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  • 1
    Online Resource
    Online Resource
    Can We Predict Incorrect PrEP Use in High HIV Risk Situations Among Men Who Have Sex With Men? An Analysis of Be-PrEP-ared, the Belgian PrEP Demonstration Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 88, No. 1 ( 2021-09-1), p. 36-44
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 1 ( 2021-09-1), p. 36-44
    Abstract: Pre-exposure prophylaxis (PrEP) efficacy for HIV prevention is highly correlated with the degree of adherence. The objective of this analysis was to identify PrEP users who did not correctly take their dose in high HIV exposure situations and to explore potential predictors of this behavior. Methods: Study participants completed a personal Web‐based diary during their entire follow-up, providing daily information on pill intake and sexual activity. They also completed a sociobehavioral questionnaire. The association between the number of unprotected high HIV exposure sex days (as a measure for suboptimal adherence) and potential predicting factors was examined using a logistic regression, followed by a negative binomial regression model. We also constructed a risk index score for predicting poor adherence. Results: A total of 40.8% of participants did not correctly use PrEP in at least one situation of high HIV exposure during follow-up. Not having a HIV-negative steady partner, reporting more than 10 occasional or more than 10 anonymous partners, using chemsex drugs, receiving money for sex, and a history of more than one sexually transmitted infection were significantly associated with unprotected high HIV exposure sex. The risk index score yielded a poor discriminative power (area under the curve 0.62 and 0.64). Conclusions: We observed a high proportion of suboptimal adherence. Even if none of the participants acquired HIV during the study, tailored adherence support is needed to specific men who have sex with men such as those taking chemsex drugs and those engaging in paid sex.
    Type of Medium: Online Resource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000002741
    RVK:
    XA 10000
    RVK:
    XA 51942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2038673-4
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  • 2
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    Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey
    BMJ ; 2021
    In:  Sexually Transmitted Infections Vol. 97, No. 6 ( 2021-09), p. 414-419
    Details
    In: Sexually Transmitted Infections, BMJ, Vol. 97, No. 6 ( 2021-09), p. 414-419
    Abstract: To examine changes in the occurrence of physical sex with non-steady partners among men who have sex with men (MSM) in Belgium during the first weeks of the COVID-19 lockdown and associations with sociodemographic factors, sexual practices, drug, alcohol and pre-exposure prophylaxis (PrEP) use. A secondary objective was to explore changes in PrEP use and the need for PrEP follow-up. Methods A cross-sectional online survey. The questionnaire was available in Dutch, French and English, between April 10 and 27 (2020), and disseminated via sexual health and lesbian, gay, bisexual, trans, queer or intersex organisations throughout Belgium. Eligibility criteria included being 18 years or older, not being exclusively heterosexual and living or being born in Belgium. Results The sample included 694 MSM. Physical sex with non-steady partners decreased from 59.1% to 8.9% during the first weeks of the lockdown. Those who had sex with non-steady partners were significantly more likely to be HIV positive, to use PrEP or to have engaged in sexual practices such as group sex, chemsex and sex work before the lockdown, compared with their counterparts. Among those who used PrEP before the lockdown, 47.0% stopped using PrEP, 19.7% used event-driven PrEP and 33.3% used daily PrEP during the lockdown. Almost two-thirds of PrEP users had a PrEP care appointment in the weeks before the lockdown and a minority received follow-up elsewhere or online. Some PrEP users had concerns regarding their follow-up. Conclusions MSM in our survey substantially reduced sexual contact with non-steady partners during the first weeks of the COVID-19 lockdown, suggesting that the risk for HIV and STI transmission in this period was low. We recommend ensuring access to sexual health services, such as HIV testing and follow-up for PrEP for the small group having multiple sex partners and engaging in sexual practices such as chemsex, or group sex, even in times of a pandemic threat.
