Open AccessMotives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis – a qualitative analysis
Author(s) -
Zimmermann Hanne ML,
Eekman Sanne W,
Achterbergh Roel CA,
Schim van der Loeff Maarten F,
Prins Maria,
Vries Henry JC,
Hoornenborg Elske,
Davidovich Udi
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25389
Subject(s) - pre exposure prophylaxis , medicine , context (archaeology) , regimen , men who have sex with men , dosing , human immunodeficiency virus (hiv) , family medicine , paleontology , syphilis , biology
In settings where both daily and event‐driven pre‐exposure prophylaxis (Pr EP ) are offered to men who have sex with men ( MSM ), a clear understanding of the motives to choose between the different dosing‐regimens can facilitate more effective Pr EP implementation. We therefore studied the motives for choosing for, switching between, and stopping daily or event‐driven Pr EP . Methods We used data (August 2015‐June 2017) from the prospective, longitudinal, open‐label Amsterdam Pr EP demonstration study, in which daily ( dPrEP ) and event‐driven Pr EP (edPr EP ) were offered to 374 HIV ‐negative MSM and two transgender persons. Participants self‐selected the preferred Pr EP ‐regimen at baseline and could switch regimens at three‐monthly follow‐up visits. We measured motives for choosing Pr EP ‐regimen at baseline and for switching and stopping Pr EP at follow‐up visits. Open‐ and closed‐end items were combined and qualitatively analysed. Results Choices of Pr EP ‐regimens were determined by personal and contextual factors, involving the perceived self‐efficacy concerning adherence, the risk‐context, and the anticipated impact of Pr EP on physical and sexual wellbeing. dPrEP was preferred because of the anticipated better adherence and the fear of side‐effects relating to edPr EP re‐initiations. Moreover, dPrEP was perceived to be more effective than edPr EP . Motives to choose edPr EP were the expected physical burden of dPrEP , anticipated side‐effects of dPrEP , and fear to forget daily doses. Regarding the risk‐context: dPrEP was preferred for unplanned and/or frequent sex, while edPr EP was chosen when risk was predictable and/or less frequent. While some chose for dPrEP to gain more sexual freedom, others chose for edPr EP to minimize sexual risk episodes. Changes in the above factors, such as changing risk patterns, changing relationships or changing physical conditions, resulted in switching regimens. Choices to stop Pr EP were related to lower sexual risk, adherence issues and side‐effects. Conclusions The great diversity of motives illustrates the importance of offering a choice of Pr EP ‐regimens. In counselling of MSM starting Pr EP , choices for Pr EP ‐regimens may be addressed as a continuum of flexible and changeable options over time. This may help individuals choose the Pr EP ‐regimen that best fits their current sexual context, priorities and personal capabilities and therefore will be more easily adhered to.