Archives of Sexual Behavior ( IF 2.9 ) Pub Date : 2024-05-22 , DOI: 10.1007/s10508-024-02862-0 Clément Le Roux 1, 2, 3 , Marc-Florent Tassi 1, 4, 5 , Cathie Faussat 2, 3, 5 , Catherine Aumond 6, 7 , Guillaume Gras 3, 7, 8 , Karl Stefic 5, 9 , Leslie Grammatico-Guillon 1, 2, 5
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Objective
HIV Pre-Exposure Prophylaxis (PrEP) has been used in France since 2016. Its effectiveness is no longer to be demonstrated. However, follow-up and adherence remain the main pitfalls. The main objective of this study was to identify factors associated with persistence or loss of PrEP follow-up.
Design
An historic cohort of PrEP users was compiled from the database of consultations in the Indre-et-Loire dedicated sexual health centers (CeGIDD) from June 2016 to June 2021.
Methods
Kaplan–Meier curves were performed to compare the group of persistent PrEP users to the discontinuation group. Factors associated with PrEP discontinuation were identified using Cox modelling, considering time-dependent variables. Final variables included in the model were selected based on the Akaike Information Criterion (AIC) and clinical relevance.
Results
Over the period, 568 PrEP users were included in the cohort. Median follow-up was 2.3 years. A quarter of users were lost to follow-up within 3 months after PrEP initiation. Sexual risk reduction AIDS community-based support (HR = 0.65[0.42;0.99]), being in a couple (HR = 0.51[0.38;0.68]), and history of syphilis (HR = 0.57[0.40;0.81]) were significantly associated with persistence of follow-up. Remote consultations (HR = 2.74[1.63;4.61]), chemsex practices (HR = 2.01[1.29;3.14]), and side effects (HR=1.72[1.03;2.88]) were significantly associated with a loss of follow-up.
Conclusion
These results suggest that more sexual risk reduction AIDS community-based counseling could be a key, necessary for supporting PrEP users in their follow-up pathway. Indeed, AIDS community-based support could be used to build a basis for developing safe pathways. Remote consultations could represent a response to the issue of access to PrEP. To create a significant impact on global HIV incidence, the PrEP offer must be extended, and at-risk PrEP users supported to maintain PrEP use.
中文翻译：
与 PrEP 持续性和失访相关的因素：5 年历史队列
客观的
法国自 2016 年起开始使用 HIV 暴露前预防 (PrEP)。其有效性尚未得到证实。然而，后续行动和依从性仍然是主要的缺陷。本研究的主要目的是确定与 PrEP 随访持续或失败相关的因素。
设计
PrEP 用户的历史队列是根据 2016 年 6 月至 2021 年 6 月安德尔-卢瓦尔省专门性健康中心 (CeGIDD) 的咨询数据库编制的。
方法
采用 Kaplan-Meier 曲线来比较持续 PrEP 使用者组与停药组。使用 Cox 模型并考虑时间相关变量来确定与 PrEP 终止相关的因素。模型中包含的最终变量是根据 Akaike 信息标准 (AIC) 和临床相关性选择的。
结果
在此期间，该队列中包括了 568 名 PrEP 用户。中位随访时间为 2.3 年。四分之一的用户在 PrEP 启动后 3 个月内失访。降低性风险的艾滋病社区支持 (HR = 0.65[0.42;0.99])、夫妻关系 (HR = 0.51[0.38;0.68]) 和梅毒病史 (HR = 0.57[0.40;0.81]) 显着与坚持不懈的随访有关。远程会诊（HR = 2.74[1.63;4.61]）、chemsex 做法（HR = 2.01[1.29;3.14]）和副作用（HR=1.72[1.03;2.88]）与失访显着相关。
结论
这些结果表明，更多的性风险降低艾滋病社区咨询可能是关键，对于支持 PrEP 用户的后续途径是必要的。事实上，基于艾滋病社区的支持可以用来为制定安全途径奠定基础。远程咨询可以作为对 PrEP 获取问题的回应。为了对全球艾滋病毒发病率产生重大影响，必须扩大 PrEP 的范围，并支持高危 PrEP 用户维持 PrEP 的使用。
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