Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users

Luxi Lal, Jennifer Audsley, Dean Anthony Murphy, Christopher K. Fairley, Mark Stoove, Norm Roth, Richard Moore, Ban Kiem Tee, Nalagafiar Puratmaja, Peter L. Anderson, David E Leslie, Robert M. Grant, John de Wit, Edwina Wright, on behalf of the VicPrEP Study Team

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: HIV preexposure prophylaxis (PrEP) decreases risk of HIV acquisition; however, its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex. Design: Multisite, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia. Methods: Participants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine (TFV/FTC) for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow-up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot testing. We present a 12-month interim analysis. Results: A total of 114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with a significant increase in STIs over the first 12 months of PrEP. Incidence (per 100 person-years) of any STI was 43.2 and 119.8 at months 0-3 and 3-12, respectively [incidence rate ratio 2.77 (1.52, 5.56)]. Adherence to PrEP medication was high by all measures, including 6 month TFV/FTC levels in dried blood spot. Conclusion: We found a significant reduction in condom use and an increase in STIs over the first 12 months of follow-up. High medication adherence rates occurring with a decline in condom use and a rise in STIs, suggest that prevention, early detection and treatment of STIs is a chief research priority in the current era of HIV PrEP.

Original languageEnglish
Pages (from-to)1709-1714
Number of pages6
JournalAIDS
Volume31
Issue number12
DOIs
Publication statusPublished - 31 Jul 2017

Keywords

  • adherence
  • HIV preexposure prophylaxis
  • sexually-transmitted infections
  • tenofovir/emtricitabine

Cite this

Lal, Luxi ; Audsley, Jennifer ; Murphy, Dean Anthony ; Fairley, Christopher K. ; Stoove, Mark ; Roth, Norm ; Moore, Richard ; Tee, Ban Kiem ; Puratmaja, Nalagafiar ; Anderson, Peter L. ; Leslie, David E ; Grant, Robert M. ; de Wit, John ; Wright, Edwina ; on behalf of the VicPrEP Study Team. / Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users. In: AIDS. 2017 ; Vol. 31, No. 12. pp. 1709-1714.
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title = "Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users",
abstract = "Objective: HIV preexposure prophylaxis (PrEP) decreases risk of HIV acquisition; however, its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex. Design: Multisite, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia. Methods: Participants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine (TFV/FTC) for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow-up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot testing. We present a 12-month interim analysis. Results: A total of 114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with a significant increase in STIs over the first 12 months of PrEP. Incidence (per 100 person-years) of any STI was 43.2 and 119.8 at months 0-3 and 3-12, respectively [incidence rate ratio 2.77 (1.52, 5.56)]. Adherence to PrEP medication was high by all measures, including 6 month TFV/FTC levels in dried blood spot. Conclusion: We found a significant reduction in condom use and an increase in STIs over the first 12 months of follow-up. High medication adherence rates occurring with a decline in condom use and a rise in STIs, suggest that prevention, early detection and treatment of STIs is a chief research priority in the current era of HIV PrEP.",
keywords = "adherence, HIV preexposure prophylaxis, sexually-transmitted infections, tenofovir/emtricitabine",
author = "Luxi Lal and Jennifer Audsley and Murphy, {Dean Anthony} and Fairley, {Christopher K.} and Mark Stoove and Norm Roth and Richard Moore and Tee, {Ban Kiem} and Nalagafiar Puratmaja and Anderson, {Peter L.} and Leslie, {David E} and Grant, {Robert M.} and {de Wit}, John and Edwina Wright and {on behalf of the VicPrEP Study Team} and Carol El-Hayek and Suzanne Crowe and Anna Pierce and Alison Duncan and Michelle Giles and Timothy Read",
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Lal, L, Audsley, J, Murphy, DA, Fairley, CK, Stoove, M, Roth, N, Moore, R, Tee, BK, Puratmaja, N, Anderson, PL, Leslie, DE, Grant, RM, de Wit, J, Wright, E & on behalf of the VicPrEP Study Team 2017, 'Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users' AIDS, vol. 31, no. 12, pp. 1709-1714. https://doi.org/10.1097/QAD.0000000000001519

Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users. / Lal, Luxi; Audsley, Jennifer; Murphy, Dean Anthony; Fairley, Christopher K.; Stoove, Mark; Roth, Norm; Moore, Richard; Tee, Ban Kiem; Puratmaja, Nalagafiar; Anderson, Peter L.; Leslie, David E; Grant, Robert M.; de Wit, John; Wright, Edwina; on behalf of the VicPrEP Study Team.

In: AIDS, Vol. 31, No. 12, 31.07.2017, p. 1709-1714.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users

AU - Lal, Luxi

AU - Audsley, Jennifer

AU - Murphy, Dean Anthony

AU - Fairley, Christopher K.

AU - Stoove, Mark

AU - Roth, Norm

AU - Moore, Richard

AU - Tee, Ban Kiem

AU - Puratmaja, Nalagafiar

AU - Anderson, Peter L.

AU - Leslie, David E

AU - Grant, Robert M.

AU - de Wit, John

AU - Wright, Edwina

AU - on behalf of the VicPrEP Study Team

AU - El-Hayek, Carol

AU - Crowe, Suzanne

AU - Pierce, Anna

AU - Duncan, Alison

AU - Giles, Michelle

AU - Read, Timothy

PY - 2017/7/31

Y1 - 2017/7/31

N2 - Objective: HIV preexposure prophylaxis (PrEP) decreases risk of HIV acquisition; however, its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex. Design: Multisite, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia. Methods: Participants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine (TFV/FTC) for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow-up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot testing. We present a 12-month interim analysis. Results: A total of 114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with a significant increase in STIs over the first 12 months of PrEP. Incidence (per 100 person-years) of any STI was 43.2 and 119.8 at months 0-3 and 3-12, respectively [incidence rate ratio 2.77 (1.52, 5.56)]. Adherence to PrEP medication was high by all measures, including 6 month TFV/FTC levels in dried blood spot. Conclusion: We found a significant reduction in condom use and an increase in STIs over the first 12 months of follow-up. High medication adherence rates occurring with a decline in condom use and a rise in STIs, suggest that prevention, early detection and treatment of STIs is a chief research priority in the current era of HIV PrEP.

AB - Objective: HIV preexposure prophylaxis (PrEP) decreases risk of HIV acquisition; however, its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex. Design: Multisite, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia. Methods: Participants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine (TFV/FTC) for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow-up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot testing. We present a 12-month interim analysis. Results: A total of 114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with a significant increase in STIs over the first 12 months of PrEP. Incidence (per 100 person-years) of any STI was 43.2 and 119.8 at months 0-3 and 3-12, respectively [incidence rate ratio 2.77 (1.52, 5.56)]. Adherence to PrEP medication was high by all measures, including 6 month TFV/FTC levels in dried blood spot. Conclusion: We found a significant reduction in condom use and an increase in STIs over the first 12 months of follow-up. High medication adherence rates occurring with a decline in condom use and a rise in STIs, suggest that prevention, early detection and treatment of STIs is a chief research priority in the current era of HIV PrEP.

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KW - HIV preexposure prophylaxis

KW - sexually-transmitted infections

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