Uptake of PrEP and condom and sexual risk behavior among MSM during the ANRS IPERGAY trial

AIDS Care. 2016;28 Suppl 1(sup1):48-55. doi: 10.1080/09540121.2016.1146653. Epub 2016 Feb 17.

Abstract

The double-blind phase of the randomized ANRS IPERGAY trial, evaluating sexual activity-based oral HIV pre-exposure prophylaxis (PrEP), was conducted among high-risk men who have sex with men (MSM). Results showed an 86% (95% CI: 40-98) relative reduction in HIV incidence among participants with tenofovir disoproxil fumarate-emtricitabine vs. placebo. The present pooled analysis aimed to analyze (i) participants' adherence to the prescribed treatment and/or condom use during sexual intercourse and (ii) sexual behavior during the double-blind phase of the study. Four hundred MSM were enrolled in the trial. Every 2 months they completed online questionnaires collecting sexual behavior and PrEP adherence data regarding their most recent sexual intercourse. A total of 2232 questionnaires (M0-M24) were analyzed. Changes over time were evaluated using a mixed model accounting for multiple measures. Irrespective of sexual partner and practice type, on average, 42.6% (min: 32.1-max: 45.8%) reported PrEP use only during their most recent episode of sexual intercourse; 29% (22.9-35.6%) reported both PrEP and condom use; 11.7% (7.2-18.9%) reported condom-use only, and 16.7% (10.8-29.6%) reported no PrEP or condom use with no significant change during the study. Scheduled (i.e., correct) PrEP use was reported on average by 59.0% (47.2-68.5%) of those reporting PrEP use during their most recent sexual intercourse. Overall, 70.3% (65.3-79.4%) and 69.3% (58.3-75.4%) of participants reported, respectively, condomless anal and condomless receptive anal intercourse during their most recent sexual encounter without significant change during follow-up. Overall, on average 83.3% (min: 70.4-max: 89.2%) of participants protected themselves by PrEP intake or condom use or both during the trial, and no increase in at-risk sexual practices was observed. None of these indicators showed significant trend during the follow-up, although we found a tendency toward decrease (p = .19) of the median number of sexual partners strengthening the absence of behavioral disinhibition. On-demand PrEP within a comprehensive HIV prevention package could improve prevention in MSM.

Keywords: MSM; On-demand HIV pre-exposure prophylaxis; adherence; sexual behavior.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-HIV Agents / administration & dosage*
  • Canada
  • Condoms / statistics & numerical data*
  • Deoxycytidine / administration & dosage
  • Double-Blind Method
  • Emtricitabine
  • Follow-Up Studies
  • France
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • Homosexuality, Male / psychology*
  • Homosexuality, Male / statistics & numerical data
  • Humans
  • Male
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Organophosphonates / administration & dosage
  • Outcome Assessment, Health Care
  • Pre-Exposure Prophylaxis*
  • Risk-Taking*
  • Safe Sex
  • Sexual Behavior / statistics & numerical data
  • Sexual Partners
  • Surveys and Questionnaires
  • Tenofovir

Substances

  • Anti-HIV Agents
  • Organophosphonates
  • Deoxycytidine
  • Tenofovir
  • Emtricitabine

Grant support

This work was sponsored by the ANRS (France Recherche Nord & Sud Sida-HIV Hépatites) and funded by ANRS, the Canadian HIV Trials Network, the Fonds de dotation Pierre Bergé pour la Prévention – SIDACTION, and the Bill and Melinda Gates Foundation.