Acceptability of an incentivised PrEP programme for men who have sex with men at high risk of HIV infection in Hong Kong: an implementation study. (October 2018)

• Record Type: Journal Article
• Authors: Kwan, Tsz Ho; Wong, Ngai Sze; Lui, Grace Chung Yan; Lee, Krystal Chi Kei; Lee, Shui Shan
• Is Part Of: Lancet. Volume 392(2018)Supplement 1
• Page Start: S77
• Publication Date: 2018-10
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(18)32706-5
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: In Hong Kong, pre-exposure prophylaxis (PrEP) was first launched as a pilot study for men who have sex with men (MSM) at high risk of HIV infection. However, the community's acceptance of such programme might affect policy making in its implementation as a service. Therefore, we aimed to examine the feasibility of an incentivised mode of PrEP delivery in the MSM community. Methods: We did a implementation study of daily co-formulated tenofovir disoproxil fumarate 300 mg plus emtricitabine 200 mg (TDF/FTC). We prescribed oral tablets of TDF/FTC to PrEP-naive, HIV-negative, high-risk MSM for 30 weeks through a pilot clinic in Hong Kong. We assessed MSM that self-referred or were referred by collaborating community organisations or HIV services using a survey about their eligibility and, if applicable, reasons for not joining the study. The key inclusion criteria were recent history of condomless anal sex and HIV negative on testing, whereas HBsAg-positive patients and those with impaired renal functions were excluded. The primary measures were acceptance rate and associated socio-behavioural factors. Consenting MSM were required to pay a fixed price at each visit but the follow-up interval was increased over time, such that the unit cost of TDF/FTC became lower for participants who remained on the programme. The actual cost of TDF/FTC was equivalent to HK$25 (US$3·20) per tablet or 13% of the market price upon completion. The study was approved by the Joint Chinese University of Hong Kong–New Territories East Cluster Clinical Research Ethics Committee. This study is registered with the Centre for Clinical Research and Biostatistics Clinical Trials Registry, number CUHK_CCRB00533, and the Chinese Clinical Trial Registry, number ChiCTR-OPC-16009603. Findings: Between Sep 21, 2017, and May 23, 2018, 292 MSM were assessed. Among 247 MSM who showed interest in the study, 196 (79%) had engaged in high-risk behaviours in the preceding 6 months. Among 229 high risk MSM, 196 (86%) indicated willingness to join the study, of which 71 ultimately enrolled. 49 (98%) of 50 MSM who used drugs during sex were interested in joining the programme (p=0·004). There were no significant associations between risky behaviours, such as the practice of condomless sex, and PrEP acceptance. The most common reason for not being interested in the study was the drug cost (24 [53%] of 45), concern about side-effects (13 [29%]), low perceived risk (ten [22%]), and feeling troublesome about taking daily medications (nine [20%]). Interpretation: An incentivised mode of PrEP delivery was moderately well accepted by high risk MSM in Hong Kong. The gap between awareness and their access to PrEP would need to be addressed in the future if programme expansion is considered, since price can be a major deterrent for some eligible people despite the lowered price. Community education on PrEP together with pre-PrEP counselling is crucial for successful implementation. Funding: AIDS Trust Fund (MSS 264 R), Hong Kong.