(P288) ENROLLMENT AND DISCONTINUATION OF PREP IN CHINA: RESULTS FROM A DEMONSTRATION TRIAL

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Chunyan Li, PhD

Postdoctoral Fellow
Tokyo College, University of Tokyo; University of North Carolina Project China, United States

Co-Author(s)

Zhuoheng Yin, MA

Research assistant
UNC Project China, United States

Co-author(s)

JT

Joseph D. Tucker

Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK, United States
IJ

Ivy Jiang

University of Chicago, United States
LL

Linghua Li

Guangzhou Eighth People's Hospital, United States
JL

Jonathan Lio

University of Chicago, United States
HH

Haojie Huang

Wuhan Tongxing LGBT Center, United States
KL

Ke Liang

Zhongnan Hospital of Wuhan University, United States
Aniruddha Hazra, MD

Assistant Professor of Medicine
University of Chicago
Chicago, Illinois, United States

Primary Presenter(s)

WT

Weiming Tang

Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, United States

Co-author(s)

RS

Renslow Sherer, Jr.

Professor of Medicine
University of Chicago, United States

Background

Limited evidence is available for PrEP persistence in China. This study investigated the PrEP uptake and discontinuation among Chinese PrEP users during 2021-2022.

Methods
A PrEP demonstration trial was conducted in Guangzhou and Wuhan, China, providing PrEP-eligible people with 12-month dosages of daily Truvada® for free. We adopted a hybrid community-clinic-partnership model for recruitment, medication delivery, and follow-up, where participants can complete all study procedures online except for lab/clinical examinations. Here we reported the PrEP uptake, retention, and PrEP discontinuation (defined as loss-to-follow-up, voluntary stop using PrEP, quitting PrEP due to adverse events).

Results

We enrolled 849 people, and 776 people initiated PrEP (91.4 %, median age= 29.2, range 18.5-59.6). 99.5% (765/766) were males, and 94.5% (724/766) self-identified as gay or bisexual. Over 70% are working, and about 60% earn ≥700 USD per month. 43.5%(n=338) received PrEP through the mail (mean delivery time= 1.67 days). 88.8% (447/503), 84.4% (196/232), 81% (120/148), and 27.6% (21/76) completed in-person or remote follow-ups at 3, 6, 9, and 12 months, respectively. A total of 57 participants (7.3%) discontinued PrEP before the study ended, of whom 52.6% discontinued within the 1^st month, and another 19 (33.3%) discontinued within 3 months (Fig1). No statistically significant differences were detected between participants who discontinued PrEP and those who retained on age, gender, and monthly income. Common reasons for discontinuation include moving (n=12, 21.1%), low perceived risk of HIV infection (n=14, 24.6%), and limited mobility during the pandemic lockdowns (n=5, 8.8%). Overall, 17 participants (2.2% of the total sample) reported adverse events, and 4 (7% of discontinuations and 0.5% of the total sample) discontinued PrEP due to adverse events. The most frequently reported events were skin rash (n=5), nausea (n=5), and diarrhea(n=2).

Conclusion

Our project demonstrated the feasibility and safety of PrEP in China with high persistence after 3-6 months. However, persistence remains a challenge due to both individual and structural factors. Disruptions from the COVID-19 pandemic and related public health responses may have increased the risk of discontinuation among PrEP users in China. Diversifying modalities of PrEP provision is also highly warranted in the PrEP care continuum.