Daily PrEP and event-driven PrEP adherence for men who have sex with men in China

The HIV incidence among Chinese men who have sex with men (MSM) has still been high over the past decade. Despite HIV pre-exposure prophylaxis (PrEP) being an effective prevention strategy, few studies have examined PrEP uptake and adherence in China. This study examined PrEP initiation and adherence among Chinese MSM enrolled in a multi-site PrEP demonstration trial.

Three-month data for this study were drawn from a PrEP demonstration project in Guangzhou and Wuhan, China. The project aimed to increase the engagement of MSM in China for HIV/STI screening, HIV risk reduction, and PrEP initiation and adherence through the use of a mobile phone app and community engagement with crowdsourcing of messages and study images. Part of the intervention was the provision of tenofovir/emtricitabine as PrEP through two types of modalities: (1) once-daily oral dose (Daily-PrEP), or (2) event-driven dose (i.e. the 2 + 1 + 1 approach, Event-Driven PrEP). The outcome of interest was PrEP adherence, defined as missing fewer than five pills in the past 30 days for Daily PrEP, and no missed doses for the Event-Driven PrEP regimen. Univariate and multivariate logistic regressions were conducted for data analyses.

A total of 927 individuals started PrEP, with follow-up data available for 650 people (70%) after 3 months. There were 593 men with a median age of 30 years (range 21-61 years) in this study. Of those people, 341 reported taking Daily-PrEP, and 93% (317/341) reported missing fewer than five pills in the past 30 days. Among 252 participants who reported taking the Event-Driven PrEP regimen, 61.5% (155/252) reported full adherence. Daily-PrEP users were more likely to report good adherence than Event-Driven PrEP users (OR 7.28, P < 0.0001, 95% CI: 4.28-12.39).

We observed a higher adherence to daily PrEP compared with Event-Driven PrEP among a sample of MSM in China. Further research is needed to examine long-term PrEP adherence among MSM in China.