HIV pre-exposure prophylaxis re-initiation among men who have sex with men: a multi-center cohort study in China
Yifan Dai
A B C , Zhuoheng Yin C , Chunyan Li D , Chengxin Fan C E , Heping Zhao F , Haojie Huang G , Quanmin Li F , Songjie Wu H , Aniruddha Hazra I , Jonathan Lio I , Ke Liang H , Linghua Li F , Renslow Sherer I , Joseph D. Tucker C J , Cheng Wang A B # and Weiming Tang B C # *
A
B
C
D
E
F
G
H
I
J
# These authors contributed equally to this paper.
Handling Editor: Nittaya Phanuphak
Abstract
Data on persistent use of HIV pre-exposure prophylaxis (PrEP) is limited among Chinese men who have sex with men (MSM). This study aimed to explore factors associated with the re-initiation of PrEP among Chinese MSM from a longitudinal PrEP demonstration trial.
A multi-center cohort study was conducted in Guangzhou and Wuhan, China (September 2021–2024), providing 1134 MSM participants with a 12-month dosage of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as oral PrEP. Following the trial, a subgroup of participants were invited to complete a 3-month post-trial follow-up survey. These participants were categorized on the basis of self-reported PrEP use patterns into (1) continued PrEP use, (2) discontinued without re-initiation, and (3) re-initiated after discontinuation. Log-binomial regression models were used to assess factors associated with PrEP re-initiation.
Out of 408 participants who completed the 3-month post-trial follow-up survey, 70.1% (n = 286/408) reported discontinuing PrEP, and 50.7% (n = 145/286) of those who discontinued subsequently re-initiated PrEP. Participants who had concurrent sexual partnerships (adjusted risk ratio [aRR] = 1.47, 95% CI: 1.11–1.96), used drugs during sex (aRR = 1.34, 95% CI: 1.09–1.65), or lived alone (aRR = 1.29, 95% CI: 1.03–1.61) were more likely to re-initiate PrEP. The Likert scale analysis indicated that perceived partner influence, specifically the expectation of condomless sex, played a significant role in re-initiation decisions (P = 0.03).
Individuals engaging in higher-risk behaviors are more likely to re-initiate PrEP, highlighting the dynamic nature of risk perception. Future interventions should focus on promoting both re-initiation and consistent condom use, emphasizing partner-related dynamics and substance use as key factors in PrEP decisions among MSM.
Keywords: China, cohort study, HIV prevention, men who have sex with men (MSM), pre-exposure prophylaxis (PrEP), PrEP adherence, re-initiation, substance use.
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