Increasing event-driven HIV pre-exposure prophylaxis use among gay, bisexual and other men who have sex with men in Australia: results from behavioural surveillance 2019–2023

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2024-11-24 DOI:10.1002/jia2.26398

Curtis Chan, Martin Holt, Anthony K. J. Smith, Timothy R. Broady, James MacGibbon, Limin Mao, Ben Wilcock, John Rule, Benjamin R. Bavinton

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引用次数: 0

Abstract

Introduction

HIV pre-exposure prophylaxis (PrEP) has been publicly available since 2018 in Australia as a daily regimen. In 2019, clinical guidelines were updated to support guidance on event-driven PrEP (ED-PrEP) use. We assessed trends in the PrEP dosing regimen by comparing daily PrEP use to ED-PrEP among cisgender gay, bisexual and other men who have sex with men (GBMSM).

Methods

Data from repeated, cross-sectional, national behavioural surveillance surveys were analysed from 2019 to 2023 among participants not living with HIV. Logistic regression models were conducted to assess trends and compared ED-PrEP users to non-PrEP users and daily PrEP.

Results

Among 38,880 participants, overall PrEP use with any regimen increased from 27.6% in 2019 to 42.7% in 2023 (OR = 1.16, 95% CI = 1.15−1.18, p < 0.001). Among 12,922 participants who reported PrEP use in the last 6 months, the proportion reporting ED-PrEP use increased from 7.6% in 2019 to 27.8% in 2023 (OR = 1.41, 95% CI = 1.37−1.46, p < 0.001) with those who reported daily PrEP decreasing from 92.4% to 63.3% (OR = 0.64, 95% CI = 0.62−0.66, p < 0.001). In a cross-sectional sub-sample in 2022–2023 (n = 8840), compared to ED-PrEP users, non-PrEP users were less likely to have received three or more HIV tests in the last 12 months (aRRR = 0.26, 95% CI = 0.22−0.31, p < 0.001), have 2−10 male sexual partners in the last 6 months (aRRR = 0.24, 95% CI = 0.14−0.41, p < 0.001) or 11 or more (aRRR = 0.26, 95% CI = 0.15−0.45, p < 0.001) compared to none, or to report condomless anal intercourse with casual partners (aRRR = 0.38, 95% CI = 0.32−0.46, p < 0.001). Compared to ED-PrEP users, daily PrEP users were more likely to have received three of more HIV tests in the last year (aRRR = 3.73, 95% CI = 3.15−4.40, p < 0.001) and less likely to be born overseas and lived in Australia for less than 5 years compared to being born in Australia (aRRR = 0.64, 95% CI = 0.49−0.83, p = 0.001).

Conclusions

While daily PrEP remains the most common PrEP dosing regimen among GBMSM in Australia, there has been a steep increase in the proportion of PrEP users who are taking ED-PrEP. Monitoring of PrEP use should continue to adapt to new dosing methods and future PrEP options. As ED-PrEP use increases, further work is needed to ensure those taking ED-PrEP are taking it effectively to prevent HIV.

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澳大利亚男同性恋、双性恋和其他男男性行为者越来越多地使用事件驱动的艾滋病毒暴露前预防措施：2019-2023 年行为监测结果

引言艾滋病暴露前预防疗法（PrEP）自 2018 年起在澳大利亚作为一种日常疗法公开上市。2019 年，临床指南进行了更新，以支持事件驱动的 PrEP（ED-PrEP）使用指南。我们通过比较男同性恋、双性恋和其他男男性行为者（GBMSM）中每日PrEP与ED-PrEP的使用情况，评估了PrEP剂量方案的趋势。方法分析了 2019 年至 2023 年期间在非 HIV 感染者中重复进行的横断面全国行为监测调查数据。采用逻辑回归模型评估趋势，并将 ED-PrEP 使用者与非 PrEP 使用者和每日 PrEP 使用者进行比较。结果在 38880 名参与者中，使用任何治疗方案的 PrEP 使用者总体比例从 2019 年的 27.6% 上升至 2023 年的 42.7%（OR = 1.16，95% CI = 1.15-1.18，p <0.001）。在报告在过去 6 个月中使用 PrEP 的 12922 名参与者中，报告使用 ED-PrEP 的比例从 2019 年的 7.6% 增加到 2023 年的 27.8%（OR = 1.41，95% CI = 1.37-1.46，p < 0.001），报告每天使用 PrEP 的参与者从 92.4% 下降到 63.3%（OR = 0.64，95% CI = 0.62-0.66，p < 0.001）。在 2022-2023 年的横断面子样本（n = 8840）中，与 ED-PrEP 使用者相比，非 ED-PrEP 使用者在过去 12 个月中接受三次或三次以上 HIV 检测的可能性较低（aRRR = 0.26，95% CI = 0.22-0.31，p < 0.001），在过去 6 个月中有 2-10 个男性性伴侣的可能性较低（aRRR = 0.24，95% CI = 0.14-0.41，p <0.001）或 11 个或更多 (aRRR = 0.26，95% CI = 0.15-0.45，p <0.001)，或报告与临时性伴侣进行无套肛交 (aRRR = 0.38，95% CI = 0.32-0.46，p <0.001)。与 ED-PrEP 使用者相比，每日 PrEP 使用者更有可能在过去一年中接受过三次或三次以上的 HIV 检测（aRRR = 3.73，95% CI = 3.15-4.40，p < 0.001），而且与在澳大利亚出生的人相比，在海外出生和在澳大利亚居住不到 5 年的人更不可能接受 HIV 检测（aRRR = 0.64，95% CI = 0.49-0.83，p = 0.001）。结论虽然在澳大利亚，每日服用 PrEP 仍是 GBMSM 最常见的 PrEP 服药方案，但服用 ED-PrEP 的 PrEP 使用者比例急剧上升。对 PrEP 使用情况的监测应继续适应新的给药方法和未来的 PrEP 选择。随着 ED-PrEP 使用的增加，需要进一步开展工作，以确保那些服用 ED-PrEP 的人能够有效地预防艾滋病毒。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.