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Dynamicity of HIV Pre-exposure Prophylaxis Usage Pattern and Association with Executed Adherence in MSM: An Implementation Study in Hong Kong

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Abstract

Pre-exposure prophylaxis (PrEP) use has been shown to be effective for HIV prevention in men who have sex with men (MSM). PrEP use coverage aside, maintenance of high PrEP adherence is crucial in ensuring the achievement of HIV prevention. In this PrEP implementation study in Hong Kong, we examined the patterns of PrEP use in MSM and evaluated their association with prevention-effective adherence for HIV prevention. In January 2020–June 2021 in Hong Kong, 312 recruited MSM (median 30 years old) were followed up for 1 year, with HIV and creatinine testing, consultation, and PrEP refill. No HIV breakthrough infection was observed. As a measure of prevention-effective adherence, executed adherence (EA) was expressed as the proportion of days with HIV risk that were protected by PrEP and/or condom in 6 months. In 65,585 diary entries of 215 MSM, the median proportion of EA achieved was 89% (IQR 84–93%). Three latent classes of PrEP users were identified by latent class analysis. Taking Class 1 “daily dominant PrEP” (n = 113, 53%) as reference, Class 2 “episodic PrEP” (n = 76, 35%) was adopted by MSM with less sexual activity, had less PrEP refill and lower EA level, while Class 3 “mixed PrEP schedule” (n = 26, 12%) MSM were more sexually active but with a similar EA level. The study findings showed varied and dynamic PrEP usage patterns in the real-world setting. Strategies for promoting adherence are needed to ensure the maintenance of high EA level among PrEP-using MSM especially those on episodic PrEP schedule.

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Acknowledgements

We thank Gilead Sciences for the study drug donation. We thank the staff of the AIDS Concern, AIDS Foundation, C.H.O.I.C.E., Blessed Ministry Community Church, Boys’ and Girls’ Clubs Association of Hong Kong, Integrated Treatment Centre of the Department of Health, Princess Margaret Hospital, Queen Elizabeth Hospital, and Social Hygiene Clinic in the referral of potential participants. We thank Mr. CY Poon and Ms. KY So for their assistance in the laboratory work, Mr. CQ Ye and Ms. Mandy Li for project coordination and assistance.

Funding

This research was supported by the Council for the AIDS Trust Fund (MSS325R), Hong Kong. The funder had no role in the study design, data collection, data analysis, data interpretation or writing of the report.

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Authors and Affiliations

  1. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China

    Ngai Sze Wong, Denise Pui-Chung Chan & Tsz Ho Kwan

  2. S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China

    Ngai Sze Wong, Denise Pui-Chung Chan, Tsz Ho Kwan & Shui Shan Lee

  3. Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China

    Ngai Sze Wong & Tsz Ho Kwan

  4. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China

    Grace Chung-Yan Lui

  5. Department of Psychiatry, The University of Hong Kong, Hong Kong, China

    Krystal Chi-Kei Lee

  6. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China

    Shui Shan Lee

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  1. Ngai Sze Wong
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Contributions

SSL, GC-YL, KC-KL, THK, DP-CC, and NSW designed and implemented the study. NSW conducted all analyses. SSL and NSW wrote the manuscript. All authors reviewed, made critical recommendations, and approved the final version of the manuscript.

Corresponding author

Correspondence to Shui Shan Lee.

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Competing Interests

SSL has served as a member of the Advisory Boards of Merck, GSK and Gilead Sciences, and received grants, drug donation and sponsorship for conference participation from Gilead Sciences. GL has served as an advisory committee member for Gilead, Merck, Sanofi Pasteur and GSK, speaker for Merck and Gilead, and has received research grants from Gilead, Merck, Janssen and GSK. NSW has received a research grant and sponsorship for conference participation from Gilead.

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Wong, N.S., Chan, D.PC., Kwan, T.H. et al. Dynamicity of HIV Pre-exposure Prophylaxis Usage Pattern and Association with Executed Adherence in MSM: An Implementation Study in Hong Kong. AIDS Behav 28, 1327–1344 (2024). https://doi.org/10.1007/s10461-023-04167-0

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