Feasibility of Short-Term PrEP Uptake for Men Who Have Sex With Men With Episodic Periods of Increased HIV Risk
Feasibility of Short-Term PrEP Uptake for Men Who Have Sex With Men With Episodic Periods of Increased HIV Risk
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DOI：
10.1097/qai.0000000000002382
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发表时间：
2020-08-15
影响因子：
3.6
通讯作者：
Mayer, Kenneth H.
中科院分区：
文献类型：
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作者：
Egan, James E.;Ho, Ken;Mayer, Kenneth H.
背景：暴露前预防(PrEP)联合恩曲他滨/富马酸替诺福韦可有效减少HIV感染。对于一些男同性恋者、双性恋者和其他男男性行为者(MSM)，由于间歇性风险、成本问题或对药物生物学后果的担忧，每天进行的PrEP可能不适合用作长期预防策略。地点：这项研究评估了短期、固定间隔发作性PrEP(Epi-PrEP)用于度假MSM的可行性。我们描述了对48名MSM实施以临床为基础的Epi-PrEP试点计划的可行性，这些MSM报告了偶尔发生无避孕套的性行为，并预计有一个明确的高危时间。方法：这是一项观察性临床干预的非随机自然主义研究。评估的主要结果是依从性，通过自我报告和血浆替诺福韦水平来衡量。结果：54名男男性接触者中，48人完成了为期3个月的访问。大多数人(93.7%)的替诺福韦浓度与度假归来时的日常使用浓度一致。近四分之三的人报告在度假期间没有避孕套的性行为，约三分之一的人报告娱乐用药。在3个月的随访中，1名参与者因在研究后无法继续使用PrEP而感染艾滋病毒。虽然不良事件很常见，但没有一个是严重的。超过70%的参与者表示有兴趣每天持续使用PrEP。结论：本研究中高危MSM对EPI-PrEP的耐受性良好，药物依从性较高。许多与会者认为，在度假时启动PrEP的经历可以成为过渡到长期使用PrEP的一种手段。
Background: Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate is efficacious in reducing HIV acquisition. For some gay, bisexual, and other men who have sex with men (MSM), daily ongoing PrEP may be unsuitable for use as a long-term prevention strategy because of episodic risk, cost issues, or concerns about the biological consequences of medication. Setting: This study evaluated the feasibility of short-term, fixed-interval episodic PrEP (Epi-PrEP) for use among vacationing MSM. We describe the feasibility of implementing a clinic-based Epi-PrEP pilot program for 48 MSM who reported occasional condomless sex and anticipated a defined high-risk time. Methods: This was a nonrandomized naturalistic study of an observational clinical intervention. The primary outcome assessed was adherence, as measured by self-report and plasma tenofovir levels. Results: Of 54 MSM who enrolled in the study, 48 completed the 3-month visit. The majority (93.7%) had tenofovir concentrations consistent with daily use on returning from vacation. Almost 3/4 reported condomless sex during vacation, and about 1/3 reported recreational drug use. During the 3-month follow-up, 1 participant had become HIV-infected because of a lapse in continued access to the PrEP after study. Although adverse events were common, none were serious. More than 70% of participants indicated an interest in daily ongoing PrEP use. Conclusions: Epi-PrEP was well tolerated by at risk MSM in this study, with high levels of medication adherence. Many participants felt the experience of initiating PrEP while on vacation could be a means for transition to long-term PrEP use.