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Human Immunodeficiency Virus Seroconversion Among Men Who Have Sex With Men Who Use Event-Driven or Daily Oral Pre-Exposure Prophylaxis (CohMSM-PrEP): A Multi-Country Demonstration Study From West Africa

2023; Oxford University Press; Volume: 77; Issue: 4 Linguagem: Inglês

10.1093/cid/ciad221

1537-6591

Christian Laurent, Issifou Yaya, Benjamin Cuer, Luis Sagaon‐Teyssier, Ephrem Mensah, Ter Tiero Elias Dah, Alou Coulibaly, Malan Jean-Baptiste Kouamé, Gilles Peytavin, Laetitia Serrano, August Eubanks, Issa Traoré, Fodié Diallo, Lucas Riegel, Daniela Rojas Castro, Claver Anoumou Dagnra, Camille Anoma, Béa Vuylsteke, Bintou Dembélé Keïta, Bruno Spire, Christian Laurent, Issifou Yaya, Sayouba Ouédraogo, Bruno Granouillac, Benjamin Cuer, Laetitia Serrano, Martine Peeters, Clotilde Couderc, Bruno Spire, Luis Sagaon‐Teyssier, Marion Mora, Gwenaëlle Maradan, Michel Bourrelly, Cyril Bérenger, Sylvie Boyer, Daniela Rojas Castro, Lucas Riegel, Paméla Palvadeau, Béa Vuylsteke, Irith De Baetselier, Thijs Reyniers, Bintou Dembélé Keïta, Fodié Diallo, Alou Coulibaly, A Maïga, Drissa Camara, M. Diarra, Aly Ouologuem, Naboh Sangaré, Abdoul Aziz Keita, Oumar Cissé, Fodé Amara Traore, Bréhima Abdrahamane Ouary, Ibrahima Kanta, Bakary Coulibaly, Camille Anoma, Malan Jean-Baptiste Kouamé, Rachelle Kotchi, Niamkey Thomas Aka, Kpassou Julien Lokrou, Noufo Hamed Coulibaly, Ekessi Jean Armel Koffi, Dibi Frédéric N’guessan, Stéphane‐Alain Babo Yoro, Adama Cissé, Ter Tiero Elias Dah, Issa Traoré, Camille Rajaonarivelo, Fayçal Rodrique Ouedraogo, Joseph Ouedraogo, Christian Coulibaly, Mamadou Ouedraogo, Ousseni Ilboudo, Abdoulazziz Traoré, Honoré Comsiambo, Ephrem Mensah, 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, Kokou Dominique Tegueni,

HIV Research and Treatment

Abstract Background Data on human immunodeficiency virus (HIV) seroconversion among men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP) in West Africa are needed. This study aimed to document HIV seroconversion and associated determinants, PrEP adherence, plasma drug concentrations, and HIV drug resistance in MSM using event-driven or daily PrEP in Burkina Faso, Côte d’Ivoire, Mali, and Togo. Methods A prospective cohort study was conducted in 2017–2021 among HIV-seronegative MSM aged 18 or over who were at high risk of HIV infection. Participants could choose between event-driven and daily PrEP, switch regimens, and discontinue or restart PrEP. The determinants of HIV incidence were investigated using a multivariate mixed-effects Poisson regression analysis. Results A total of 647 participants were followed for a total time of 1229.3 person-years. Of 5371 visits, event-driven PrEP was chosen in 3873 (72.1%), and daily PrEP in 1400 (26.1%). HIV incidence was 2.4 per 100 person-years (95% confidence interval [CI] 1.5–3.6) for event-driven PrEP, and 0.6 per 100 person-years (95% CI .1–2.3) for daily PrEP (adjusted incidence rate ratio 4.40, 95% CI 1.00–19.36, P = .050). Adequate adherence was lower with event-driven than daily PrEP (44.3% vs 74.9%, P < .001). Plasma drug concentrations were undetectable in 92 (97.9%) of the 94 measures taken for 23 participants who seroconverted. Only 1 participant had resistance to PrEP drugs. Conclusions HIV seroconversions mainly occurred in participants who chose event-driven PrEP. The study's data highlighted major difficulties with adherence to this regimen. Improving adherence to event-driven PrEP constitutes a major research and public health priority in this context.