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Most US MSM Unaware of-and Not Interested in-As-Needed PrEP
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HIVR4P Virtual, January 27-28 and February 3-4, 2021
Mark Mascolini
Only a little more than one third of men who have sex with men (MSM) in a national US cohort knew about event-driven preexposure prophylaxis (ED-PrEP) [1]. Fewer than 1 in 5 survey respondents said they would prefer ED-PrEP to standard daily PrEP. (ED-PrEP is often called "on-demand" or "as-needed" PrEP.)
PrEP has gained popularity among US MSM [2], at least until the COVID pandemic arrived. The US Centers for Disease Control and Prevention (CDC) endorses only daily PrEP, although research shows that ED-PrEP works well in MSM [3,4]. The World Health Organization (WHO) now sanctions ED-PrEP for MSM who have less frequent sex, which the WHO defines as less than twice weekly [5]. The WHO also endorses ED-PrEP for MSM "who would find ED-PrEP more effective and convenient" and men who can "plan for sex at least 2 hours in advance, or who can delay sex for at least 2 hours" [5].
Researchers from Chicago's Northwestern University conducted this study to find out how many US MSM know about, have interest in, and may be eligible for ED-PrEP. They gathered data from two cohorts: RADAR, a longitudinal cohort of about 1200 MSM in Chicago, and a national cross-sectional survey of MSM recruited by social media to explore biomedical HIV prevention.
This analysis involved 424 men from RADAR and 267 from the national online survey. The investigators collected data from October 2019 to mid-March 2020, when COVID-19 started spreading rapidly in the United States. Participants got a detailed description of ED-PrEP, which consists of 2 pills 2 to 24 hours before anal sex, 1 pill 24 hours after the first 2 pills, and 1 pill 24 hours after the third pill.
The investigators did not ask RADAR men if they knew about ED-PrEP. Among 267 online-survey men, 38.9% had heard about ED-PrEP. But only 18.5% knew details about how it works. Small minorities of men in both cohorts said they would prefer ED-PrEP over daily dosing-10.3% in RADAR and 17.7% in the online-survey group.
Larger minorities of both groups currently took PrEP-20.6% in RADAR and 32.6% in the national survey group. Among all men participating in the study, only 4% used ED-PrEP. But substantial proportions of both groups would be eligible for ED-PrEP by WHO criteria [5] listed above-50% of the RADAR group and 30.5% of the national survey group.
The researchers cautioned that they conducted cross-sectional surveys of two convenience samples. And the samples differed: RADAR men were younger, more racially diverse, and less sexually active. Because the investigators surveyed both groups before the COVID-19 pandemic took hold in the United States, responses may not reflect current thinking about ED-PrEP among US MSM.
The Northwestern researchers concluded that US MSM have little awareness of or interest in ED-PrEP, and very few of them use it. But a large minority meets WHO eligibility criteria for ED-PrEP [5]. The investigators see a need for "clear and consistent guidelines for ED-PrEP" in the United States as a way to increase understanding and perhaps use of this effective strategy.
References
1. Newcomb M, Ryan D, Hall CX, Macapagal K, Mustanski B. Limited knowledge of, interest in, and eligibility for event-driven PrEP among MSM in two samples in the United States. HIVR4P (HIV Research for Prevention) Virtual, January 27-28 and February 3-4, 2021. Abstract OA07.03.
2. Mouhanna F, Castel AD, Sullivan PS, et al. Small-area spatial-temporal changes in pre-exposure prophylaxis (PrEP) use in the general population and among men who have sex with men in the United States between 2012 and 2018. Ann Epidemiol. 2020;49:1-7. doi: 10.1016/j.annepidem.2020.07.001.
3. Molina JM, Capitant C, Spire B, et al; ANRS IPERGAY Study Group. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373:2237-2246. doi: 10.1056/NEJMoa1506273.
4. Molina JM, Charreau I, Spire B, et al; ANRS IPERGAY Study Group. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4:e402-e410. doi: 10.1016/S2352-3018(17)30089-9.
5. World Health Organization. What's the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: Update to WHO's recommendation on oral PrEP. Technical brief. July 2019. https://www.who.int/hiv/pub/prep/211/en/
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