Participation, Retention and Uptake in a Multicentre Pre-exposure Prophylaxis Cohort Using Online, Smartphone-compatible Data Collection

F Hovaguimian; E Martin; M Reinacher; M Rasi; AJ Schmidt; E Bernasconi; E Boffi El Amari; DL Braun; A Calmy; K Darling; V Christinet; C Depmeier; C Hauser; S Läuchli; J Notter; M Stoeckle; B Surial; P Vernazza; P Bruggmann; P Tarr; D Haerry; R Bize; N Low; A Lehner; J Böni; RD Kouyos; JS Fehr; B Hampel

Disclosures

HIV Medicine. 2022;23(2):146-158. 

In This Article

Abstract and Introduction

Abstract

Objectives: The aim of the study was to assess the feasibility of a national pre-exposure prophylaxis (PrEP) programme using smartphone-compatible data collection.

Methods: This was a multicentre cohort study (NCT03893188) enrolling individuals interested in PrEP in Switzerland. All centres participate in the SwissPrEPared programme, which uses smartphone-compatible data collection. Feasibility was assessed after centres had enrolled at least one participant. Participants were HIV-negative individuals presenting for PrEP counselling. Outcomes were participation (number enrolled/number eligible), enrolment rates (number enrolled per month), retention at first follow-up (number with first follow-up/number enrolled), and uptake (proportion attending first visit as scheduled). Participant characteristics were compared between those retained after baseline assessment and those who dropped out.

Results: Between April 2019 and January 2020, 987 individuals were assessed for eligibility, of whom 969 were enrolled (participation: 98.2%). The median enrolment rate was 86 per month [interquartile range (IQR) 52–137]. Retention at first follow-up and uptake were both 80.7% (782/969 and 532/659, respectively). At enrolment, the median age was 40 (IQR 33–47) years, 95% were men who have sex with men, 47% had a university degree, and 75.5% were already taking PrEP. Most reported multiple casual partners (89.2%), previous sexually transmitted infections (74%) and sexualized drug use (73.1%). At baseline, 25.5% tested positive for either syphilis, gonorrhoea or chlamydia. Participants who dropped out were at lower risk of HIV infection than those retained after baseline assessment.

Conclusions: In a national PrEP programme using smartphone-compatible data collection, participation, retention and uptake were high. Participants retained after baseline assessment were at considerable risk of HIV infection. Younger, less educated individuals were underrepresented in the SwissPrEPared cohort.

Introduction

Since its approval in 2016 by the European Medicines Agency, pre-exposure prophylaxis (PrEP) has been widely used to prevent HIV transmission as an alternative or in addition to conventional prevention measures. As of November 2019, 16 out of 53 countries in Europe and Central Asia reported PrEP reimbursement as part of their national health services.[1] Despite approval in neighbouring countries and growing interest among target populations [such as men who have sex with men (MSM)],[2] PrEP use in Switzerland remained off-label and poorly controlled (e.g. online purchase without medical prescription or in neighbouring countries) until recently (approval: April 2020). Taking PrEP without medical oversight is of concern, because of possible drug-related side effects, poor adherence and viral resistance (e.g. in those taking PrEP despite an undiagnosed HIV infection or in those newly infected despite PrEP).[3,4]

Whilst there is growing evidence that wide PrEP availability contributes to reducing HIV infection rates,[5–8] concerns have been raised as to whether the current resurgence of other sexually transmitted infections (STIs), such as gonorrhoea, chlamydia, syphilis and viral hepatitis, could be attributed to PrEP.[9–11] Although changes in sexual behaviour, such as an increase in condomless sex after PrEP start, have been associated with PrEP use,[12,13] these findings have been inconsistent,[14,15] and it remains unclear to what extent other factors, such as differences in STI screening rates, may also contribute to the recent rise in STIs.

To address these points, the SwissPrEPared programme (https://www.swissprepared.ch/en) was launched in April 2019. The goals of this national PrEP programme are to provide personalized prevention measures to individuals at considerable risk of HIV infection, to harmonize quality standards of PrEP consultations across Switzerland, and to serve as an official exchange and training platform for health care providers involved in PrEP prescription. Counselling is based on standardized, online, smartphone-compatible questionnaires that participants complete before their visit. Yearly data analysis and direct feedback from participants and study centres allow continuous adjustments of the programme format. Nested within this prevention programme, the SwissPrEPared cohort study (NCT03893188) follows programme participants longitudinally over a 3-year period, with the following research objectives: to obtain epidemiological data on PrEP use in Switzerland, to monitor STIs, and to evaluate sexual health and wellbeing in individuals interested in PrEP.

Because the implementation of a national PrEP programme using online, smartphone-compatible data collection for counselling remains challenging, the primary aim of this study was to provide feasibility data after each participating centre had enrolled at least one participant. More specifically, we assessed participation, enrolment rates, retention at first follow-up and uptake. We were also interested in exploring the relatively early cohort profile and assessed participant characteristics at cohort registration.

processing....