Transcript Patterns of sex and PrEP in Bangkok MSM (HPTN 067/ADAPT Study)

Patterns of sex and PrEP
in Bangkok MSM
(HPTN 067/ADAPT Study)
Tareerat Chemnasiri, Anchalee Varangrat, K. Rivet Amico, Supaporn
Chaikummao, Anupong Chitwarakorn, Bonnie J. Dye, Robert M. Grant,
Timothy H. Holtz, and the HPTN 067/ADAPT Study Team
July 20th, 2015
Qualitative component methods
• In August 2013 and March 2014, 38 HPTN
067/ADAPT MSM participants joined a qualitative
evaluation: 32 participants joined in 6 focus-group
discussions (FGDs) and 6 attended key-informant
interviews (KIIs), 2 per each study regimen after
they completed 34 weeks of study follow-up.
•
We double-coded Thai transcripts and analyzed
qualitative data using Atlas.ti (v.7.1) computer
software. Grounded theory and content analysis
were used to analyze the data.
Results
Socio-demographic characteristics
Age (years)
Median = 30
Range = 21-50
21-25
26-30
31-35
36-40
>40
N=38
%
10
10
11
5
2
26
26
29
13
6
Employment status
Full-time employment
Part-time employment
Not employed
27
4
7
71
11
18
Education
Completed primary school
Completed technical training
Not completed college
Completed college
1
1
3
33
3
3
8
86
Marital status
Never married
38
100
Daily
regimen
Patterns of sex
• Have sex frequently
• Prefer not to plan for sex
• Do not have control over planning for sex with
sexual partners
• Self-perceived of having high HIV risk
Pros
• Easily taken, can take with daily vitamins
• Able to set tablet-taking time regardless of sex
• No need to carry tablets
• No need to disclose about PrEP use
Cons
• Concerns about long-term impacts and side effects
• Fear of being seen as being HIV-infected
• Difficult to use if sex were infrequent
• Difficulty to take daily for long period of time
• Routine change
• Tablet fatigue
• Affordability
“It would be awkward to take a tablet before or after sex. The sexual
partner would ask what the tablet was for. But for daily dose, I could say
it was dietary supplement. That’s easy.” (FGD/Daily arm)
“I’m not at risk of getting HIV and I don’t do anything to make myself at
risk. I don’t even have sex, why I need to take tablets daily.”
(KII/Daily arm)
Timedriven
regimen
Patterns of sex
• Have infrequent sex events
• Inability to plan sex / have no control over planning for
sex with sexual partners
Pros
• Fewer doses (less concerns about side effects)
• Able to choose the day to take tablets (2 doses/week)
• No need to plan for sex (keep few tablets in pocket for
post-sex dose after unexpected sex event)
Cons
• Difficulty in linking routine activity with 2 tablet-taking
days
• Complicated regimen (No more than 1 dose in a 2 hour
window)
• Need to carry few tablets at all times
• Difficult to hide tablets from sexual partners
• Planning for sex made sex no longer enjoyable
“My boyfriend always controls when to have sex, even though it is not
often. So, I continue to take tablet 2 days a week and just wait for the
sex to happen.” (FGD/Time-driven arm)
“I don’t plan for sex, I only carry tablets with me all the time.”
(FGD/Time-driven arm)
Eventdriven
regimen
Patterns of sex
• Have infrequent sex events
• Ability of sex planning / have control over
planning for sex with sexual partners
Pro
• Fewer doses (less concerns about side effects)
Cons
• Need sex planning
• Need to carry tablets at all times (pre/post-sex
dose)
• Difficult to hide tablets from sexual partners
• Regimen confusion (need to count by the hour)
• Complicated regimen (No more than 1 dose in a
2 hour window)
“I always ask for sex from my boyfriend. Sometimes, he says yes.
Sometimes, he’s tired. But, if I’m really horny I would take a tablet and
get what I want.” (FGD/Event-driven arm)
“After coming back from the bar, I took a tablet at 2 am right before
having sex and I had to wait 2 hours to take post sex dose at 4 am. I
already fell asleep by then.” (KII/Event-driven arm)
Summary
• Daily dose is the easiest regimen without
ability of planning for sex, but there are
concerns about long-term impact and
affordability
• Non-daily PrEP would be another choice
for those MSM who have infrequent sex
events, capacity to plan for sex, and ability
to take a post-sex dose
Conclusions
• Preferences for regimens varied within each group,
highlighting the need for different PrEP regimen
options for MSM.
• PrEP adherence counseling should be given to PrEP
user in order to remind how important the adherence
is and to ensure user’s understanding on how to take
tablets correctly.
• Disseminating information about PrEP mitigates
stigma and fosters more effective use.
Poster presentation # WELBPE23
ACKNOWLEDGEMENTS
The HIV Prevention Trials Network is sponsored by the
National Institute of Allergy and Infectious Diseases,
the National Institute of Mental Health, and the National
Institute on Drug Abuse, all components of the
U.S. National Institutes of Health.
The HPTN 067 Bangkok Study Team acknowledges:
Our participants
Study staff at Silom Community Clinic @TropMed
Thailand Ministry of Public Health
Epidemiology Branch, Division of HIV/AIDS Prevention, CDC
MSM Community Advisory Board
FHI 360
SCHARP
HPTN Laboratory Center