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Pre-exposure Prophylaxis Persistence Among Greek Sexual Minority Men: Results from PrEP for Greece (P4G) Study

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Abstract

Nearly half the new HIV infections in Greece occur in sexual minority men, yet pre-exposure prophylaxis is not currently supported in the national HIV program. We examined factors associated with PrEP persistence among Greek SMM in PrEP for Greece, the first PrEP study in Greece. Participants (n = 100) were recruited from 2016 to 2018 through respondent-driven sampling among SMM in Athens, receiving supplies for daily PrEP at interval visits over 12-months. PrEP persistence, operationalized as Total PrEP Time, was high, 74% of participants achieving perfect persistence. Higher alcohol risk scores (OR 1.27, 95% CI 1.08–1.49) and adherence to HIV testing guidelines (OR 1.23, 95% CI 1.00–1.51) were associated with persistence. Housing impermanence (OR 0.14, 95% CI 0.04–0.48) and serostatus disclosure concerns (OR 0.77, 95% CI 0.60–0.97) were associated with limited PrEP persistence. While PrEP persistence among Greek SMM is high, socioeconomic factors and societal attitudes may challenge prevention efforts.

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Data is available upon request.

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References

  1. Center for Disease Control and Prevention. CDC statement on FDA approval of drug for HIV prevention. Published July 16, 2012. Accessed 25 March 2021.

  2. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  Google Scholar 

  3. Hatzakis A, Sypsa V, Paraskevis D, et al. Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme. Addiction. 2015;110(9):1453–67.

    Article  Google Scholar 

  4. Sypsa V, Psichogiou M. Paraskevis D et al. Rapid decline in HIV incidence among persons who inject drugs during a fast-track combination prevention program after an HIV outbreak in Athens. JID 2017;215: 1496–1505.

  5. Pasipanodya EC, Jain S, Sun X, et al. Trajectories and predictors of longitudinal preexposure prophylaxis adherence among men who have sex with men. J Infect Dis. 2018;218(10):1551–9.

    Article  Google Scholar 

  6. Grov C, Rendina HJ, John SA, et al. Determining the roles that club drugs, marijuana, and heavy drinking play in PrEP medication adherence among gay and bisexual men: Implications for treatment and research. AIDS Behav. 2019;23(5):1277–86.

    Article  Google Scholar 

  7. Storholm ED, Volk JE, Marcus JL, et al. Risk perception, sexual behaviors, and PrEP adherence among substance-using men who have sex with men: a qualitative study. Prev Sci. 2017;18(6):737–47.

    Article  Google Scholar 

  8. Mannheimer S, Hirsch-Moverman Y, Franks J, et al. Factors associated with sex-related pre-exposure prophylaxis adherence among men who have sex with men in New York City in HPTN 067. J Acquir Immune Defic Syndr. 2019;80(5):551–8.

    Article  CAS  Google Scholar 

  9. Nikolopoulos GK, Chanos S, Tsioptsias E, et al. HIV incidence among men who have sex with men at a community-based facility in Greece. Cent Eur J Public Health. 2019;27(1):54–7.

    Article  Google Scholar 

  10. Paraskevis D, Nikolopoulos G, Tsiara C et al. HIV-1 outbreak among injecting drug users in Greece, 2011: a preliminary report. Euro Surveill. 2011;16(36):pii=19962.

  11. Paraskevis D, Nikolopoulos G, Fotiou A et al. Economic Recession and Emergence of an HIV-1 Outbreak among Drug Injectors in Athens Metropolitan Area: A Longitudinal Study. Plos One 2013;8(11):e78941.

  12. Nikolopoulos GK, Sypsa V, Bonovas S, et al. Big events in Greece and HIV infection among people who inject drugs. Subst Use Misuse. 2015;50(7):825–38.

    Article  Google Scholar 

  13. Kimani M, van der Elst EM, Chiro O et al. PrEP interest and HIV-1 incidence among MSM and transgender women in coastal Kenya. J Int AIDS Soc. 2019;22(6):e25323.

  14. Uthappa CK, Allam RR, Pant R, et al. Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population. HIV Med. 2018;19(4):243–325.

    Article  CAS  Google Scholar 

  15. Torres TS, Konda KA, Vega-Ramirez EH et al. Factors Associated With Willingness to Use Pre-Exposure Prophylaxis in Brazil, Mexico, and Peru: Web-Based Survey Among Men Who Have Sex With Men. JMIR Public Health Surveill. 2019;5(2):e13771.

