(P295) An Oral Pre-Exposure Prophylaxis Demonstration Project Among Men who have sex with men in Benin, West Africa

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

SD

Souleymane DIABATÉ

Professor
CHU de Québec-Université Laval Research Center
Québec, Quebec, Canada

Co-author(s)

LB

Luc Béhanzin

École nationale de formation des techniciens supérieurs en santé publique et en surveillance épidémiologique, Université de Parakou, Parakou, Bénin, United States
FG

Fernand Guédou

Organisation pour la Promotion de la Santé et le Développement communautaire, Cotonou, Bénin, United States
MA

Michel Alary

CHU de Québec-Université Laval Research Center, United States

Background. Since many countries in sub-Saharan Africa are moving towards the implementation of oral pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM), data are needed to assess its feasibility and relevance in real life.

Methods. In this oral PrEP demonstration study conducted prospectively in Benin, a combination of Tenofovir disoproxil fumarate-TDF 300 mg and Emtricitabine-FTC 200mg (TDF-FTC) was added to an HIV prevention package already offered to MSM and made of clinical and behavioural components. Behavioural and drug related variables like uptake, self-reported adherence, condom use and sexually transmitted infections including HIV were investigated. Participants could chose between daily and event-driven PrEP.

Results. Overall, 204 HIV-negative men initiated PrEP. The majority of them (79.9%) started with daily PrEP. Retention rates at month-3, 6, 9 and 12 were 95.6%, 88.2%, 85.8% and 84.8%, respectively. Some switches occurred between the two PrEP options. At month-6 and month-12, approximately, half of the men on daily PrEP and three quarters of those using the event-driven option achieved perfect adherence (self-reported), i.e. seven pills taken during the last week for daily PrEP and all last seven at-risk sexual episodes covered under the event-driven option. The mean number (standard deviation) of male sexual partners reported over the last six months decreased from 2.1 (1.70) at baseline to 1.5 (1.27) at month-12 (p value for trend < 0.001). At baseline and at each follow-up visit, about two thirds of the participants reported inconsistent condom use. Three HIV seroconversions (2-daily and 1-event-driven) occurred during follow-up and crude HIV incidence (95% confidence interval) was 1.53 (0.31-4.50)/100 person-years. Neisseria gonorrhoeae and Chlamydia trachomatis prevalence was high (27.9%) at baseline and infection at more than one anatomic site (anal, pharyngeal and urethral) was common, but the prevalence declined significantly from month-3 to month-6 (p-value=0,037). Between month-6 and month-12, there were some downward and upward changes, but they were not statistically significant.

Conclusion. In West Africa, oral PrEP introduction in routine practice as a component of a holistic HIV prevention package is feasible and may not result in a significant increase in condomless sex among MSM.