Increased awareness of event-driven PrEP and knowledge of how to use it: results from a cross-sectional survey of gay and bisexual men in Australia
Curtis Chan A * , Doug Fraser A , Andrew E. Grulich A , Steven Philpot A , Matthew Vaughan B , Michael Wacher B and Benjamin R. Bavinton AA The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
B ACON, Surry Hills, NSW, Australia.
Sexual Health 19(6) 501-508 https://doi.org/10.1071/SH22101
Submitted: 8 June 2022 Accepted: 13 July 2022 Published: 3 August 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Recent changes to Australian PrEP prescribing guidelines support the use of event-driven pre-exposure prophylaxis (ED-PrEP) to prevent HIV among gay and bisexual men (GBM). Social marketing campaigns to increase awareness of ED-PrEP were conducted in early 2021. This study aimed to assess the awareness and knowledge of this method after these campaigns.
Methods: We conducted a national cross-sectional online survey about PrEP knowledge and attitudes from March to May 2021. Participants were asked if they had heard of ED-PrEP. Among aware participants, questions about the ‘2-1-1’ method were asked to assess knowledge. Bivariate and multivariate logistic regression analyses were conducted to assess the characteristics of those who were aware of ED-PrEP, and those who had correct knowledge of ED-PrEP. Analysis was restricted to non-HIV-positive cis-GBM who were aware of PrEP.
Results: Among the 419 participants eligible for this analysis, 286 (68.3%) had heard of ED-PrEP. Awareness was associated with living in a postcode with ≥10% gay men, PrEP experience, and belief ED-PrEP is effective. Of these 286 participants, 125 (43.7%) correctly answered questions about how to take ED-PrEP. Correct knowledge was associated with PrEP experience and belief ED-PrEP is effective.
Conclusions: A growing proportion of GBM are aware of ED-PrEP, but many still do not know how to take it as per clinical guidelines. More work is needed to increase knowledge among GBM to promote effective use of this method.
Keywords: event-driven PrEP, gay men, health promotion, HIV prevention, HIV/AIDS, men who have sex with men, on-demand PrEP, pre-exposure prophylaxis.
References
[1] Bavinton BR, Grulich AE. HIV pre-exposure prophylaxis: scaling up for impact now and in the future. Lancet Public Health 2021; 6 e528–33.| HIV pre-exposure prophylaxis: scaling up for impact now and in the future.Crossref | GoogleScholarGoogle Scholar |
[2] Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med 2015; 373 2237–46.
| On-demand preexposure prophylaxis in men at high risk for HIV-1 infection.Crossref | GoogleScholarGoogle Scholar |
[3] World Health Organization. What’s the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: update to WHO’s recommendation on oral PrEP. Geneva: World Health Organization; 2019.
[4] European AIDS Clinical Society. EACS Guidelines Version 8.0 October 2015. Brussels: EACS; 2015.
[5] Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). The ASHM PrEP Guidelines Sept 2019 update. Sydney: ASHM; 2019.
[6] Hoornenborg E, Coyer L, Achterbergh RCA, Matser A, Schim van der Loeff MF, Boyd A, et al. Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study. Lancet HIV 2019; 6 e447–55.
| Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study.Crossref | GoogleScholarGoogle Scholar |
[7] Reyniers T, Nöstlinger C, Laga M, De Baetselier I, Crucitti T, Wouters K, et al. Choosing between daily and event-driven pre-exposure prophylaxis: results of a Belgian PrEP demonstration project. J Acquir Immune Defic Syndr 2018; 79 186–94.
| Choosing between daily and event-driven pre-exposure prophylaxis: results of a Belgian PrEP demonstration project.Crossref | GoogleScholarGoogle Scholar |
[8] Laurent C, Dembélé Keita B, Yaya I, Le Guicher G, Sagaon-Teyssier L, Agboyibor MK, et al. HIV pre-exposure prophylaxis for men who have sex with men in west Africa: a multicountry demonstration study. Lancet HIV 2021; 8 e420–8.
| HIV pre-exposure prophylaxis for men who have sex with men in west Africa: a multicountry demonstration study.Crossref | GoogleScholarGoogle Scholar |
[9] Broady TR, Chan C, Bavinton B, Mao L, Molyneux A, Delhomme F, et al. Gay community periodic surveys: Sydney 2021. Sydney: Centre for Social Research in Health, UNSW Sydney; 2021.
[10] Chan C, Broady T, Bavinton B, Mao L, Hynes A, McKenzie T, et al. Gay community periodic survey: Melbourne 2021. Sydney: Centre for Social Research in Health, UNSW Sydney; 2021.
