Cohen prepo7/26/2023 The survey questions are shown in Additional file 1: Appendix S1. The outcomes of this study included factors associated with former PrEP use, reasons for stopping PrEP and self-reported side effects. The study was rolled out in two waves in 20. After providing consent on the survey website, participants completed an anonymous online survey concerning PrEP use, sexual behaviour, reasons for stopping PrEP and side effects. Current and former PrEP users were recruited on dating apps, a community website, in anonymous testing sites and through peers. The PrApp study is a cross-sectional study investigating PrEP use in Germany. Moreover, we investigate the sexual behaviour of former PrEP users to inform HIV prevention strategies. Here, we investigate factors associated with stopping PrEP and identify barriers that may be addressed in order to maximise PrEP persistence. Moreover, fears of side effects, experiencing stigma, and fears of insufficient protection by PrEP could also keep some from continuing their use of PrEP. lack of health insurance cover, language barriers, self-payments, or frequent doctor visits. Other reasons for stopping PrEP indicate access barriers, e.g. Other people stop PrEP because of adverse drug effects. Some users change their sexual behaviour or only have risky sex during certain periods in their lives. The reasons for stopping PrEP are diverse. Ensuring persistence with PrEP was associated with the biggest impact on HIV incidence, yet many users discontinue PrEP within the first year after initiation with some studies finding that less than half were retained. PrEP programmes need to ensure that people stay on PrEP for as long as they are at risk. Statutory health insurances have reimbursed PrEP since September 2019, which is expected to increase the uptake of PrEP. In Germany, generic PrEP for 40–70€ self-pay per month became available in 2017. Widespread roll-out was associated with a reduction in new HIV diagnoses in men who have sex with men (MSM) in Australia, Paris, London, and the United States. HIV pre-exposure prophylaxis (PrEP) with Tenofovirdisoproxil/Emtricitabine (TDF/FTC) is a powerful tool for HIV prevention and is recommended by national and international guidelines. Moreover, prevention strategies for people stopping PrEP are required, since some remain at high risk for HIV. To maximise persistence with PrEP we need to develop strategies for younger PrEP users, reduce logistic barriers to access PrEP, and to develop effective communication on side-effect management. 27.9%, p < 0.001) than did other former PrEP users. Former PrEP users with many partners and inconsistent condom use more often indicated logistic reasons for stopping (46.5% vs. After stopping PrEP, 18.7% of former PrEP users indicated inconsistent condom use while having ≥4 sex partners within the previous 6 months. 24.0%, p = 0.020) compared to former PrEP users who used PrEP for longer. 22.5%, p = 0.015) and not wanting to take a chemical substance (33.2% vs. Former PrEP users using PrEP < 3 months were more likely to stop PrEP due to concerns over long-term side effects (32.0% vs. However, 31.4% of former users identified logistic reasons and 17.5% stopped due to side effects. The most common reason for stopping PrEP was a reduced need for PrEP (49.1%). Moreover, they were more often unhappy with their sex life, which was more pronounced in former daily PrEP users (aOR = 4.5, 95% CI 2.9–7.1) compared to former on-demand users (aOR = 1.8, 95% CI 1.1–2.9, p interaction = 0.005). Former PrEP users were more likely 18–29 years old than current users (adjusted OR = 1.6, 95% confidence interval (CI) 1.1–2.3). We recruited 4848 current and 609 former PrEP users in two study waves (July–October 2018, April–June 2019). The results were analysed using descriptive methods and logistic regression. Participants were recruited through dating apps, a PrEP community website, anonymous testing sites and peers. MethodsĬurrent and former PrEP users in Germany were recruited to complete an anonymous online survey on PrEP use and sexual behaviour. We analysed factors associated with stopping PrEP, barriers that may deter people from continuing PrEP and investigated sexual behaviour after stopping PrEP. Persistence of individuals at risk of HIV with Pre-Exposure Prophylaxis (PrEP) is critical for its impact on the HIV epidemic.
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