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A Competing Risks Duration Model to Study PrEP Discontinuation Among MSM in France: The ERAS 2023 Study
Clément Boutet1, Marion Di Ciaccio2,3, Bruno Spire2
1Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France. clement.boutet@ird.fr.
AIDS and Behavior
|April 29, 2025
Summary
High discontinuation rates of HIV pre-exposure prophylaxis (PrEP) limit its effectiveness. This study found no evidence of PrEP weariness among gay and bisexual men, indicating specific factors drive discontinuation.
Area of Science:
- Public Health
- Epidemiology
- Sexual Health
Background:
- High discontinuation rates of HIV pre-exposure prophylaxis (PrEP) reduce its effectiveness in at-risk populations.
- Understanding reasons for PrEP discontinuation is crucial for improving HIV prevention strategies.
Purpose of the Study:
- To investigate the reasons for PrEP discontinuation among gay and bisexual men who have sex with men (GBMSM) in France.
- To identify factors associated with different reasons for PrEP discontinuation and assess PrEP weariness.
Main Methods:
- Analysis of data from the French online survey Enquête Rapport au Sexe 2023, including 4819 GBMSM.
- Construction of 'PrEP duration' and a three-category 'reason for PrEP discontinuation' variable (changes in sexual behaviors, desire to discontinue, clinical reasons).
- Application of a Weibull accelerated failure time model with competing risks to analyze discontinuation factors and duration dependence.
Main Results:
- Median PrEP duration was 19 months.
- Discontinuation due to behavioral changes was less likely when PrEP was initiated in a sexual health structure.
- Desire to stop PrEP was more likely in regions with lower seropositivity rates, and clinical reasons were more common in smaller municipalities.
- Negative duration dependence indicated lower discontinuation probability with longer PrEP use.
Conclusions:
- No evidence of PrEP weariness was found among GBMSM.
- Specific factors, rather than general weariness, are associated with PrEP discontinuation.
- Tailored interventions addressing behavioral, geographical, and clinical factors are needed to improve PrEP adherence and effectiveness.
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