1887
Research Open Access
Like 0

Abstract

Introduction

Users of pre-exposure prophylaxis (PrEP) require periodic testing for HIV, sexually transmitted infections (STI) and renal function. Before PrEP was made free of charge through statutory health insurance in late 2019, PrEP users in Germany had to pay for testing themselves.

Aim

We investigated self-reported HIV, STI and renal function testing frequencies among self-funded PrEP users in Germany, factors associated with infrequent testing, and STI diagnoses.

Methods

A cross-sectional anonymous online survey in 2018 and 2019 recruited current PrEP users via dating apps for men who have sex with men (MSM), a PrEP community website, anonymous testing sites and friends. We used descriptive methods and logistic regression for analysis.

Results

We recruited 4,848 current PrEP users. Median age was 37 years (interquartile range (IQR): 30–45), 88.7% identified as male, and respectively 26.3%, 20.9% and 29.2% were tested less frequently for HIV, STI and renal function than recommended. Participants with lower STI testing frequency were significantly less likely to report STI diagnoses during PrEP use, especially among those with many partners and inconsistent condom use. Factors most strongly associated with infrequent testing included not getting tested before starting PrEP, using PrEP from informal sources and on-demand/intermittent PrEP use.

Discussion

In a setting of self-funded PrEP, many users obtained medical tests less frequently than recommended, which can lead to missed diagnoses. Barriers to testing should be addressed to enable proper medical supervision. The suitability of testing frequencies to PrEP users with less frequent risk exposures needs to be evaluated.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2022.27.14.2100503
2022-04-07
2022-05-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.14.2100503
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/27/14/eurosurv-27-14-2.html?itemId=/content/10.2807/1560-7917.ES.2022.27.14.2100503&mimeType=html&fmt=ahah

