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Non-daily use of HIV Pre-exposure prophylaxis: a tale of two cities

Projectomschrijving

PrEP is een pil met hiv-remmers die een hiv-infectie kan voorkomen. De pil is bedoeld voor mensen die geen hiv hebben, maar die wel een verhoogd risico lopen om geïnfecteerd te raken. Je kunt de pil dagelijks nemen voor een continue bescherming, of alleen tijdens bepaalde periodes (periodiek).

In het AMPrEP (Amsterdam PrEP) project en het Belgische Be-PrEP-ared project onderzochten we de toepasbaarheid van dagelijkse en periodieke PrEP bij mannen die seks hebben met mannen en transgender personen (in totaal 576 deelnemers). Met dit gezamenlijke project willen we extra inzichten krijgen door de gegevens van beide studies samen te voegen. We willen beter begrijpen waarom men kiest voor dagelijks of periodieke PrEP. Ook zullen we bestuderen welke kenmerken geassocieerd zijn met het oplopen van een hiv- of hepatitis C-infectie. De groep periodieke PrEP-gebruikers is relatief klein in beide studies, maar door de gegevens samen te voegen kunnen we onze conclusies beter onderbouwen.

Lees meer informatie over hiv en de onderzoeken op onze themapagina over hiv

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Titel: Comparing MSM using event-driven PrEP to those using daily PrEP - data from two European PrEP demonstration projects
Auteur: Vita W. JONGEN, Thijs REYNIERS, Zorah M.H. YPMA, Maarten F. SCHIM VAN DER LOEFF, Udi DAVIDOVICH, Hanne M.L. ZIMMERMANN, Liza COYER, Mark A.M. VAN DEN ELSHOUT, Henry J.C. DE VRIES, Kristien WOUTERS, Tom SMEKENS, Bea VUYLSTEKE, Maria PRINS, Marie LAGA, Elske HOORNENBORG1

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Eindverslag

Pre-expositie profylaxe (PrEP) is een medicijn waarmee infectie met hiv voorkomen kan worden. PrEP kan zowel dagelijks als rondom de seks gebruikt worden. Wij bestudeerden de voorkeur voor beide inname schema’s, en hoe vaak mensen wisselden. Hiertoe hebben we data uit PrEP demonstratie projecten in Nederland en België gebruikt. Ook hebben we gekeken naar het voorkomen van seksueel overdraagbare aandoeningen onder de PrEP gebruikers.

Samenvatting van de aanvraag

Non-daily use of HIV Pre-exposure prophylaxis: a tale of two cities Pre-exposure prophylaxis Including antiretrovirals to prevent HIV infection as part of a comprehensive HIV prevention package has given us an opportunity to control the HIV epidemic. Pre-exposure prophylaxis (PrEP) consists of antiretroviral medication taken by those who are HIV-uninfected and at increased risk for HIV infection. Two large randomised trials in the UK and France/Canada have demonstrated high efficacy (86%) in preventing HIV. The Minister of Health in the Netherlands has decided to roll out PrEP nationwide, starting in 2019. In Belgium, PrEP has been nationally implemented since 2017. PrEP can be taken in two ways: daily and event-driven. For daily use, people take one tablet of tenofovir with emtricitabine daily; for event-driven use, pe0ple take two tablets prior to sex and one tablet daily two days following sex. Offering the choice between daily and event-driven PrEP may help to scale-up PrEP use, especially among those with less frequent HIV exposure risk unwilling to take daily medication. Event-driven PrEP (edPrEP) use translates to fewer tablets and thus lower costs and an improved cost-effectiveness ratio. Although the Ipergay study has convincingly demonstrated the efficacy of edPrEP, only few countries worldwide have offered edPrEP and a limited number of studies have examined edPrEP. More insight is needed into key aspects of event-driven PrEP, including preferred choices of PrEP regimens, user profiles, changes between regimens over time, sexual risk behaviour and incidence of sexually transmitted infections (STIs), particularly HIV, while on edPrEP in demonstration or routine programs. AMPrEP and Be-PrEP-ared In 2015, the Amsterdam PrEP demonstration project (Public Health Service of Amsterdam, Amsterdam, the Netherlands) and the Be-PrEP-ared study (Institute of Tropical Medicine, ITM, Antwerp, Belgium) were initiated. Both had an innovative design, being the first to offer participants the choice between daily and event-driven PrEP regimens. Men who have sex with men (MSM) and transgender people at increased risk of HIV infection were eligible, with 376 and 200 participants enrolled in the respective studies in 2015-2016. Event-driven PrEP was chosen by about a quarter of participants in both projects, hence resulting in fairly limited power to perform various analyses within this PrEP regimen. By combining data from both sources, we hope to gain better insight in the choices people make for HIV prevention options, and to provide evidence-based recommendations for implementation of PrEP. The aim of this application The overall aim of this application is to gain insights into the motives, choice, use, associations and outcomes of daily and event-driven PrEP regimens, offered at choice of the participant, among MSM and transgender people. Given the scarce data on event-driven PrEP, we focus on event-driven PrEP users and outcomes. A second aim is to provide the basis for collaboration by pooling data from two PrEP demonstration projects (AMPrEP and Be-PrEP-ared), allowing for joint analyses and further collaboration. Research questions The research questions of this application are: A. What is the uptake and what are the motives, use, profiles, and associations of an initial choice for event-driven PrEP in the two PrEP cohorts? B. What are the outcomes of event-driven PrEP users in terms of incidence rates of HIV and Hepatitis C virus (HCV) infection, in comparison to daily PrEP users? Expected impact and outcomes With both study groups capable and eager to collaborate, joint data and analyses have advantages well beyond this application: future joint analyses, future research questions and, after the initial analyses of the individual projects, future initiatives to combine PrEP data from other studies. This project will fill current knowledge gaps on event-driven PrEP use and will provide the much-needed data necessary for clinical guidance and decision making regarding PrEP implementation at national and international level. Important questions regarding profiles of event-driven PrEP users, levels of protection, and incidence of HCV infection will be answered in this project. When a research collaborative has been established, the road to further, more in-depth analyses and collaboration in the future is paved, and further joint activities can be executed by smaller initiatives such as these. The information from this project will inform health professionals counseling PrEP users or conducting research, as well as health policy stakeholders to make decisions shaping PrEP implementation structures and prevention programmes with the aim to stop the HIV epidemic

Onderwerpen

Kenmerken

Projectnummer:
522008009
Looptijd: 100%
Looptijd: 100 %
2019
2021
Onderdeel van programma:
Projectleider en penvoerder:
E. Hoornenborg
Verantwoordelijke organisatie:
GGD Amsterdam