PA_3 #08 HIV testing as the bridge between awareness and acceptance of PrEP among MSM Tsz Ho Kwan, BSc, MIET PhD Candidate in Public Health 1 June 2017
Content Background HIV epidemiology in Hong Kong MSM community PrEP Current situation of PrEP in Hong Kong Objective Methods Results Conclusions 2
Background 43% (3579/8410) of all HIV cases in Hong Kong were infected through homosexual/bisexual transmission (1984-2016) Men who have sex with men (MSM) accounted for 61% newly diagnosed cases in 2016 Chan KCW. Press conference on local HIV/AIDS situation in 2016. [Presentation] Centre for Health Protection. 28th February 2017. 3
Background Pre-exposure prophylaxis (PrEP) Daily pill containing two HIV drugs (TDF/FTC) To prevent HIV infection Efficacy in MSM: 86% [PROUD] / 99%[iPrEx] World Health Organization (WHO) recommendation (2016): Oral pre-exposure prophylaxis (PrEP) containing TDF should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches (strong recommendation, high-quality evidence) Anderson PL, et al. Emtricitabine-tenofovir exposure and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra125. McCormack S, 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. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach - Second edition. 4 Geneva: World Health Organization; 2016.
Background PrEP is currently unavailable in Hong Kong 1.12% (5/444) MSM had taken PrEP before [unpublished] 5
Background In order to facilitate PrEP promotion and implementation, understanding factors associated with awareness and acceptance is crucial 6
Objective To assess the role of different variables, particularly HIV testing, in affecting awareness and acceptance of PrEP among Hong Kong MSM 7
Methods An online self-administered survey was conducted for 2 months Variables were dichotomised and categorised into 5 groups Demographics Considerations when seeking partners Networking patterns Sexual behaviours PrEP-related factors 8
Methods PrEP-related factors Awareness Acceptance Assuming the degree of recognition, efficacy, price, and safety are identical, which PrEP regimen do you prefer the most? Daily Time-driven Event-driven Injectable Would not consider taking PrEP Service model 9
Methods φ coefficient was measured for each variable pair T-test was used to assess directional correlation Correlations with p<0.01 were regarded significant 10
Methods Network approach Node: Factor Edge: Significant correlation Variable A Variable B Variable C Variable E Variable F Variable D 11
Methods Factors with direct significant association with awareness or acceptance of PrEP were included in the network as a node Correlations between all these factors were also added to the network Variable A Variable B Variable C Acceptance of PrEP Awareness of PrEP Variable D 12
Methods Betweenness centrality of a node was assessed to identify important variables in the factor network The normalised number of all-pairs shortest paths passing through a node 1 4 3 2 5 13
Results A total of 444 MSM without known HIV infection were recruited Aug Sep 2016 113 variables established 804 significant links (13% of all possible links [aka density]) 14
Results Demographics Networking patterns Considerations when seeking partners Sexual behaviours PrEP-related factors Negative association Positive association Legend 15
Results Negative association Positive association 0.00 Betweenness centrality Legend 0.39 0.50 0.30 0.22 0.07 0.07 16
Conclusions Engagement in HIV testing plays an important role in one s acceptance of PrEP 17
Conclusions Sexual health-conscious MSM accepted PrEP, but their risk levels and the needs of PrEP are not known 18
Conclusions Effective dissemination of information relating to sexual health depends on the understanding of the pattern of MSM s networking channels There is a need to introduce PrEP through specific platforms to raise the community s awareness 19
Conclusions Integrating pre-prep screening (including, for example, risk assessment) and referral in community-based testing services could be an important strategy to achieve HIV prevention 20
Acknowledgements Funding agency Research Grants Council of Hong Kong (RGC Ref. No.: 14103315) Technical support Li Ka Shing Institute of Health Sciences 21
PA_3 #08 The end Thank you for your attention