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Factors associated with the informal use of HIV pre-exposure prophylaxis in Germany: a cross-sectional study.
J Int AIDS Soc 2019; 22(10):e25395JI

Abstract

INTRODUCTION

Until September 2019, pre-exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self-pay or through informal non-prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use.

METHODS

We conducted a cross-sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions.

RESULTS

We recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informal PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum-specific OR = 31.7, 95% CI 4.6 to 219.5).

CONCLUSIONS

Informal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use.

Authors+Show Affiliations

Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany.Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.Praxis Jessen² + Kollegen, Berlin, Germany.Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31583823

Citation

Koppe, Uwe, et al. "Factors Associated With the Informal Use of HIV Pre-exposure Prophylaxis in Germany: a Cross-sectional Study." Journal of the International AIDS Society, vol. 22, no. 10, 2019, pp. e25395.
Koppe U, Marcus U, Albrecht S, et al. Factors associated with the informal use of HIV pre-exposure prophylaxis in Germany: a cross-sectional study. J Int AIDS Soc. 2019;22(10):e25395.
Koppe, U., Marcus, U., Albrecht, S., Jansen, K., Jessen, H., Gunsenheimer-Bartmeyer, B., & Bremer, V. (2019). Factors associated with the informal use of HIV pre-exposure prophylaxis in Germany: a cross-sectional study. Journal of the International AIDS Society, 22(10), pp. e25395. doi:10.1002/jia2.25395.
Koppe U, et al. Factors Associated With the Informal Use of HIV Pre-exposure Prophylaxis in Germany: a Cross-sectional Study. J Int AIDS Soc. 2019;22(10):e25395. PubMed PMID: 31583823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with the informal use of HIV pre-exposure prophylaxis in Germany: a cross-sectional study. AU - Koppe,Uwe, AU - Marcus,Ulrich, AU - Albrecht,Stefan, AU - Jansen,Klaus, AU - Jessen,Heiko, AU - Gunsenheimer-Bartmeyer,Barbara, AU - Bremer,Viviane, PY - 2019/01/21/received PY - 2019/09/03/accepted PY - 2019/10/5/entrez PY - 2019/10/5/pubmed PY - 2019/10/5/medline KW - PrEP KW - affordability KW - informal PrEP KW - men who have sex with men KW - non-daily use KW - testing SP - e25395 EP - e25395 JF - Journal of the International AIDS Society JO - J Int AIDS Soc VL - 22 IS - 10 N2 - INTRODUCTION: Until September 2019, pre-exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self-pay or through informal non-prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use. METHODS: We conducted a cross-sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions. RESULTS: We recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informal PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum-specific OR = 31.7, 95% CI 4.6 to 219.5). CONCLUSIONS: Informal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use. SN - 1758-2652 UR - https://www.unboundmedicine.com/medline/citation/31583823/Factors_associated_with_the_informal_use_of_HIV_pre-exposure_prophylaxis_in_Germany:_a_cross-sectional_study L2 - https://doi.org/10.1002/jia2.25395 DB - PRIME DP - Unbound Medicine ER -