Frontiers in Medicine (Apr 2022)

Medication Non-adherence and Condomless Anal Intercourse Increased Substantially During the COVID-19 Pandemic Among MSM PrEP Users: A Retrospective Cohort Study in Four Chinese Metropolises

  • Yangyang Gao,
  • Yangyang Gao,
  • Yangyang Gao,
  • Yangyang Gao,
  • Qinghai Hu,
  • Qinghai Hu,
  • Qinghai Hu,
  • Qinghai Hu,
  • Sequoia I. Leuba,
  • Le Jia,
  • Le Jia,
  • Le Jia,
  • Le Jia,
  • Hongyi Wang,
  • Hongyi Wang,
  • Hongyi Wang,
  • Hongyi Wang,
  • Xiaojie Huang,
  • Yaokai Chen,
  • Hui Wang,
  • Jing Zhang,
  • Jing Zhang,
  • Jing Zhang,
  • Jing Zhang,
  • Zhenxing Chu,
  • Zhenxing Chu,
  • Zhenxing Chu,
  • Zhenxing Chu,
  • Lukun Zhang,
  • Zixin Wang,
  • Hong Shang,
  • Hong Shang,
  • Hong Shang,
  • Hong Shang,
  • Junjie Xu,
  • Junjie Xu,
  • Junjie Xu,
  • Junjie Xu,
  • CROPrEP Study Team,
  • Xiaoqing He,
  • Yao Li,
  • Fang Zhao,
  • Yijun Duan,
  • Rui Li,
  • Shangcao Li,
  • Hang Li,
  • Zhili Hu,
  • Rantong Bao,
  • Sitong Cui,
  • Zhaozhen Liu,
  • Zehao Ye,
  • Xiaoyun Shi

DOI
https://doi.org/10.3389/fmed.2022.738541
Journal volume & issue
Vol. 9

Abstract

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BackgroundThe coronavirus disease (COVID-19) pandemic has impacted HIV prevention strategies globally. However, changes in pre-exposure prophylaxis (PrEP) adherence and HIV-related behaviors, and their associations with medication adherence among men who have sex with men (MSM) PrEP users remain unclear since the onset of the COVID-19 pandemic.MethodsA Retrospective Cohort Study of HIV-negative MSM PrEP users was conducted in four Chinese metropolises from December 2018 to March 2020, assessing the changes in PrEP adherence and HIV-related behaviors before and during the COVID-19. The primary outcome was poor PrEP adherence determined from self-reported missing at least one PrEP dose in the previous month. We used multivariable logistic regression to determine factors correlated with poor adherence during COVID-19.ResultsWe enrolled 791 eligible participants (418 [52.8%] in daily PrEP and 373 [47.2%] in event-driven PrEP). Compared with the data conducted before the COVID-19, the proportion of PrEP users decreased from 97.9 to 64.3%, and the proportion of poor PrEP adherence increased from 23.6 to 50.1% during the COVID-19 [odds ratio (OR) 3.24, 95% confidence interval (CI) 2.62–4.02]. While the percentage of condomless anal intercourse (CAI) with regular partners (11.8 vs. 25.7%) and with casual partners (4.4 vs. 9.0%) both significantly increased. The proportion of those who were tested for HIV decreased from 50.1 to 25.9%. Factors correlated with poor PrEP adherence during the COVID-19 included not being tested for HIV (adjusted odds ratio [aOR] = 1.38 [95% CI: 1.00, 1.91]), using condoms consistently with regular partners (vs. never, aOR = 2.19 [95% CI: 1.16, 4.13]), and being married or cohabitating with a woman (vs. not married, aOR = 3.08 [95% CI: 1.60, 5.95]).ConclusionsIncreased poor PrEP adherence and CAI along with the decrease in HIV testing can lead to an increase in HIV acquisition and drug resistance to PrEP. Targeted interventions are needed to improve PrEP adherence and HIV prevention strategies.

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