Widening the Net for Pre-Exposure Prophylaxis for HIV

L. Townsend1, H. Tuite2

  1. Department of Infectious Disease, St James’s Hospital, James’s St, Dublin 8
  2. Department of Infectious Disease, University Hospital Galway, Newcastle Road, Galway

Sir,

HIV management has change dramatically since the AIDS epidemic first hit Ireland in the eighties. HIV has been transformed from a fatal condition to a manageable chronic disease. Prevention of acquisition remains frustrating, with few breakthroughs in vaccine development. The use of pre-exposure prophylaxis (PrEP) as prevention in high-risk groups has been shown to reduce HIV acquisition. Its benefit was first shown in the iPrEx study[i]. The primary high-risk group is men who have sex with men (MSM) who have recently engaged in condomless anal intercourse with two or more partners, have recently had an STI, or had a recent course of post-exposure prophylaxis (PEP). PrEP involves a single tablet of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) taken daily or on demand.

Prior PrEP studies were in large urban centres; there are few studies addressing PrEP in a rural setting. We investigated PrEP feasibility in a HIV centre with a predominantly rural catchment area. The University Hospital of Galway (UHG) serves the city of Galway, which has a population of 79,934[ii]. However, its catchment area covers a population of 709,383, with over 70% residing in rural locations[iii].

We conducted a cross-sectional survey of MSM attendees at STI clinics in UHG over a three-month period. A questionnaire was distributed to all attendees reporting MSM activity. Demographic information, sexual practices, knowledge of PrEP, and attitude towards PrEP was collected.

Eighty-one responses were received. Seventy-three (90%) were homosexual, with 8 (10%) identifying as bisexual. Fifty-nine (73%) were Irish. The mean number of partners in the preceding three months was 2.92, with forty-three (53%) reporting condomless sex in that period. The commonest reason given for unprotected sex was the influence of alcohol (21 respondents).

Six (7%) responders received PEP in the last year, while seventeen (21%) were treated for an STI. Thirty (37%) reported using drugs in concordance with sex.

Fifty-four (67%) had heard of PrEP, with 49 (91%) stating they would consider taking PrEP. All would take PrEP if it was free, while 18 (33%) would pay €70/month. One respondent felt they would have issues with PrEP compliance.

Overall, we found that over half (53%) of responders had more than 2 partners and had condomless sex in the preceding 3 months, and 21% had an STI in the preceding six months. Attitudes towards PrEP were favourable. There is a target population who are both eligible and eager to take PrEP outside of the large urban centres. This supports the establishment of PrEP monitoring clinics outside Dublin, to ensure the health needs of the at-risk population are met.

Corresponding Author
Liam Townsend

Department of Infectious Disease
St James’s Hospital
James’s St
Dublin 8
townsenl@tcd.ie

References

  1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine. 2010 Dec 30;363(27):2587-99.
  2. Office CS. Census 2016 Summary Results 2016 [Available from: https://www.cso.ie/en/media/csoie/newsevents/documents/census2016summaryresultspart1/Census2016SummaryPart1.pdf.
  3. Executive HS. Saolta University Health Care Group Operational Plan Saolta Website2018 [Available from: https://www.hse.ie/eng/services/publications/serviceplans/service-plan-2018/operational-plans-2018/saolta-university-health-care-group-operational-plan-2018.pdf

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