    Type of Medium: Online Resource
    ISSN: 1368-4973 , 1472-3263
    URL: Article
    DOI: 10.1136/sextrans-2020-054756
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2027968-1
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  • 3
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    The Impact of PrEP on the Sex Lives of MSM at High Risk for HIV Infection: Results of a Belgian Cohort
    Springer Science and Business Media LLC ; 2021
    In:  AIDS and Behavior Vol. 25, No. 2 ( 2021-02), p. 532-541
    Details
    In: AIDS and Behavior, Springer Science and Business Media LLC, Vol. 25, No. 2 ( 2021-02), p. 532-541
    Type of Medium: Online Resource
    ISSN: 1090-7165 , 1573-3254
    URL: Article
    DOI: 10.1007/s10461-020-03010-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2014832-X
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  • 4
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    Awareness of, Willingness to Take PrEP and Its Actual Use Among Belgian MSM at High Risk of HIV Infection: Secondary Analysis of the Belgian European MSM Internet Survey
    Springer Science and Business Media LLC ; 2022
    In:  AIDS and Behavior Vol. 26, No. 6 ( 2022-06), p. 1793-1807
    Details
    In: AIDS and Behavior, Springer Science and Business Media LLC, Vol. 26, No. 6 ( 2022-06), p. 1793-1807
    Type of Medium: Online Resource
    ISSN: 1090-7165 , 1573-3254
    URL: Article
    DOI: 10.1007/s10461-021-03526-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2014832-X
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  • 5
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    Recurrent Sexually Transmitted Infections Among a Cohort of Men Who Have Sex With Men Using Preexposure Prophylaxis in Belgium Are Highly Associated With Sexualized Drug Use
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Sexually Transmitted Diseases Vol. 48, No. 10 ( 2021-10), p. 726-732
    Details
    In: Sexually Transmitted Diseases, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 10 ( 2021-10), p. 726-732
    Abstract: Men who have sex with men (MSM) experiencing recurrent sexually transmitted infections (STIs) may play a crucial role in the STI epidemic. However, there is limited understanding of what kind of behavior leads to recurrent STIs. Methods A total of 179 MSM using preexposure prophylaxis were followed up for 18 months and were screened quarterly for chlamydia, gonorrhea, and syphilis from 2015 to 2018 in Belgium. Participants were stratified into 3 different groups (no STI, one STI episode, recurrent STI episodes during the study). Sociodemographic and sexual behavioral characteristics were compared between the 3 groups, and significant associations with recurrent STI were explored using multivariate logistic regression models. Results A total of 62.0% (n = 111/179) of participants experienced at least one STI during the study, and more than 1 in 3 became reinfected with an STI at another visit (n = 66/179 [36.9%]). Participants experiencing recurrent STIs reported the highest frequency of sexualized drug use (86.4%) compared with participants experiencing one (60.0%) or no STI (47.1%). Therefore, sexualized drug use was highly associated with recurrent STIs (adjusted odds ratio [aOR] . 4.35). Other factors associated with recurrent STIs were being younger than 40 years (aOR, 3.29), had a high number ( 〉 4) of nonsteady partners with whom receptive (aOR, 1.17) or insertive (aOR, 1.12) condomless anal intercourse occurred in the last 3 months. Conclusions Sexualized drug use was the greatest risk factor for having recurrent STIs. Tailoring prevention and care, including specialized services tackling problematic drug use in a sexual context, may help to curb the STI epidemic among MSM.
