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HIV Pre-exposure Prophylaxis Re-initiation among Men Who Have Sex with Men: A multi-center Cohort Study in China

Yifan Dai , Zhuoheng Yin , Chunyan Li, Chengxin Fan, Heping Zhao, Haojie Huang, Quanmin Li, Songjie Wu, Aniruddha Hazra, Jonathan Lio, Ke Liang, Linghua Li, Renslow Sherer, Joseph Tucker , Cheng Wang, Weiming Tang

Abstract

Abstract Objectives: This study aimed to explore factors associated with the re-initiation of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China. Given the high rate of PrEP discontinuation, understanding these factors is crucial for improving intervention strategies. Method: A multi-center cohort study was conducted in Guangzhou and Wuhan, China, involving MSM participants who had received 12 months of TDF+FTC for PrEP. Following the trial, participants completed a three-month follow-up survey. Participants were categorized into continued PrEP use, discontinued without re-initiation, and re-initiation after discontinuation. Sociodemographic, behavioral, and attitudinal data were collected. Log-binomial regression models were used to assess factors associated with PrEP re-initiation. Results: Out of 408 participants who completed the three-month follow-up, 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 (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). Conclusion: Our findings suggest that 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.

SH24200  Accepted 26 February 2025

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