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Awareness of ED-PrEP and interest in switching from daily oral PrEP to ED-PrEP in Brazil, Peru and Mexico ' the ImPrEP study

Title
Awareness of ED-PrEP and interest in switching from daily oral PrEP to ED-PrEP in Brazil, Peru and Mexico ' the ImPrEP study
Presenter
Brenda Hoagland
Authors
B. Hoagland * (1), T. Torres (1), K.A. Konda (2), E.H. Vega_Ramirez (3), J.V. Guanira (2), H. Vermandere (4), R.I. Moreira (5), I.C. Leite (6), M. Derrico (1), C. Pimenta (7), M. Benedetti (1), S. Bautista (4), B. Grinsztejn (1), C. Caceres (2), V.G. Veloso (1), ImPrEP Study Group
Institutions
(1) Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, (2) Universidad Peruana Cayetano Heredia, Lima, Peru, (3) National Institute of Psychiatry Ramon de la Fuente Muñz, Ciudad de Mexico, Mexico, (4) National Institute of Public Health, Ciudad de Mexico, Mexico, (5) Evandro Chagas Infectious Diseases National Institute/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, (6) Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, (7) Brazilian Ministry of Health, Brasília, Brazil

BACKGROUND: The WHO recommend Event Driven (ED)-PrEP for cisgender men who have sex with men (MSM) at risk for HIV and reporting infrequent sex. ImPrEP is a PrEP demonstration study conducted in Brazil, Peru and Mexico. We report results of a cross-sectional study to evaluate awareness of and interest in ED-PrEP among participants.
METHODS: Participants responded questions about sex frequency, current PrEP use and ED-PrEP (awareness/interest). Reasons for interest in switching from daily PrEP to ED-PrEP were assessed using a four-point Likert scale and responses were grouped as 'strongly agree/agree' vs. 'strongly disagree/disagree'. We used chi-square test to compare across countries.
RESULTS: From February/2020 to January/2021, 3,764 completed the questionnaire in Brazil (58.5%), Mexico (27.1%) and Peru (14.4%). The majority were MSM (97.6%) and median age was 31 years (IQR:26-37). Daily PrEP use as prescribed was reported by 96.9%. Sex < 2 days/week was reported by 23.4%. ED-PrEP awareness was higher in Mexico (36.3%) than in Brazil (30.2%) and Peru (27.8%) (p<.001). After a brief explanation, 22.1% reported interest in switching from daily PrEP to ED-PrEP, with higher rates in Mexico (26.9%) and Peru (26.0%) than in Brazil (18.8%) (p<.001). The main reasons for interest were: ED-PrEP is more convenient (85.4%), ability to postpone unplanned sex (80.8%) and capacity to predict sex (73.6%). For the 77.9% not interested, the main reasons were: comfort with daily PrEP (98.1%), ED-PrEP is a difficult regimen (92.7%) and feeling anxious about own HIV risk (90.8%). Inability to anticipate sex was higher in Mexico (93.1%) than Peru (89.6%) and Brazil (85.3%) (p<.001), while having concerns with ED-PrEP efficacy was less reported in Brazil (53.0%) than Peru (73.9%) and Mexico (75.7%) (p<.001). MSM reporting sex < 2 days/week were more interested in switching to ED-PrEP than those having sex '¥ 2 days/week (38.1% vs. 17.2%; p<.001).
CONCLUSIONS: Awareness and interest in switching to ED-PrEP was low among Latin-American MSM who use daily PrEP. However, those who reported infrequent sex showed interest and considered it a convenient regimen. Beliefs about low efficacy and anxiety about HIV infection risk suggest that knowledge dissemination is necessary to increase interest in ED-PrEP.