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Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa

2022; BioMed Central; Volume: 22; Issue: 1 Linguagem: Inglês

10.1186/s12889-022-14211-8

1471-2458

August Eubanks, Bakary Coulibaly, Bintou Dembélé Keïta, Camille Anoma, Ter Tiero Elias Dah, Ephrem Mensah, Sékou Kaba, Kpassou Julien Lokrou, Faïçal Rodrigue Ouedraogo, Aléda Mawuli Badjassim, Gwenaëlle Maradan, Michel Bourrelly, Marion Mora, Lucas Riegel, Daniela Rojas Castro, Issifou Yaya, Bruno Spire, Christian Laurent, Luis Sagaon‐Teyssier, Sayouba Ouédraogo, Bruno Granouillac, Laetitia Serrano, Martine Peeters, Cyril Bérenger, Marion Fiorentino, Paméla Palvadeau, Béa Vuylsteke, Irith De Baetselier, Thijs Reyniers, Tania Crucitti, Fodié Diallo, Alou Coulibaly, Kader Maïga, Drissa Camara, M. Diarra, Aly Ouologuem, Abdoul Aziz Keita, Fodé Amara Traore, Oumar Cissé, Bréhima Abdrahamane Ouary, Ibrahima Kanta, Malan Jean-Baptiste Kouamé, Rachelle Kotchi, Niamkey Thomas Aka, Noufo Hamed Coulibaly, Jean Armel Ekessi Koffi, Frédéric Dibi N’guessan, Stéphane‐Alain Babo Yoro, Adama Cissé, Issa Traoré, Camille Rajaonarivelo, Joseph Ouedraogo, Juste Rodrigue Touré, Christian Coulibaly, Mamadou Ouedraogo, Elisabeth Thio, Ousseni Ilboudo, Abdoulazziz Traoré, Honoré Comsiambo, Mawuényégan Kouamivi Agboyibor, Anani Attisso, Anouwarsadat Kokouba, Aléda Mawuli Badjassim, Kouakou Kokouvi Selom Agbomadji, Messan Attiogbe, Kossi Jeff Yaka, Agbégnigan Lorette Ekon, Julien Bimba, Claver Anoumou Dagnra,

Adolescent Sexual and Reproductive Health

Multiple barriers compromise pre-exposure prophylaxis (PrEP) engagement (i.e., use and adherence) in men who have sex with men (MSM). In low/middle-income countries, little is known about PrEP engagement in this population. In West Africa, the CohMSM-PrEP study was one of the rare interventions providing PrEP to MSM. We estimated PrEP use and correct adherence rates in CohMSM-PrEP, together with associated factors over time. METHODS: CohMSM-PrEP recruited MSM in four community-based clinics in Mali, Côte d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included collecting socio-behavioral data, and providing a comprehensive HIV prevention package, PrEP (daily or event-driven), and peer educator (PE)-led counselling. Using repeated measures, multivariate generalized estimating equations models were used to identify factors associated with self-reported i) PrEP use and ii) correct PrEP adherence during participants' most recent anal intercourse (defined as four pills/week for daily users and 2 + 1 + 1 for event-driven users).Five hundred twenty participants were included with a median follow-up time of 12 months (IQR 6-21). Of the 2839 intercourses declared over the follow-up period, PrEP use was self-reported for 1996 (70%), and correct PrEP adherence for 1461 (73%) of the latter. PrEP use was higher in participants who also attended participating clinics outside of scheduled visits (adjusted odds ratio (aOR) [95% Confidence Interval, CI], p-value; 1.32[1.01-1.71], 0.040), and in those who practiced condomless anal sex (1.86[1.54-2.24], < 0.001). Correct adherence was higher in those who often contacted PE outside of scheduled visits (2.16[1.01-4.64], 0.047) and in participants who adopted receptive/versatile sexual positions with stable partners (1.36[1.03-1.81], 0.030). Instead, after an interaction effect between financial situation and regimen was tested, it was lower in event-driven users with a difficult/very difficult financial situation (comfortable/just making ends meet & daily, 4.19[2.56-6.86], < 0.001; difficult/very difficult & daily, 6.47[4.05-10.30], < 0.001; comfortable/just making ends meet & event-driven, 1.63[1.22-2.17], 0.001), and in participants who felt alone (0.76[0.58-0.99], 0.042).Community-based clinic attendance and PE contact outside of scheduled visits were both associated with higher PrEP engagement, but some socially and economically marginalized participants struggled with adherence. As scale-up continues in West Africa, we recommend implementing community-based interventions and providing extra support for vulnerable users to ensure adequate PrEP engagement.