[11] Carneiro PB, Rincon C, Golub S. Predictors of event-driven regimen choice in current PrEP users and sexual behavior characteristics of MSM receiving sexual health services in New York City. AIDS Behav 2021; 25 2410–18.
| Predictors of event-driven regimen choice in current PrEP users and sexual behavior characteristics of MSM receiving sexual health services in New York City.Crossref | GoogleScholarGoogle Scholar |
[12] Cornelisse VJ, Lal L, Price B, Ryan KE, Bell C, Owen L, et al. Interest in switching to on-demand HIV pre-exposure prophylaxis (PrEP) among Australian users of daily PrEP: an online survey. Open Forum Infect Dis 2019; 6 ofz287
| Interest in switching to on-demand HIV pre-exposure prophylaxis (PrEP) among Australian users of daily PrEP: an online survey.Crossref | GoogleScholarGoogle Scholar |
[13] Chan C, Vaccher S, Fraser D, Grulich AE, Holt M, Zablotska-Manos I, et al. Preferences for current and future PrEP modalities among PrEP-experienced gay and bisexual men in Australia. AIDS Behav 2022; 26 88–95.
| Preferences for current and future PrEP modalities among PrEP-experienced gay and bisexual men in Australia.Crossref | GoogleScholarGoogle Scholar |
[14] Therapeutic Goods Administration. Australian public assessment report for tenofovir disoproxil fumarate/emtricitabine. Australian Government Department of Health; 2016.
[15] Smith AKJ, Haire B, Newman CE, Holt M. Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians. Sex Health 2021; 18 187–94.
| Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians.Crossref | GoogleScholarGoogle Scholar |
[16] Power M, Lewis DA, Richardson D. On-demand HIV pre-exposure prophylaxis: what are the healthcare workers’ barriers to delivery in a culturally and linguistically diverse population? Sex Transm Infect 2020; 96 549
| On-demand HIV pre-exposure prophylaxis: what are the healthcare workers’ barriers to delivery in a culturally and linguistically diverse population?Crossref | GoogleScholarGoogle Scholar |
[17] Chan C, Vaccher S, Fraser D, Grulich A, Holt M, Zablotska-Manos I, et al. Incorrect knowledge of event-driven PrEP “2-1-1” dosing regimen among PrEP-experienced gay and bisexual men in Australia. J Acquir Immune Defic Syndr 2022; 90 132–139.
| Incorrect knowledge of event-driven PrEP “2-1-1” dosing regimen among PrEP-experienced gay and bisexual men in Australia.Crossref | GoogleScholarGoogle Scholar |
[18] Vuylsteke B, Reyniers T, De Baetselier I, Nöstlinger C, Crucitti T, Buyze J, et al. Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence. J Int AIDS Soc 2019; 22 e25407
| Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence.Crossref | GoogleScholarGoogle Scholar |
[19] Wu H-J, Wen-Wei Ku S, Chang HH, Li C-W, Ko N-Y, Strong C. Imperfect adherence in real life: a prevention-effective perspective on adherence to daily and event-driven HIV pre-exposure prophylaxis among men who have sex with men – a prospective cohort study in Taiwan. J Int AIDS Soc 2021; 24 e25733
| Imperfect adherence in real life: a prevention-effective perspective on adherence to daily and event-driven HIV pre-exposure prophylaxis among men who have sex with men – a prospective cohort study in Taiwan.Crossref | GoogleScholarGoogle Scholar |
[20] Saberi P, Scott HM. On-demand oral pre-exposure prophylaxis with tenofovir/emtricitabine: what every clinician needs to know. J Gen Intern Med 2020; 35 1285–88.
| On-demand oral pre-exposure prophylaxis with tenofovir/emtricitabine: what every clinician needs to know.Crossref | GoogleScholarGoogle Scholar |
[21] Power J. Movement, knowledge, emotion: gay activism and HIV/AIDS in Australia. Canberra, Australia: ANU Press; 2011.
[22] Rowe MS, Dowsett GW. Sex, love, friendship, belonging and place: is there a role for ‘Gay Community’ in HIV prevention today? Cult Health Sex 2008; 10 329–44.
| Sex, love, friendship, belonging and place: is there a role for ‘Gay Community’ in HIV prevention today?Crossref | GoogleScholarGoogle Scholar |
[23] ‘Take Me’: ACON launches campaign promoting new years to take PrEP [press release]. 20/01/2021; Sydney: ACON; 2021.
[24] Callander D, Mooney-Somers J, Keen P, Guy R, Duck T, Bavinton BR, et al. Australian ‘gayborhoods’ and ‘lesborhoods’: a new method for estimating the number and prevalence of adult gay men and lesbian women living in each Australian postcode. Int J Geogr Inf Sci 2020; 34 2160–76.
| Australian ‘gayborhoods’ and ‘lesborhoods’: a new method for estimating the number and prevalence of adult gay men and lesbian women living in each Australian postcode.Crossref | GoogleScholarGoogle Scholar |
[25] World Health Organization. Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management. Geneva: World Health Organization; 2020.
