Three quarters of men who have sex with men (MSM) who used but stopped daily oral preexposure prophylaxis (PrEP) claimed interest in long-acting injected (LAI) PrEP in a large Washington, DC group . Two thirds of men currently using oral PrEP and more than half of those who never tried oral PrEP stated their interest in LAI PrEP in this cross-sectional study.
LAI PrEP, now in clinical trials, holds the promise of greater convenience for people who prefer monthly shots to daily or as-needed pills . Surveys in New York City found that one third to two thirds of MSM using oral PrEP would prefer switching to LAI PrEP [3,4]. Researchers at George Washington University and other institutions conducted a new study to determine interest in LAI PrEP among MSM with different oral PrEP histories.
The analysis involved HIV-negative MSM at least 18 years old who lived in the Washington, DC area in July-December 2017. The researchers excluded men who used LAI PrEP in a trial. Participants recruited at randomly selected MSM venues completed an interviewer-administered survey then had a rapid HIV test. The investigators used multivariable logistic regression to identify predictors of simultaneously (1) being likely or extremely like to use LAI PrEP and (2) preferring LAI PrEP to daily oral PrEP.
Among the 303 men surveyed, 44% were younger than 30, 40% were black, 34% white, and 16% Hispanic. About one third of men, 31%, currently used daily oral PrEP, while another 10% previously took but stopped oral PrEP. The remaining 59% never took oral PrEP. Among current PrEP users, 93% missed 5 or fewer doses in the past month. Majorities of men in all 3 oral PrEP user groups expressed interest in LAI PrEP (P = 0.13 across groups).
-- Among 94 current daily oral PrEP users, 65% had interest in LAI PrEP.
-- Among 29 former daily oral PrEP users, 76% stated interest in LAI PrEP.
-- Among 180 MSM who never took oral PrEP, 58% claimed interest in LAI PrEP.
Multivariate logistic regression determined that oral PrEP history did not affect interest in and preference for LAI PrEP. Neither did race/ethnicity or being younger than 30 years old. In an analysis limited to current oral PrEP users, race/ethnicity and age also failed to predict interest in switching to LAI PrEP. In this group, missing more than 5 oral doses in the past 30 days failed to predict interest in LAI PrEP. Among all men, education level and household income did not differ significantly by LAI PrEP interest status.
The researchers proposed that high interest in LAI PrEP among MSM not currently using daily oral PrEP suggests that LAI PrEP could expand PrEP coverage among MSM.
1. Levy M, Agopian A, Magnus M, et al. Interest in long-acting injectable PrEP by one's history of oral PrEP use among men who have sex with men in Washington, DC. HIV Research for Prevention (HIVR4P), October 21-25, 2018, Madrid. Abstract P25.07.
2. Meyers K, Golub SA. Planning ahead for implementation of long-acting HIV prevention: challenges and opportunities. Curr Opin HIV AIDS. 2015;10:290-295. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620059/
3. John SA, Whitfield THF, Rendina HJ, Parsons JT, Grov C. Will gay and bisexual men taking oral pre-exposure prophylaxis (PrEP) switch to long-acting injectable PrEP should it become available? AIDS Behav. 2018;22:1184-1189.
4. Meyers K, Wu Y, Brill A, Sandfort T, Golub SA. To switch or not to switch: Intentions to switch to injectable PrEP among gay and bisexual men with at least twelve months oral PrEP experience. PLoS One. 2018;13:e0200296.