    Type of Medium: Online Resource
    ISSN: 1537-4521 , 0148-5717
    URL: Article
    DOI: 10.1097/OLQ.0000000000001424
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2055170-8
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  • 6
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    Trajectories of PrEP use among men who have sex with men: a pooled analysis of two prospective, observational cohort studies
    Wiley ; 2023
    In:  Journal of the International AIDS Society Vol. 26, No. 7 ( 2023-07)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 26, No. 7 ( 2023-07)
    Abstract: Daily and event‐driven oral pre‐exposure prophylaxis (PrEP) reduce the risk of HIV acquisition. PrEP use can vary over time, yet little is known about the trajectories of PrEP use irrespective of the chosen PrEP regimens among men who have sex with men (MSM). Methods Using data from a mobile, web‐based diary application collected daily from 17 August 2015 until 6 May 2018, we analysed PrEP use and sexual behaviour in two large cohorts, AMPrEP (Amsterdam, the Netherlands) and Be‐PrEP‐ared (Antwerp, Belgium). In both cohorts, participants could choose between daily and event‐driven oral PrEP every 3 months. We used group‐based trajectory modelling to identify trajectories of PrEP use over time and their determinants. In addition, we estimated the incidence rate of chlamydia, gonorrhoea and syphilis within these trajectories. Results We included 516 MSM ( n = 322 AMPrEP; n = 194 Be‐PrEP‐ared), of whom 24% chose event‐driven PrEP at PrEP initiation. Participants contributed 225,015 days of follow‐up (median = 508 days [IQR = 429−511]). Four distinct PrEP use trajectories were identified: ≤2 tablets per week (“low frequency,” 12% of the total population), 4 tablets per week (“variable,” 17%), “almost daily” (31%) and “always daily” (41%). Compared to participants with “low frequency” PrEP use, participants with “variable” (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.04−4.60) and “almost daily” PrEP use were more often AMPrEP participants (OR = 2.64, 95% CI = 1.27−5.49). “Almost daily” PrEP users were more often employed (OR = 6.76, 95% CI = 2.10−21.75) and were younger compared to participants with “low frequency” PrEP use. In addition, the number of days on which anal sex occurred was lower among participants with “low frequency” PrEP use compared to the other groups (all p 〈 0.001). Compared to “low frequency” PrEP users, the incidence rates of chlamydia and gonorrhoea were higher for participants with “almost daily” and “always daily” PrEP use. Conclusions We uncovered four distinct PrEP use trajectories, pointing to different patterns of PrEP use in practice beyond the two‐regimen dichotomy. These trajectories were related to sexual behaviour and rates of sexually transmitted infection. Tailoring PrEP care according to different PrEP use patterns could be an important strategy to improve efficient PrEP delivery.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v26.7
    DOI: 10.1002/jia2.26133
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2467110-1
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  • 7
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    Choosing event‐driven and daily HIV pre‐exposure prophylaxis – data from two European PrEP demonstration projects among men who have sex with men
    Wiley ; 2021
    In:  Journal of the International AIDS Society Vol. 24, No. 8 ( 2021-08)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 24, No. 8 ( 2021-08)
    Abstract: Daily and event‐driven PrEP are both efficacious in reducing the risk for HIV infection. However, the practice of event‐driven PrEP (edPrEP) is less well studied, in particular when provided as an alternative to daily PrEP. We studied regimen preferences and switches, and sexually transmitted infection (STI) incidence. Methods We analysed pooled data from two prospective cohort studies among MSM: Be‐PrEP‐ared, Belgium and AMPrEP, the Netherlands. In both projects, participants could choose between daily and edPrEP at three‐monthly study visits, when they were also screened for sexually transmitted infections including hepatitis C (HCV). We assessed the proportion choosing each regimen, and the determinants of choosing edPrEP at baseline. Additionally, we compared the incidence rates (IRs) of HCV, syphilis and chlamydia or gonorrhoea between regimens using Poisson regression. The study period was from 3 August 2015 until 24 September 2018. Results and discussion We included 571 MSM, of whom 148 (25.9%) chose edPrEP at baseline. 31.7% of participants switched regimen at least once. After 28 months, 23.5% used edPrEP. Older participants (adjusted odds ratio (aOR) = 1.38 per 10 years, 95% confidence interval (CI) = 1.15 to 1.64) and those unemployed (aOR = 1.68, 95% CI = 1.03 to 1.75) were more likely to initially choose edPrEP. IR of HCV and syphilis did not differ between regimens, but the IR of chlamydia/gonorrhoea was higher among daily users (adjusted incidence rate ratio = 1.61, 95% CI = 1.35 to 1.94). Conclusions A quarter of participants chose edPrEP at baseline and at 28 months this proportion was similar. Although the IR of HCV and syphilis were similar in the two regimens, the lower incidence of chlamydia and gonorrhoea among edPrEP users may suggest that less frequent STI testing of this group could be considered.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v24.8
    DOI: 10.1002/jia2.25768