[26] MacGibbon J, Lea T, Ellard J, Murphy D, Bear B, Kolstee J, et al. Attitudes to biomedical HIV prevention among Australian gay and bisexual men: key findings from the PrEPARE Project 2019. Sydney: Centre for Social Research in Health, UNSW Sydney; 2019.
[27] Zimmermann HML, Eekman SW, Achterbergh RCA, Schim van der Loeff MF, Prins M, de Vries HJC, et al. Motives for choosing, switching and stopping daily or event-driven pre-exposure prophylaxis – a qualitative analysis. J Int AIDS Soc 2019; 22 e25389
| Motives for choosing, switching and stopping daily or event-driven pre-exposure prophylaxis – a qualitative analysis.Crossref | GoogleScholarGoogle Scholar |
[28] Hojilla JC, Marcus JL, Silverberg MJ, Hare CB, Herbers R, Hurley L, et al. Early adopters of event-driven human immunodeficiency virus pre-exposure prophylaxis in a large healthcare system in San Francisco. Clin Infect Dis 2020; 71 2710–12.
| Early adopters of event-driven human immunodeficiency virus pre-exposure prophylaxis in a large healthcare system in San Francisco.Crossref | GoogleScholarGoogle Scholar |
[29] Macapagal K, Nery-Hurwit M, Matson M, Crosby S, Greene GJ. Perspectives on and preferences for on-demand and long-acting PrEP among sexual and gender minority adolescents assigned male at birth. Sex Res Soc Policy 2021; 18 39–53.
| Perspectives on and preferences for on-demand and long-acting PrEP among sexual and gender minority adolescents assigned male at birth.Crossref | GoogleScholarGoogle Scholar |
[30] Philpot SP, Prestage G, Holt M, Maher L, Haire B, Bourne A, et al. Reasons for not using HIV pre-exposure prophylaxis (PrEP) among gay and bisexual men in Australia: mixed-methods analyses from a national, online, observational study. Behav Med 2022;
| Reasons for not using HIV pre-exposure prophylaxis (PrEP) among gay and bisexual men in Australia: mixed-methods analyses from a national, online, observational study.Crossref | GoogleScholarGoogle Scholar |
[31] Bell JS, Richards GC. Off-label medicine use: ethics, practice and future directions. Aust J Gen Pract 2021; 50 329–31.
| Off-label medicine use: ethics, practice and future directions.Crossref | GoogleScholarGoogle Scholar |
[32] Grant RM, Mannheimer S, Hughes JP, Hirsch-Moverman Y, Loquere A, Chitwarakorn A, et al. Daily and nondaily oral preexposure prophylaxis in men and transgender women who have sex with men: the human immunodeficiency virus prevention trials network 067/ADAPT study. Clin Infect Dis 2018; 66 1712–21.
| Daily and nondaily oral preexposure prophylaxis in men and transgender women who have sex with men: the human immunodeficiency virus prevention trials network 067/ADAPT study.Crossref | GoogleScholarGoogle Scholar |
[33] Kwan TH, Lui GCY, Lam TTN, Lee KCK, Wong NS, Chan DPC, et al. Comparison between daily and on-demand PrEP (pre-exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: a randomized, controlled, open-label, crossover trial. J Int AIDS Soc 2021; 24 e25795
| Comparison between daily and on-demand PrEP (pre-exposure prophylaxis) regimen in covering condomless anal intercourse for men who have sex with men in Hong Kong: a randomized, controlled, open-label, crossover trial.Crossref | GoogleScholarGoogle Scholar |
[34] Haberer JE, Bangsberg DR, Baeten JM, Curran K, Koechlin F, Amico KR, et al. Defining success with HIV pre-exposure prophylaxis: a prevention-effective adherence paradigm. AIDS 2015; 29 1277–85.
| Defining success with HIV pre-exposure prophylaxis: a prevention-effective adherence paradigm.Crossref | GoogleScholarGoogle Scholar |
[35] Hebel S, Kahn-Woods E, Malone-Thomas S, McNeese M, Thornton L, Sukhija-Cohen A, et al. Discrepancies between self-reported adherence and a biomarker of adherence in real-world settings. J Acquir Immune Defic Syndr 2020; 85 454–7.
| Discrepancies between self-reported adherence and a biomarker of adherence in real-world settings.Crossref | GoogleScholarGoogle Scholar |
[36] Bavinton BR, Vaccher S, Jin F, Prestage GP, Holt M, Zablotska-Manos IB, et al. High levels of prevention-effective adherence to HIV PrEP: an analysis of substudy data from the EPIC-NSW trial. J Acquir Immune Defic Syndr 2021; 87 1040–47.
| High levels of prevention-effective adherence to HIV PrEP: an analysis of substudy data from the EPIC-NSW trial.Crossref | GoogleScholarGoogle Scholar |