Patterns of HIV pre-exposure prophylaxis use and sexual risk behaviours amongst men who have sex with men attending sexual health clinics in Wales

Problem

HIV pre-exposure prophylaxis (PrEP) has been available through the NHS in Wales since July 2017. In the UK, detailed longitudinal data are lacking on medication use and sexual behaviour within the same individual. Without these, it is difficult to gain an accurate understanding of whether PrEP is being used to its fullest potential, and this could have an impact on HIV-prevention policies and interventions to support the use of PrEP. We aimed to determine the patterns of PrEP use and sexual risk behaviours amongst men who have sex with men (MSM) attending sexual health clinics in Wales.

Approach

We conducted an ecological momentary assessment study of individuals in receipt of PrEP across four health boards offering PrEP in Wales. Participants were provided with an electronic medication cap which recorded the date and time of each cap opening and completed brief weekly sexual behaviour surveys capturing daily data on condomless sex. At four time points, data were collected capturing health beliefs and behaviours around PrEP use, symptoms/side effects, STI diagnoses/treatments, and health service resource use.

Findings

Sixty participants were recruited between September 2019 and January 2020. Last follow-up was December 2020. Data on PrEP use covered 13,322 days and sexual behaviour 12,913 days (85% and 82% of potential study days respectively). Analysis is ongoing. We will describe trends in PrEP use and sexual behaviour over time, as well as examine the treatment, individual, and social factors that are associated with PrEP use and sexual risk behaviour over time. Whether these factors operate differently pre- and intra-pandemic will also be examined.

Consequences

Our findings will provide an understanding of the ways in which PrEP is used in Wales and inform the development of an intervention to support PrEP users in optimising its use.