Background
Data on PrEP usage is limited in China. This study aimed to provide information on PrEP uptake, persistence, discontinuation, adverse events, and HIV incidence among Chinese at-risk PrEP users.
Methods
We conducted a 12-month PrEP demonstration project in Wuhan and Guangzhou, China, using a community and clinic hybrid delivery model. Healthcare providers implemented prescribing, medical consultation, and PrEP dispensing through clinic visits or courier delivery with CBOs’ assistance. PrEP refill was monthly for the first quarter and trimonthly thereafter. PrEP continuation and adherence information (defined as self-reported taking more than 6 pills in 7 days for daily and strictly adherence to 2+1+1 for events-driven) was surveyed quarterly. Enrollment, PrEP persistence, adherence, discontinuation, and adverse events were descriptively summarized.
Results
From September 2021 to September 2024, a total of 3649 GBMSM were screened, and 1200 were enrolled. Of those, 1138 participants started oral PrEP, with a median age of 29.1(SD=5.9). Most participants identified as gay or bisexual (93.7%, 1066/1138), and 99.6% were cis-gender men(1134/1138). After initiation, PrEP persistence rates at 3, 6, 9, and 12 months were 82.9% (943/1138), 75.9% (864/1138), 70.1% (793/1131), and 65.4% (720/1101) respectively (ongoing). The self-reported adherence rate was 64.4%(733/1138), 59.3%(675/1138), 53.0% (599/1131), and 49.4% (544/1101) at months 3, 6, 9 and 12. In the first-time survey, 42.6% (412/943) and 57.5% (531/ 943) chose the daily and on-demand regimen. Among them, 40.3% (166/412) of daily users and 18.8% (100/531) of on-demand users had changed their regimens, thereafter. 381 participants (33.5%, 381/1138) discontinued PrEP use during the study. Twenty-three types of adverse effects were identified, with nausea (n=16), dizziness (n=12), and diarrhea (n=9) being the three most frequently reported. Seven participants were seroconverted, resulting in an HIV incidence rate of 0.67 per 100 person-years.
Conclusions
The hybrid CBO and clinic-based model proved feasible for reaching and dispensing PrEP among Chinese at-risk populations. On-demand use drugs were popular alternatives and one-half of participants engaged in sex using alcohol and nitrates. Long-term PrEP persistence and optimal adherence continuously decreased among Chinese users during the 12-month period.