References

  1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587-99.  https://doi.org/10.1056/NEJMoa1011205  PMID: 21091279 
  2. Grulich AE, Guy R, Amin J, Jin F, Selvey C, Holden J, et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV. 2018;5(11):e629-37.  https://doi.org/10.1016/S2352-3018(18)30215-7  PMID: 30343026 
  3. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53-60.  https://doi.org/10.1016/S0140-6736(15)00056-2  PMID: 26364263 
  4. Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237-46.  https://doi.org/10.1056/NEJMoa1506273  PMID: 26624850 
  5. Molina JM, Charreau I, Spire B, Cotte L, Chas J, Capitant C, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402-10.  https://doi.org/10.1016/S2352-3018(17)30089-9  PMID: 28747274 
  6. Deutsche AIDS Gesellschaft (DAIG). Deutsch-Östereichische Leitlinien zur HIV-Präexpositionsprophylaxe. Stuttgart: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.; 2018. AWMF-Register-Nr: 055-008. Available from: https://www.awmf.org/uploads/tx_szleitlinien/055-008l_S2k_HIV-Praeexpositionsprophylaxe_2019-01_01.pdf.
  7. Centers for Disease Control and Prevention (CDC). Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 update. A clinical practice guideline. Atlanta: CDC; 2018. Available from: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf
  8. European Medicines Agency (EMA). Truvada - Summary of product characteristics. [Accessed 30th Oct 2021]. Available from: https://www.ema.europa.eu/en/documents/product-information/truvada-epar-product-information_en.pdf
  9. Drak D, Barratt H, Templeton DJ, O’Connor CC, Gracey DM. Renal function and risk factors for renal disease for patients receiving HIV pre-exposure prophylaxis at an inner metropolitan health service. PLoS One. 2019;14(1):e0210106.  https://doi.org/10.1371/journal.pone.0210106  PMID: 30653509 
  10. Jotwani V, Scherzer R, Glidden DV, Mehrotra M, Defechereux P, Liu A, et al. Pre-exposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and kidney tubular dysfunction in HIV-uninfected individuals. J Acquir Immune Defic Syndr. 2018;78(2):169-74.  https://doi.org/10.1097/QAI.0000000000001654  PMID: 29767638 
  11. World Health Organization (WHO). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. Geneva: WHO; 2016. Available from: https://apps.who.int/iris/handle/10665/208825
  12. Ayerdi Aguirrebengoa O, Vera García M, Arias Ramírez D, Gil García N, Puerta López T, Clavo Escribano P, et al. Low use of condom and high STI incidence among men who have sex with men in PrEP programs. PLoS One. 2021;16(2):e0245925.  https://doi.org/10.1371/journal.pone.0245925  PMID: 33539363 
  13. Chapin-Bardales J, Johnson Jones ML, Kirkcaldy RD, Bernstein KT, Paz-Bailey G, Phillips C, et al. Pre-exposure prophylaxis use and detected sexually transmitted infections among men who have sex with men in the United States-national HIV behavioral surveillance, 5 US cities, 2017. J Acquir Immune Defic Syndr. 2020;85(4):430-5.  https://doi.org/10.1097/QAI.0000000000002482  PMID: 33136740 
  14. van Wifferen F, Hoornenborg E, Schim van der Loeff MF, Heijne J, van Hoek AJ. Cost-effectiveness of two screening strategies for Chlamydia trachomatis and Neisseria gonorrhoeae as part of the PrEP programme in the Netherlands: a modelling study. Sex Transm Infect. 2021;97(8):607-12.  https://doi.org/10.1136/sextrans-2020-054741  PMID: 33431605 
  15. Marcus U, Mirandola M, Schink SB, Gios L, Schmidt AJ. Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men-is it time to re-evaluate STI-screening as a control strategy? PLoS One. 2021;16(3):e0248582.  https://doi.org/10.1371/journal.pone.0248582  PMID: 33720969 
  16. Hofmann A, Bätzing J, Marcus U, Bremer V, Bartmeyer B. [How many people have been tested for HIV in the outpatient sector in Germany?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2020;63(10):1262-70.  https://doi.org/10.1007/s00103-020-03210-y  PMID: 32897408 
  17. Paul Ehrlich Institute (PHE). HIV self-tests. Langen: PHE. [Accessed: 1 Nov 2021]. Available from: https://www.pei.de/EN/newsroom/hiv-self-tests/hiv-self-tests-content.html
  18. Robert Koch Institute (RKI). Gemeinsames Teststellenprojekt 2017. Zeittrends 2015-2017. Berlin: RKI; 2018. Available from: https://edoc.rki.de/bitstream/handle/176904/5895.3/Teststellenbericht_2017.pdf?sequence=1&isAllowed=y
  19. Chandra C, Weiss KM, Kelley CF, Marcus JL, Jenness SM. Gaps in sexually transmitted infection screening among men who have sex with men in pre-exposure prophylaxis (PrEP) care in the United States. Clin Infect Dis. 2021;73(7):e2261-9.  https://doi.org/10.1093/cid/ciaa1033  PMID: 32702116 
