Journal Article

An analysis of baseline data from the PROUD study: an open-label randomised trial of pre-exposure prophylaxis

Clarke, Amanda, Sullivan, Ann K., McOwan, Alan, Taylor, Stephen, Saunders, John, Gill, Owen N., Fisher, Martin, Brady, Michael, Portman, Mags, Desai, Monica, Bayley, Jake, Mackie, Nicola, Reeves, Iain, McCormack, Sheena, Gilson, Richard, Gafos, Mitzy, White, David, Bowman, Christine, Lacey, Charles J., Nardone, Anthony, Antonucci, Simone, Dunn, David T., Schembri, Gabriel, Dolling, David I., Fox, Julie

2016

Overview

Background Pre-exposure prophylaxis (PrEP) has proven biological efficacy to reduce the sexual acquisition of the human immunodeficiency virus (HIV). The PROUD study found that PrEP conferred higher protection than in placebo-controlled trials, reducing HIV incidence by 86 % in a population with seven-fold higher HIV incidence than expected. We present the baseline characteristics of the PROUD study population and place the findings in the context of national sexual health clinic data. Methods The PROUD study was designed to explore the real-world effectiveness of PrEP (tenofovir-emtricitabine) by randomising HIV-negative gay and other men who have sex with men (GMSM) to receive open-label PrEP immediately or after a deferral period of 12 months. At enrolment, participants self-completed two baseline questionnaires collecting information on demographics, sexual behaviour and lifestyle in the last 30 and 90 days. These data were compared to data from HIV-negative GMSM attending sexual health clinics in 2013, collated by Public Health England using the genitourinary medicine clinic activity database (GUMCAD). Results The median age of participants was 35 (IQR: 29–43). Typically participants were white (81 %), educated at a university level (61 %) and in full-time employment (72 %). Of all participants, 217 (40 %) were born outside the UK. A sexually transmitted infection (STI) was reported to have been diagnosed in the previous 12 months in 330/515 (64 %) and 473/544 (87 %) participants reported ever having being diagnosed with an STI. At enrolment, 47/280 (17 %) participants were diagnosed with an STI. Participants reported a median (IQR) of 10 (5–20) partners in the last 90 days, a median (IQR) of 2 (1–5) were condomless sex acts where the participant was receptive and 2 (1–6) were condomless where the participant was insertive. Post-exposure prophylaxis had been prescribed to 184 (34 %) participants in the past 12 months. The number of STI diagnoses was high compared to those reported in GUMCAD attendees. Conclusions The PROUD study population are at substantially higher risk of acquiring HIV infection sexually than the overall population of GMSM attending sexual health clinics in England. These findings contribute to explaining the extraordinary HIV incidence rate during follow-up and demonstrate that, despite broad eligibility criteria, the population interested in PrEP was highly selective. Trial registration Current Controlled Trials ISRCTN94465371 . Date of registration: 28 February 2013.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adolescent / Adult / Anti-HIV Agents - administration & dosage / Anti-HIV Agents - adverse effects / Antiretroviral drugs / Biomedicine / Care and treatment / Demographics / Disease prevention / Drug Administration Schedule / Drug resistance / Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination - administration & dosage / Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination - adverse effects / England - epidemiology / Gays & lesbians / Health aspects / Health Sciences / Hepatitis / HIV / HIV (Viruses) / HIV Infections - epidemiology / HIV Infections - prevention & control / HIV Infections - transmission / HIV Infections - virology / Homosexuality, Male / Hospitals / Human immunodeficiency virus / Humans / Immune system / Incidence / Infections / Male / Medical tests / Medicine / Medicine & Public Health / Mens health / Middle Aged / MSM (Men who have sex with men) / Pilot Projects / Population / Primary Prevention - methods / Questionnaires / Reverse Transcriptase Inhibitors - administration & dosage / Reverse Transcriptase Inhibitors - adverse effects / Risk Assessment / Risk Factors / Sexual behavior / Sexual health / Sexually transmitted diseases / Socioeconomic Factors / Statistics for Life Sciences / STD / Surveys and Questionnaires / Time Factors / Treatment Outcome / Unsafe Sex - prevention & control / Young Adult