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Behavior Change and Sexually Transmitted Incidence in Relation to PREP Use Among Men Who Have Sex with Men in Kenya

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Abstract

We measured change in sexual practices and the incidence of C. trachomatis (CT) and N. gonorrhoeae (NG) within a prospective cohort of Kenyan MSM taking PrEP in Kenya. Over the one year of study participation, CT and NG were diagnosed in urine at baseline, 6- and 12- months. Multivariable Cox regression identified factors associated with incident infection. Sexual practices were assessed at baseline and every 3 months. We evaluated changes over time and in relation to PrEP adherence via generalized estimating equation analysis. From October 2017—January 2018, 158 participants initiated PrEP, having 10.3% baseline CT/NG prevalence (either or both). The incidence was 17.2 cases per 100 person-years (95% CI 11.7–25.5). Incident CT/NG increased with report of: transactional male sex partner (adjusted Hazard Ratio (aHR) = 2.46, p = 0.016, z = 2.40), regular female sex partner (aHR = 2.22, p = 0.051, z = 1.96), greater social support (highest vs. lowest quartile, aHR = 6.24, p = 0.012, z = 2.51), and CT/NG infection prior to enrollment (aHR = 2.90, p = 0.002, z = 3.03). Multiple sex partners, condomless sex, and transactional sex decreased over time and were not associated with PrEP adherence. Urethral CT/NG incidence remained high and there was no evidence of PrEP-related behavioral change. There is need for ongoing etiologic testing, improved understanding of risk from female sex partners, and development of more effective risk reduction interventions.

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Funding

This research has been supported by the Evidence for HIV Prevention in Southern Africa (grant number MM/EHPSA/NRHS/0515008).

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SDM: Funding acquisition, conceptualization, methodology, formal analyses, visualization, writing original draft; DO: Project administration, supervision, methodology, investigation, data curation, writing—review and editing; SG: Funding acquisition, conceptualization, methodology, writing—review and editing; GN: Methodology, investigation, data curation, writing—review and editing; RCB: Funding acquisition, conceptualization, methodology, writing—review and editing; FO: Funding acquisition, conceptualization, project administration, supervision, methodology, investigation, data curation, writing—review and editing.

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Correspondence to Supriya D. Mehta.

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Mehta, S.D., Okall, D., Graham, S.M. et al. Behavior Change and Sexually Transmitted Incidence in Relation to PREP Use Among Men Who Have Sex with Men in Kenya. AIDS Behav 25, 2219–2229 (2021). https://doi.org/10.1007/s10461-020-03150-3

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