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2467110-1
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  • 8
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    The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review
    Springer Science and Business Media LLC ; 2020
    In:  BMC Health Services Research Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: Strengthening HIV prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential game changer because of its high clinical efficacy and the feasibility of its provision to different key populations. Documenting the existing experience with PrEP service delivery in a variety of real-world settings will inform how its uptake and usage can be maximised. Methods We conducted a scoping review using the five-step framework provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing the implementation of real-world PrEP service delivery models reporting on four key components: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set. Results This review included 33 articles for charting and analysing of the results. The identified service delivery models showed that PrEP services mainly targeted people at high risk of HIV acquisition, with some models targeting specific key populations, mainly men who have sex with men. PrEP was often delivered centralised and in a clinical or hospital setting. Yet also community-based as well as home-based PrEP delivery models were reported. Providers of PrEP were mainly clinically trained health professionals, but in some rare cases community workers and lay providers also delivered PrEP. In general, in-person visits were used to deliver PrEP. More innovative digital options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied in a minority of the service delivery models in mainly high-resource settings. Conclusions A range of possible combinations was found between all four components of PrEP service delivery models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could be expanded and optimised to respond to key populations with unmet HIV prevention needs in different settings.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-020-05568-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2050434-2
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  • 9
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    Drug use, depression and sexual risk behaviour: a syndemic among early pre-exposure prophylaxis (PrEP) adopters in Belgium?
    Informa UK Limited ; 2020
    In:  AIDS Care Vol. 32, No. sup2 ( 2020-05-13), p. 57-64
    Details
    In: AIDS Care, Informa UK Limited, Vol. 32, No. sup2 ( 2020-05-13), p. 57-64
    Type of Medium: Online Resource
    ISSN: 0954-0121 , 1360-0451
    URL: Article
    DOI: 10.1080/09540121.2020.1739218
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2003080-0
    SSG: 5,2
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  • 10
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    Table_4.DOCX
    Frontiers Media SA ; 2022
    In:  Frontiers in Medicine Vol. 9 ( 2022-3-30)
    Details
    In: Frontiers in Medicine, Frontiers Media SA, Vol. 9 ( 2022-3-30)
    Abstract: In Belgium, the provision of pre-exposure prophylaxis (PrEP) for HIV prevention is centralized in specialized HIV clinics. Engaging family physicians in PrEP care could help scale-up its delivery and reach underserved populations. The objective of this study was to gain insight into family physicians' self-perceived roles in providing PrEP. Methods We conducted 16 online group discussions with a total of 105 Flemish family physicians, between November 2020 and February 2021. A brief online questionnaire assessed their socio-demographics and experience with sexual health. We analyzed verbatim transcribed data using a grounded theory approach. Results Despite limited awareness and experience, participants reported a high willingness to be more actively involved in PrEP care. Four potential roles for the family physician in PrEP care were identified: acting as low-threshold entry point for advice; opportunistic case finding of PrEP candidates; initiating appropriate care for PrEP-eligible clients; and ensuring high-quality follow-up care for PrEP users. Participants framed each of these roles within their current activities and responsibilities as primary care providers. Yet, participants differed in their views on the concrete operationalization of these roles, and in the extent of their involvement in PrEP. Particular challenges were a lack of experience with antiretrovirals, perceived limited exposure to clients at high HIV risk, and a lack of expertise and resources to conduct time-intensive risk assessments and counseling related to PrEP. Conclusion Belgian family physicians demonstrated a keen willingness to be involved in PrEP care, but had differing views on the practical implementation into their practices. Providing tailored training on sexual health and PrEP, and investing in collaboration between primary and secondary care, could optimize the integration of PrEP in the primary care practice.
    Type of Medium: Online Resource
    ISSN: 2296-858X
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fmed.2022.828695
    DOI: 10.3389/fmed.2022.828695.s001
    DOI: 10.3389/fmed.2022.828695.s002
    DOI: 10.3389/fmed.2022.828695.s003
    DOI: 10.3389/fmed.2022.828695.s004
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2775999-4
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