TY - JOUR
T1 - Stopping and restarting PrEP and loss to follow-up among PrEP-taking men who have sex with men and transgender women at risk of HIV-1 participating in a prospective cohort study in Kenya
AU - Wahome, Elizabeth
AU - Boyd, Anders
AU - Thiong’o, Alexander N.
AU - Mohamed, Khamisi
AU - Oduor, Tony
AU - Gichuru, Evans
AU - Mwambi, John
AU - van der Elst, Elise
AU - Graham, Susan M.
AU - Prins, Maria
AU - Sanders, Eduard J.
N1 - Funding Information: This work was partially funded by IAVI with generous support from USAID and other donors; a full list of IAVI donors is available at www.iavi.org. This work was also supported by the University of Washington Center for AIDS Research, a National Institutes of Health (NIH)-funded programme under award number AI027757, which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK. SMG was also supported by the Robert W. Anderson Endowed Chair in Medicine. This research was funded in whole or in part by the Wellcome Trust (203077). For the purpose of Open Access, the author has applied a CC-BY public copyright licence to any author-accepted manuscript version arising from this submission. This work was also supported in part through the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [DEL-15-006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS) Alliance for Accelerating Excellence in Science in Africa (AESA) and is supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (107752) and the UK government. The views expressed in this publication are those of the authors and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. The contents are the responsibility of the study authors and do not necessarily reflect the views of USAID, NIH, the United States government or the Wellcome Trust. This report was published with permission from the director of KEMRI. We would like to thank the participants and KEMRI-Wellcome Trust Research Programme clinic research team for their contributions to the study. Funding Information: This work was partially funded by IAVI with generous support from USAID and other donors; a full list of IAVI donors is available at www.iavi.org . This work was also supported by the University of Washington Center for AIDS Research, a National Institutes of Health (NIH)‐funded programme under award number AI027757, which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK. SMG was also supported by the Robert W. Anderson Endowed Chair in Medicine. This research was funded in whole or in part by the Wellcome Trust (203077). For the purpose of Open Access, the author has applied a CC‐BY public copyright licence to any author‐accepted manuscript version arising from this submission. This work was also supported in part through the Sub‐Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [DEL‐15‐006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS) Alliance for Accelerating Excellence in Science in Africa (AESA) and is supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (107752) and the UK government. The views expressed in this publication are those of the authors and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. The contents are the responsibility of the study authors and do not necessarily reflect the views of USAID, NIH, the United States government or the Wellcome Trust. This report was published with permission from the director of KEMRI. Publisher Copyright: © 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
PY - 2022/8
Y1 - 2022/8
N2 - Objective: To assess frequency and predictors of switching between being on and off PrEP and being lost to follow-up (LTFU) among men who have sex with men (MSM) and transgender women (TGW) with access to PrEP services in Sub-Saharan Africa. Methods: This was a prospective cohort study of MSM and TGW from coastal Kenya who initiated daily oral PrEP from June 2017 to June 2019. Participants were followed monthly for HIV-1 testing, PrEP refill, risk assessment and risk reduction counselling. Follow-up was censored at the last visit before 30 June 2019, or the last HIV-1-negative visit (for those with HIV-1 seroconversion), whichever occurred first. We estimated transition intensities (TI) and predictors of switching: (i) between being off and on PrEP; and (ii) from either PrEP state and being LTFU (i.e. not returning to the clinic for > 90 days) using a multi-state Markov model. Results: In all, 134 participants starting PrEP were followed for a median of 20.3 months [interquartile range (IQR): 7.7–22.1]. A total of 49 (36.6%) people stopped PrEP 73 times [TI = 0.6/person-year (PY), 95% confidence interval (CI): 0.5–0.7] and, of these, 25 (51.0%) restarted PrEP 38 times (TI = 1.2/PY, 95% CI: 0.9–1.7). In multivariable analysis, stopping PrEP was related to anal sex ≤ 3 months, substance-use disorder and travelling. Restarting PrEP was related to non-Christian or non-Muslim religion and travelling. A total of 54 participants were LTFU: on PrEP (n = 47, TI = 0.3/PY, 95% CI: 0.3–0.5) and off PrEP (n = 7, TI = 0.2/PY, 95% CI: 0.1–0.4). In multivariable analysis, becoming LTFU while on PrEP was associated with secondary education or higher, living in the area for ≤ 1 year, residence outside the immediate clinic area and alcohol-use disorder. Conclusions: Switching between being on and off PrEP or becoming LTFU while on PrEP was frequent among individuals at risk of HIV-1 acquisition. Alternative PrEP options (e.g. event-driven PrEP) may need to be considered for MSM and TGW with PrEP-taking challenges, while improved engagement with care is needed for all MSM and TGW regardless of PrEP regimen.
AB - Objective: To assess frequency and predictors of switching between being on and off PrEP and being lost to follow-up (LTFU) among men who have sex with men (MSM) and transgender women (TGW) with access to PrEP services in Sub-Saharan Africa. Methods: This was a prospective cohort study of MSM and TGW from coastal Kenya who initiated daily oral PrEP from June 2017 to June 2019. Participants were followed monthly for HIV-1 testing, PrEP refill, risk assessment and risk reduction counselling. Follow-up was censored at the last visit before 30 June 2019, or the last HIV-1-negative visit (for those with HIV-1 seroconversion), whichever occurred first. We estimated transition intensities (TI) and predictors of switching: (i) between being off and on PrEP; and (ii) from either PrEP state and being LTFU (i.e. not returning to the clinic for > 90 days) using a multi-state Markov model. Results: In all, 134 participants starting PrEP were followed for a median of 20.3 months [interquartile range (IQR): 7.7–22.1]. A total of 49 (36.6%) people stopped PrEP 73 times [TI = 0.6/person-year (PY), 95% confidence interval (CI): 0.5–0.7] and, of these, 25 (51.0%) restarted PrEP 38 times (TI = 1.2/PY, 95% CI: 0.9–1.7). In multivariable analysis, stopping PrEP was related to anal sex ≤ 3 months, substance-use disorder and travelling. Restarting PrEP was related to non-Christian or non-Muslim religion and travelling. A total of 54 participants were LTFU: on PrEP (n = 47, TI = 0.3/PY, 95% CI: 0.3–0.5) and off PrEP (n = 7, TI = 0.2/PY, 95% CI: 0.1–0.4). In multivariable analysis, becoming LTFU while on PrEP was associated with secondary education or higher, living in the area for ≤ 1 year, residence outside the immediate clinic area and alcohol-use disorder. Conclusions: Switching between being on and off PrEP or becoming LTFU while on PrEP was frequent among individuals at risk of HIV-1 acquisition. Alternative PrEP options (e.g. event-driven PrEP) may need to be considered for MSM and TGW with PrEP-taking challenges, while improved engagement with care is needed for all MSM and TGW regardless of PrEP regimen.
KW - HIV-1
KW - Kenya
KW - MSM
KW - PrEP
KW - lost to follow-up
KW - predictors
UR - http://www.scopus.com/inward/record.url?scp=85123717018&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/hiv.13237
DO - https://doi.org/10.1111/hiv.13237
M3 - Article
C2 - 35088511
SN - 1464-2662
VL - 23
SP - 750
EP - 763
JO - HIV medicine
JF - HIV medicine
IS - 7
ER -