Medication Non-adherence and Condomless Anal Intercourse Increased Substantially During the COVID-19 Pandemic Among MSM PrEP Users: A Retrospective Cohort Study in Four Chinese Metropolises

Yangyang Gao; Qinghai Hu; Sequoia I Leuba; Le Jia; Hongyi Wang; Xiaojie Huang; Yaokai Chen; Hui Wang; Jing Zhang; Zhenxing Chu; Lukun Zhang; Zixin Wang; Hong Shang; Junjie Xu; CROPrEP Study Team

doi:10.3389/fmed.2022.738541

Medication Non-adherence and Condomless Anal Intercourse Increased Substantially During the COVID-19 Pandemic Among MSM PrEP Users: A Retrospective Cohort Study in Four Chinese Metropolises

Front Med (Lausanne). 2022 Apr 29:9:738541. doi: 10.3389/fmed.2022.738541. eCollection 2022.

Authors

Yangyang Gao^{1

2

3

4}, Qinghai Hu^{1

2

3

4}, Sequoia I Leuba⁵, Le Jia^{1

2

3

4}, Hongyi Wang^{1

2

3

4}, Xiaojie Huang⁶, Yaokai Chen⁷, Hui Wang⁸, Jing Zhang^{1

2

3

4}, Zhenxing Chu^{1

2

3

4}, Lukun Zhang⁸, Zixin Wang⁹, Hong Shang^{1

2

3

4}, Junjie Xu^{1

2

3

4}; CROPrEP Study Team

Collaborators

CROPrEP Study Team:
Xiaoqing He, Yao Li, Fang Zhao, Yijun Duan, Rui Li, Shangcao Li, Hang Li, Zhili Hu, Rantong Bao, Sitong Cui, Zhaozhen Liu, Zehao Ye, Xiaoyun Shi

Affiliations

¹ National Health Commission Key Laboratory of Acquired Immunodeficiency Syndrome (AIDS) Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
² Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.
³ Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.
⁴ Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
⁵ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
⁶ Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.
⁷ Chongqing Public Health Medical Center, Chongqing, China.
⁸ Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People's Hospital of Shenzhen, Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China.
⁹ Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.

Abstract

Background: The coronavirus disease (COVID-19) pandemic has impacted HIV prevention strategies globally. However, changes in pre-exposure prophylaxis (PrEP) adherence and HIV-related behaviors, and their associations with medication adherence among men who have sex with men (MSM) PrEP users remain unclear since the onset of the COVID-19 pandemic.

Methods: A Retrospective Cohort Study of HIV-negative MSM PrEP users was conducted in four Chinese metropolises from December 2018 to March 2020, assessing the changes in PrEP adherence and HIV-related behaviors before and during the COVID-19. The primary outcome was poor PrEP adherence determined from self-reported missing at least one PrEP dose in the previous month. We used multivariable logistic regression to determine factors correlated with poor adherence during COVID-19.

Results: We enrolled 791 eligible participants (418 [52.8%] in daily PrEP and 373 [47.2%] in event-driven PrEP). Compared with the data conducted before the COVID-19, the proportion of PrEP users decreased from 97.9 to 64.3%, and the proportion of poor PrEP adherence increased from 23.6 to 50.1% during the COVID-19 [odds ratio (OR) 3.24, 95% confidence interval (CI) 2.62-4.02]. While the percentage of condomless anal intercourse (CAI) with regular partners (11.8 vs. 25.7%) and with casual partners (4.4 vs. 9.0%) both significantly increased. The proportion of those who were tested for HIV decreased from 50.1 to 25.9%. Factors correlated with poor PrEP adherence during the COVID-19 included not being tested for HIV (adjusted odds ratio [aOR] = 1.38 [95% CI: 1.00, 1.91]), using condoms consistently with regular partners (vs. never, aOR = 2.19 [95% CI: 1.16, 4.13]), and being married or cohabitating with a woman (vs. not married, aOR = 3.08 [95% CI: 1.60, 5.95]).

Conclusions: Increased poor PrEP adherence and CAI along with the decrease in HIV testing can lead to an increase in HIV acquisition and drug resistance to PrEP. Targeted interventions are needed to improve PrEP adherence and HIV prevention strategies.

Keywords: COVID-19; adherence–compliance–persistence; condomless anal intercourse (CAI); men who have sex with men (MSM); pre-exposure prophylaxis (PrEP).