Substantial increase in HIV risk behaviors and poor PrEP adherence among men who have sex with men during the COVID-19 pandemic: an observational longitudinal study in four cities of China


BACKGROUND: The novel coronavirus disease (COVID-19) pandemic has a massive impact on the oral Pre-exposure prophylaxis (PrEP) project, with dramatically reduced PrEP use. However, the changes in HIV risk behaviors, HIV testing behaviors, and PrEP adherence has remained unclear since the COVID-19 pandemic. We investigated these changes among men who have sex with men (MSM) taking PrEP in China and analyzed the associated factors of poor PrEP adherence before and during the COVID-19 pandemic.
METHODS: An observational longitudinal analysis of HIV-negative MSM using PrEP with two oral strategies based on an ongoing PrEP trial in four cities of China from February 12 to March 8, 2020ï¼?assessing the change in sexual behavior characteristics and PrEP adherence before and during the COVID-19 pandemic. We used logistic models to analyze the correlated factors of poor PrEP adherence.
RESULTS: We enrolled 791 eligible participants from CROPrEP (418 in daily PrEP, 373 in on-demand PrEP). Compared with the follow-up data (the 4th-week visit) before the COVID-19, both condomless anal intercourse (CAI) with regular partners (25.7% vs. 11.8%) and with casual partners (9.0% vs. 3.6%) were significantly increased (all P < 0.05). Meanwhile, the proportion of HIV testing in the past month decreased from 50.1% to 25.9%, the proportion of PrEP use decreased from 97.9% to 64.3%, while the prevalence of poor PrEP adherence increased from 23.6% to 50.1% (Odds ratio [OR] 3.3, 95% CI 2.6-4.0). Poor PrEP adherence in the past month correlated with the absence of HIV test (Adjusted odds ratio [AOR] 1.4, 95% CI 1.0-1.9), using condoms with regular sexual partners all time (vs. never aOR 2.2, 95% CI 1.2-4.1) and marring or cohabitating with females (vs. not married aOR 3.1, 95% CI 1.6-5.9).
CONCLUSIONS: CAI and poor PrEP adherence increased substantially, coinciding with a dramatic reduction in HIV testing among MSM PrEP users may undermine PrEP's protection effect and increase the risk of HIV drug resistance. Our research highlight that it's necessary to provide HIV self-testing (HIVST) reagents or online interventions to improve protective sexual behaviors and PrEP adherence, especially for those MSM who marry or cohabitate with females.