Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 27, 2021
Date Accepted: Nov 21, 2021
Condomless anal sex associated with heterogeneous profiles of HIV pre-exposure prophylaxis use and sexual activities among men who have sex with men: A latent class analysis using sex diary data on a mobile app
ABSTRACT
Background:
New innovative technology such as mobile apps has been developed to increase PrEP adherence and the use of log sex diaries. The contiguity of mobile apps reduces the recall bias that affects the reported condom and PrEP use. However, none of the mobile apps were designed for event-driven PrEP users, and few studies have demonstrated the potential usage of sex diary data that could facilitate the understanding of the different HIV risks among heterogeneous profiles of sex diaries and PrEP use.
Objective:
To discriminate the heterogeneous profiles of sex events and PrEP use and examine the risk of condomless anal sex among different types of sex events.
Methods:
We recruited 35 adult men who have sex with men from two medical centers in Taiwan since May 2020 and followed up for four months. Participants should be on PrEP or willing to take PrEP. They were asked to log sex events, PrEP use, and dosing regimens on a mobile app that aimed to improve PrEP adherence. Latent class analysis was used to distinguish the profiles of sex events and PrEP use. Indicators include correct intake of PrEP for each sex event, participants’ sexual positioning, partner’s HIV status, and age.
Results:
A total of 551 sex events were classified into three classes by latent class analysis: PrEP non-adherent flip-flopping (42%), PrEP imperfect-adherent power bottoming (52%), and PrEP adherent serodiscordant topping (6%). “PrEP non-adherent flip-flopping” was more likely to have condomless anal sex than “PrEP imperfect-adherent power bottoming” (OR=1.83, 95% CI=1.03-3.25) after considering random intercepts for individuals, and this class was in need of increasing PrEP adherence and condom sue. “PrEP imperfect-adherent power bottoming” realized their own risk and packaged PrEP with condoms to protect themselves. Up to 99% of sex events in “PrEP adherent serodiscordant topping” were protected by PrEP, but all of the sex events in this groups were condomless.
Conclusions:
Using the sex diary data could advance the knowledge of identifying high-risk groups. HIV prevention strategy should be more flexible and combine PrEP with condoms for future HIV prevention.
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