to gain more sexual freedom (n=17). Other reasons to switch to edPrEP included experiencing side-effects (n=14), having less sex than anticipated (n=20), experimenting with another regimen (n=2) and receiving negative reactions from the environment (n=1).
Doubts about edPrEP''s safety (n=2), inability to plan sex (n=13) and desire for more structure (n=9) were motivators to switch to dPrEP.
Motives to temporarily stop dPrEP (n=99) were situational (e.g. medical issues or vacations). Changed life circumstances (n=2) and reduced sexual risk (n=6) were motives to completely stop with PrEP use (n=12).
Conclusions: A great variety of personal and contextual factors determine the choices for PrEP regimens, related switches and stops. In order to successfully support future PrEP users, a tailored approach, addressing choices for PrEP regimens as a continuum of flexible and changeable choices, is essential.