Background: 

Reducing HIV transmission using pre-exposure prophylaxis (PrEP) requires focussing on individuals at high acquisition risk, such as men who have sex with men with a history of nonoccupational post-exposure prophylaxis (nPEP). This study aims to characterize longitudinal trends in PrEP uptake and its determinants among nPEP users in Montréal.

Methods: 

Eligible attendees at Clinique médicale l'Actuel were recruited prospectively starting in October 2000 (nPEP) and January 2013 (PrEP). Linking these cohorts, we characterized the nPEP-to-PrEP cascade, examined the determinants of PrEP uptake after nPEP consultation using a Cox proportional-hazard model, and assessed whether PrEP persistence differed by nPEP history using Kaplan–Meier curves.

Results: 

As of August 2019, 31% of 2682 nPEP cohort participants had 2 or more nPEP consultations. Subsequent PrEP consultations occurred among 36% of nPEP users, of which 17% sought nPEP again afterward. Among 2718 PrEP cohort participants, 46% reported previous nPEP use. Among nPEP users, those aged 25–49 years [hazard ratio (HR) = 1.3, 95% confidence interval (CI): 1.1 to 1.7], with more nPEP episodes (HR = 1.4, 95% CI: 1.3 to 1.5), who reported chemsex (HR = 1.3, 95% CI: 1.1 to 1.7), with a sexually transmitted infection history (HR = 1.5; 95% CI: 1.3 to 1.7), and who returned for their first nPEP follow-up visit (HR = 3.4, 95% CI: 2.7 to 4.2) had higher rates of PrEP linkage. There was no difference in PrEP persistence between nPEP-to-PrEP and PrEP only participants.

Conclusion: 

Over one-third of nPEP users were subsequently prescribed PrEP. However, the large proportion of men who repeatedly use nPEP calls for more efficient PrEP-linkage services and, among those who use PrEP, improved persistence should be encouraged.

中文翻译：

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与使用过nPEP的男性发生性行为的男性接触前的预防性摄取：蒙特利尔（加拿大）一家大型性健康诊所中的参与者的纵向分析

背景： 

使用暴露前预防（PrEP）减少HIV传播需要将注意力集中在获得风险高的个体上，例如与有非职业暴露后预防（nPEP）历史的男性发生性行为的男性。这项研究旨在表征蒙特利尔nPEP使用者中PrEP摄取的纵向趋势及其决定因素。

方法： 

从2000年10月（nPEP）和2013年1月（PrEP）开始准入招募Cliniquemédicalel'Actuel的合格参与者。链接这些队列，我们​​对nPEP-PrEP级联进行了表征，使用Cox比例风险模型检查了nPEP咨询后PrEP摄取的决定因素，并使用Kaplan-Meier曲线评估了PrEP持久性是否因nPEP历史而有所不同。

结果： 

截至2019年8月，在2682名nPEP队列参与者中，有31％进行了2次或更多次nPEP咨询。随后，有36％的nPEP用户进行了PrEP咨询，其中17％的用户随后再次寻求了nPEP。在2718名PrEP队列参与者中，有46％的人先前曾使用过nPEP。在nPEP用户中，年龄在25-49岁之间的人群[危险比（HR）= 1.3，95％置信区间（CI）：1.1至1.7]，其中nPEP事件更多（HR = 1.4，95％CI：1.3至1.5），谁报告了chemsex（HR = 1.3，95％CI：1.1至1.7），具有性传播感染史（HR = 1.5； 95％CI：1.3至1.7），并且首次返回nPEP随访（HR = 3.4，95％CI：2.7至4.2）具有较高的PrEP连锁率。在nPEP-to-PrEP和仅PrEP的参与者之间，PrEP持久性没有差异。

结论： 

随后，超过三分之一的nPEP用户被处方PrEP。但是，大量重复使用nPEP的男性要求更有效的PrEP链接服务，并且在使用PrEP的男性中，应鼓励改善持久性。