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ImPrEP Study: Same-Day PrEP Initiation Results in Good Overall Continuation Among MSM, TGW

With 1329.6 person-years of PrEP use accumulated, early continuation was achieved by 79.8% of participants.

One strategy to increase pre-exposure prophylaxis (PrEP) uptake in areas where its implementation is limited is to promote same-day initiation. In Latin America, where the HIV epidemic persists, especially among men who have sex with men (MSM) and transgender women (TGW), health care resources are often scarce and new tactics to increase PrEP use are needed.

The ImPrEP study assessed the feasibility and safety of same-day initiation of daily oral tenofovir plus emtricitabine (TDF/FTC) among high-risk MSM and TGW in Brazil, Peru, and Mexico. Results were presented at the 10th IAS Conference on HIV Science (IAS 2019).

Between February 2018 and April 2019, investigators recruited, screened, and enrolled 4954 HIV-uninfected MSM and TGW ≥18 years old who exhibited a 1+ risk criteria (Brazil [3205], Peru [1010], and Mexico [739]). The median age of participants was 29 years (Interquartile range [IQR 24-36]), and MSM made up 94% (4648/4954) of the study population. TGW made up the remaining 6% (306/4954) of participants.

Participants underwent creatinine, hepatitis B, and sexually transmitted infection testing and were given same-day—as well a 30-day supply of—TDF/FTC.

Primary outcomes were PrEP early continuation defined as attendance to the first 2 follow-up visits within 120 days of initiation, in addition to adherence using pharmacy refill data defined as having at least 16 days of PrEP medication filled per 30-day period (medication possession ratio ≥0.53).

In total, ImPrEP accumulated 1329.6 person-years of PrEP use. Early continuation was achieved by 79.8% of participants, although the rate was significantly lower among TGW at 56% (Odds Ratio=0.29; Confidence Interval 95%: 0.21-0.40). PrEP adherence overall was 96.9%.

“Our study offers evidence that same-day PrEP initiation in Latin America is feasible and safe, with overall good levels of early continuation and adherence,” investigators concluded. “TGW and young MSM may require differentiated care to improve PrEP continuation.”

The study, “Safety, early continuation and adherence of same day PrEP initiation among MSM and TGW in Brazil, Mexico and Peru: the ImPrEP Study,” was presented Tuesday, July 23 2019, at IAS 2019 in Mexico City, Mexico.