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Risk Compensation After Initiation of Daily Oral Pre-exposure Prophylaxis Among Sexual and Gender Minorities in Nigeria

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Abstract

Pre-exposure prophylaxis (PrEP) use may be associated with risk compensation. We enrolled and provided PreP to sexual and gender minorities (SGM) in Abuja, Nigeria between April 2018 and May 2019. Behavioral information and samples for urogenital and anorectal Chlamydia trachomatis and Neisseria gonorrhoeae sexually transmitted infections (STIs) were collected at baseline. Blood samples for PrEP assay and self-reported adherence were collected at three-monthly follow-up visits. STIs were detected using Aptima Combo2 assay. We estimated the odds ratios (ORs) of PCR-diagnosed bacterial STIs and self-reported behavioral outcomes (condomless anal intercourse [CAI] and concurrent sexual relationships) with conditional logistic regression. Of 400 SGM who initiated PrEP, 206 were eligible for analysis, and had a median age of 24 years (IQR 22–27). In multivariable analysis, participants in the PrEP period had decreased odds of CAI (adjusted OR: 0.49, 95% CI 0.28, 0.84). PrEP use was not associated with risk compensation.

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Data Availability

Data, materials, and code cannot be shared publicly due to the institutionalized criminalization of same sex relationship in Nigeria (country of study). The study investigators are committed to protecting the privacy of all participants. However, the IRB protocol allows the publication of aggregated data that can be requested from implementationscienceunit@somumaryland.onmicrosoft.com.

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Acknowledgements

We are grateful to all study participants and the staff of the TRUST/RV368 clinic for their participation and commitment to this study. In particular, we are grateful to Mr. Ruxton Adebiyi for his contributions to data management for this study.

Funding

This work was supported by Fogarty Epidemiology Research Training for Public Health Impact in Nigeria Program (D43TW010051) and the National Institutes of Health (R01 MH099001, R01 A120913, R01 MH110358). The views expressed in this manuscript are the authors and not the funders of the study.

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Authors and Affiliations

  1. Department of Public Health and Epidemiology, University of Maryland School of Medicine, 725 West Lombard Street, S422, Baltimore, MD, 21201, USA

    Olusegun A. Adeyemi & Daniel Morgan

  2. International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria

    Olusegun A. Adeyemi & Nadia A. Sam-Agudu

  3. Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA

    Rebecca G. Nowak, Nadia A. Sam-Agudu & Manhattan E. Charurat

  4. School of Medicine, University of California, Irvine, CA, USA

    Jaih Craddock

  5. Division of Biostatistics and Bioinformatics, Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA

    Min Zhan

  6. Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA

    Trevor A. Crowell

  7. U.S Military HIV Research Program, Silver Spring, MD, USA

    Trevor A. Crowell

  8. The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Stefan Baral

  9. Center for International Health, Education, and Biosecurity, Abuja, Nigeria

    Sylvia Adebajo

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  1. Olusegun A. Adeyemi
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  2. Rebecca G. Nowak
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  3. Daniel Morgan
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  4. Nadia A. Sam-Agudu
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  10. Manhattan E. Charurat
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Consortia

for the TRUST/RV368 Study Group

Contributions

OAA conceptualized the study and drafted the initial manuscript. OAA analyzed the data under the guidance of MZ. RGN, DM, NASA, JC, MZ, TAC, SB, SA, and MEC reviewed and edited the manuscript. MEC was responsible for funding acquisition. RGN DM, NASA, JC, MZ, SA, and MEC supervised the study.

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Correspondence to Olusegun A. Adeyemi.

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None declared.

Ethical Approval

Ethical clearance was obtained from the Federal Capital Territory Research Ethics Committee, Abuja (FHREC/2012/01/22/09-08-12), and the Institutional Review Board of the University of Maryland, Baltimore (HP-0052013).

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All participants provided written informed consent prior to any study procedures.

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Adeyemi, O.A., Nowak, R.G., Morgan, D. et al. Risk Compensation After Initiation of Daily Oral Pre-exposure Prophylaxis Among Sexual and Gender Minorities in Nigeria. Arch Sex Behav (2024). https://doi.org/10.1007/s10508-024-02859-9

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