  20. Huang YA, Tao G, Samandari T, Hoover KW. Laboratory testing of a cohort of commercially insured users of HIV preexposure prophylaxis in the United States, 2011-2015. J Infect Dis. 2018;217(4):617-21.  https://doi.org/10.1093/infdis/jix595  PMID: 29145597 
  21. Rusie LK, Orengo C, Burrell D, Ramachandran A, Houlberg M, Keglovitz K, et al. Preexposure prophylaxis initiation and retention in care over 5 years, 2012-2017: are quarterly visits too much? Clin Infect Dis. 2018;67(2):283-7.  https://doi.org/10.1093/cid/ciy160  PMID: 29506057 
  22. Spinelli MA, Scott HM, Vittinghoff E, Liu AY, Morehead-Gee A, Gonzalez R, et al. Provider adherence to pre-exposure prophylaxis monitoring guidelines in a large primary care network. Open Forum Infect Dis. 2018;5(6):ofy099.  https://doi.org/10.1093/ofid/ofy099  PMID: 29977959 
  23. O’Halloran C, Owen G, Croxford S, Sims LB, Gill ON, Nutland W, et al. Current experiences of accessing and using HIV pre-exposure prophylaxis (PrEP) in the United Kingdom: a cross-sectional online survey, May to July 2019. Euro Surveill. 2019;24(48):1900693.  https://doi.org/10.2807/1560-7917.ES.2019.24.48.1900693  PMID: 31796157 
  24. Koppe U, Marcus U, Albrecht S, Jansen K, Jessen H, Gunsenheimer-Bartmeyer B, et al. Factors associated with the informal use of HIV pre-exposure prophylaxis in Germany: a cross-sectional study. J Int AIDS Soc. 2019;22(10):e25395.  https://doi.org/10.1002/jia2.25395  PMID: 31583823 
  25. Bundesministerium fuer Gesundheit (BMG). Gesetzlicher Anspruch für HIV-Präexpositionsprophylaxe (PrEP) kommt. [Legal entitlement for HIV pre-exposure prophylaxis (PrEP) upcoming]. Berlin: BMG; 2019. Available from: https://www.bundesgesundheitsministerium.de/terminservice-und-versorgungsgesetz/prep.html
  26. van Dijk M, de Wit JBF, Kamps R, Guadamuz TE, Martinez JE, Jonas KJ. Socio-sexual experiences and access to healthcare among informal PrEP Users in the Netherlands. AIDS Behav. 2021;25(4):1236-46.  https://doi.org/10.1007/s10461-020-03085-9  PMID: 33196938 
  27. Chow EP, Fairley CK. The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission. J Int AIDS Soc. 2019;22(S6) Suppl 6;e25354.  https://doi.org/10.1002/jia2.25354  PMID: 31468730 
  28. Chow EPF, Cornelisse VJ, Read TRH, Lee D, Walker S, Hocking JS, et al. Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhoea among men who have sex with men, a new public health message: a cross-sectional survey. Sex Transm Infect. 2016;92(7):532-6.  https://doi.org/10.1136/sextrans-2015-052502  PMID: 26941362 
  29. Edwards S, Carne C. Oral sex and transmission of non-viral STIs. Sex Transm Infect. 1998;74(2):95-100.  https://doi.org/10.1136/sti.74.2.95  PMID: 9634339 
  30. Saini R, Saini S, Sharma S. Oral sex, oral health and orogenital infections. J Glob Infect Dis. 2010;2(1):57-62.  https://doi.org/10.4103/0974-777X.59252  PMID: 20300419 
  31. Cornelisse VJ, Lal L, Price B, Ryan KE, Bell C, Owen L, et al. Interest in switching to on-demand HIV pre-exposure prophylaxis (PrEP) among Australian users of daily PrEP: an online survey. Open Forum Infect Dis. 2019;6(7):ofz287.  https://doi.org/10.1093/ofid/ofz287  PMID: 31304192 
  32. Koppe U, Marcus U, Albrecht S, Jansen K, Gunsenheimer-Bartmeyer B, Bremer V. HIV pre-exposure prophylaxis (PrEP) use in Germany before and after cost-coverage by statutory health insurances. 18th European AIDS Conference, London, 2021, PE6/17
  33. Jansen K, Steffen G, Potthoff A, Schuppe AK, Beer D, Jessen H, et al. STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany. BMC Infect Dis. 2020;20(1):110.  https://doi.org/10.1186/s12879-020-4831-4  PMID: 32033533 
  34. Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J, et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA. 2019;321(14):1380-90.  https://doi.org/10.1001/jama.2019.2947  PMID: 30964528 
  35. Jenness SM, Weiss KM, Goodreau SM, Gift T, Chesson H, Hoover KW, et al. Incidence of gonorrhea and chlamydia following human immunodeficiency virus preexposure prophylaxis among men who have sex with men: A Modeling Study. Clin Infect Dis. 2017;65(5):712-8.  https://doi.org/10.1093/cid/cix439  PMID: 28505240 
  36. Kojima N, Klausner JD. Patients may accurately self-collect pharyngeal and rectal specimens for Neisseria gonorrhoeae and Chlamydia trachomatis infection: But is there benefit? Clin Infect Dis. 2021;73(9):e3181-2.  https://doi.org/10.1093/cid/ciaa1272  PMID: 32877526 
/content/10.2807/1560-7917.ES.2022.27.14.2100503
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error