Socio-behavioral correlates of PrEP uptake and correct PrEP adherence in men who have sex with men in West Africa (CohMSM-PrEP ' ANRS12369 ' Expertise France)

Title

Socio-behavioral correlates of PrEP uptake and correct PrEP adherence in men who have sex with men in West Africa (CohMSM-PrEP ' ANRS12369 ' Expertise France)

Presenter

August Eubanks

Authors

A. Eubanks * (1), B. Coulibaly (2), B. Dembélé Keita (2), C. Anoma (3), T.T. Dah (4,5), E. Mensah (6), M. Diarra (2), K.J. Lokrou (3), J. Ouedraogo (4), A.M.F. Badjassim (6), G. Maradan (1,7), M. Bourrelly (1,8), M. Mora (1), L. Riegel (8), D. Rojas Castro (1,8), I. Yaya (9), B. Spire (1), C. Laurent (9), L. Sagaon-Teyssier (1,2), the CohMSM-PrEP Study Group

Institutions

(1) Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, (2) ARCAD Santé PLUS, Bamako, Mali, (3) Espace Confiance, Abidjan, Cote D''Ivoire, (4) Association African Solidarité, Ouagadougou, Burkina Faso, (5) Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso, (6) Espoir Vie Togo, Lomé, Togo, (7) ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France, (8) Coalition Plus, Community-Based Research Laboratory, Pantin, France, (9) TransVIHMI, Univ Montpellier, IRD, INSERM, Montpellier, France

BACKGROUND: For men who have sex with men (MSM), multiple barriers compromise pre-exposure prophylaxis (PrEP) engagement. However, in low and middle-income countries little is known about PrEP engagement for MSM. In West Africa, the CohMSM-PrEP demonstration project was one of the rare interventions providing PrEP to MSM. We investigated the rate and factors associated with PrEP uptake and correct adherence in CohMSM-PrEP.
METHODS: CohMSM-PrEP recruited MSM in four community-based clinics in Mali, Côte d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included a prevention package, PrEP (daily or event-driven), peer-led counselling (prevention and adherence) and psychosocial support, as well as socio-behavioral data collection. Multivariate generalized estimating equations (GEE) models were used to identify the factors associated with 1) PrEP uptake during most recent anal intercourse and 2) correct self-reported PrEP adherence.
RESULTS: 520 participants were retained for analysis and had a median follow-up time of 12 months (IQR 6-21). They declared 2838 sexual intercourses, of which 1995 (70%) were protected by PrEP. Among PrEP-protected intercourses, correct adherence accounted for 1461 (73%) of sexual intercourses. The multivariate analyses for both outcomes are in Table 1. Those who found PrEP use to be difficult had less uptake, while those with increased clinic attendance had more uptake. After uptake, incorrect adherence was more likely for socioeconomically vulnerable event-driven users, highly stigmatized heterosexual-identifying participants, and those who felt alone. Both outcomes were associated with behavioral characteristics.

CONCLUSIONS: In the region's hostile sociocultural context, socially and economically marginalized participants struggled to use PrEP sufficiently. Support for PrEP use is an essential part of PrEP delivery. As scale-up continues in West Africa, we recommend using MSM-friendly clinics and providing extra support for vulnerable PrEP users to ensure adequate PrEP engagement.

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