  16. Bowman B, Psichogiou M, Papadopoulou M, et al. Sexual mixing and HIV transmission potential among Greek men who have sex with men: results from SOPHOCLES. AIDS and Behavior. 2021. Online ahead of print.

  17. Giorgetti R, Tagliabracci A, Schifano F, et al. When “Chems” meet sex: a rising phenomenon called “ChemSex.” Curr Neuropharmacol. 2017;15(5):762–70.

    Article  CAS  Google Scholar 

  18. Young LE, Jonas AB, Michaels S, et al. Social-structural properties and HIV prevention among young men who have sex with men in the ballroom house and independent gay family communities. Soc Sci Med. 2017;174:26–34.

    Article  Google Scholar 

  19. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.

    Article  CAS  Google Scholar 

  20. Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth. J Adolesc Health. 2007;40(1):96–8.

    Article  Google Scholar 

  21. Humeniuk R, Ali R, Babor TF, et al. Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction. 2008;103(6):1039–47.

    Article  Google Scholar 

  22. Pyra M, Rusie L, Castro M et al. A taxonomy of pragmatic measures of HIV preexposure prophylaxis use. AIDS. 2020 Jul 17. Online ahead of print. PMID: 32694417

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Acknowledgements

This work was supported by Gilead Sciences (study number CO-US-276-1695), National Institute of Allergy and Infectious Diseases, National Institutes of Health (grant R21 AI118998), the Pritzker School of Medicine and the Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases. We’d also like to thank all of our participants and staff at Laiko General Hospital of Athens who helped support this work.

Funding

This work was supported by Gilead Sciences (study number CO-US-276-1695), NIH grant R21 AI118998, the Pritzker School of Medicine and the Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases.

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Author notes

  1. Mweya Waetjen and Martha Papadopoulou are co-first authors.

Authors and Affiliations

  1. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Mweya Waetjen, Sophocles Chanos & John Schneider

  2. First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Martha Papadopoulou & Mina Psichogiou

  3. Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA

    Rey Flores & Chuanhong Liao

  4. Department of Medicine, University of Chicago, Chicago, IL, USA

    Rey Flores

  5. Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece

    Vana Sypsa, Sotiris Roussos, Dimitrios Paraskevis, Angelos Hatzakis & John Schneider

  6. Positive Voice, Athens, Greece

    Nikos Dedes

  7. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA

    John Schneider

  8. Section of Infectious Diseases and Global Health, Departments of Medicine and Public Health Sciences, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, USA

    John Schneider

Authors
  1. Mweya Waetjen
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  2. Martha Papadopoulou
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  3. Rey Flores
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  4. Vana Sypsa
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  5. Sotiris Roussos
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  6. Sophocles Chanos
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  7. Nikos Dedes
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  8. Chuanhong Liao
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  9. Dimitrios Paraskevis
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  10. Angelos Hatzakis
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  11. John Schneider
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  12. Mina Psichogiou
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Contributions

MW wrote the first draft and edited subsequent drafts; MP conducted study procedures and edits of drafts; RF wrote second draft and main edits of all drafts; VS created study design and edits of drafts; SR created study design and edits of drafts; SC created study design and community engagement; ND created study design and community engagement; CL performed statistical analysis; DP created study design and edits of drafts; AH created study design and edits of drafts; JS created study design and edits of drafts; MP created study design and edits of drafts.

Corresponding author

Correspondence to John Schneider.

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Conflict of Interest

The authors declare they have no conflict of interest.

Ethical Approval

Institutional Review Boards of participating institutions approved all research activities related to this study. We obtained written informed consent from all participants. Participants received HIV prevention education during the intervention and were connected to appropriate health care or supportive services. All protocols and policies for the study were approved by the Institutional Review Board at the University of Chicago, the Hellenic Scientific Society for the Study of AIDS and STDs, and the Scientific Council of Laiko General Hospital of Athens. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all survey respondents included in the study.

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Waetjen, M., Papadopoulou, M., Flores, R. et al. Pre-exposure Prophylaxis Persistence Among Greek Sexual Minority Men: Results from PrEP for Greece (P4G) Study. AIDS Behav 26, 1039–1046 (2022). https://doi.org/10.1007/s10461-021-03459-7

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  • DOI: https://doi.org/10.1007/s10461-021-03459-7

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