Adherence of PrEP users to recommendations for regular HIV testing

HIV pre-exposure prophylaxis (PrEP) is a preventive medication, taken by mouth daily or injected as infrequently as 6 times a year. Adoption of PrEP has been considered one of the biggest factors in reducing HIV infections worldwide.

However, simply taking PrEP is not enough to prevent HIV. German guidelines require PrEP users to get tested regularly for HIV, sexually transmitted infections (STIs), and kidney function. Notably, German PrEP users had to cover treatment and appointment costs themselves by September 2019. A study, published in Eurosurveillanceexamined testing frequencies among German PrEP users during this self-funded period.

Investigators recruited German PrEP users from July to October 2018 and from April to June 2019. Participants were identified through men who have sex with men (MSM) dating apps (Grindr, Romeo, Hornet), a German community website about PrEP and anonymous information about HIV/STI testing locations. Participants were also asked to recruit friends who matched the study criteria. After consenting to the study, participants completed an anonymous survey about their PREP use, screening practices, and STI history.

Participants were identified as cisgender men, cisgender women, or gender diverse (including transgender, non-binary, or intersex gender identity). Source of current PrEP use was categorized as ‘medical prescription’ or ‘informal’ (whether they received the drug from internet platforms, dealers or friends). Anyone who responded that they had not paid for the tests was considered ‘cost coverage’, while those who had paid any amount for their tests were ‘self-payers’. Testing locations included “testing only at doctor’s”, “testing at doctor’s and other locations”, and “only using checkpoints, self-tests or other locations”; Checkpoints are anonymous test sites in Germany.

A total of 2,118 current and former PrEP users were included in wave 1 of the survey, and 2,730 were included in wave 2. The average age of the sample was 37 and 88.7% were cisgender men.

Results showed that 22.0% of participants had at least 1 gonorrhea diagnosis, 21.4% had 1 or more chlamydia diagnoses, and 13.0% had at least 1 syphilis diagnosis during use. of PrEP. Of all study participants, 3.4% said they had not had any medical tests before starting PrEP, and 8.0% said they were not being tested during their current use. of PrEP.

Germany recommends PrEP for people at “substantial” risk of HIV infection. Specific recommendations ask potential PrEP users to first be screened for HIV, hepatitis B virus (HBV), and kidney failure. After starting PrEP, users should receive medical supervision while using PrEP, be tested at least every 3 months to ensure they are still HIV-negative, be screened for syphilis every 3 months , be screened for gonorrhea and chlamydia every 3 to 6 months, and have kidney function monitored regularly.

Most participants said they received HIV and kidney function tests at least every 3 months and STI tests at least every 6 months. Participants who obtained PrEP from informal sources had much lower rates of testing before and during PrEP use. The most important factor associated with inadequate HIV testing frequencies was not having been tested before starting PrEP.

Overall, PrEP users reported testing frequencies below German recommendations for regular testing for HIV (26.3%), STIs (20.9%), and kidney function (29.2%) ). Participants who frequently tested themselves for STIs had a higher proportion of self-reported STI diagnoses while using PrEP. Those least frequently tested for HIV, STIs, and kidney function generally reported not being tested before starting PrEP, obtaining PrEP from informal sources, and using PrEP on demand or intermittently .

HIV and STI testing rates in this German study were higher than in the United States. Investigators noted that the stigma around PrEP may prevent some people from seeking medical care and regular testing. “We will investigate barriers to regular testing in future surveys,” the investigators concluded.

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