Daily PrEP and Event Driven PrEP adherence for men who have sex with men in China

Introduction: The HIV incidence among Chinese men who have sex with men (MSM) is still high over the past decade. Despite HIV Pre-exposure prophylaxis (PrEP) being an effective prevention strategy, few studies have examined PrEP uptake and adherence in China. This study examined PrEP initiation and adherence among Chinese MSM enrolled in a multi-site PrEP demonstration trial. Methods: Three-month data for this study were drawn from a PrEP demonstration project in Guangzhou and Wuhan, China. The project aimed to increase the engagement of MSM in China for HIV/STI screening, HIV risk reduction, and PrEP initiation and adherence through the use of a mobile phone app and community engagement with crowdsourcing of messages and study images. Part of the intervention was the provision of Tenofovir/emtricitabine (TDF/FTC) as PrEP through two types of modalities: (1) once-daily oral dose (Daily-PrEP) or (2) event-driven dose (i.e. the 2+1+1 approach, Event Driven-PrEP). The outcome of interest was PrEP adherence, defined as missing fewer than five pills in the last 30 days for Daily PrEP and no missed doses for the Event-Driven PrEP regimen. Univariate and multivariate logistic regressions were conducted for data analyses. Results: A total of 927 individuals started PrEP, with follow-up data available for 650 people (70%) after three months. There were 593 men with a median age of 30 (min=21, max=61) years in this study. Of those people, 341 reported taking Daily-PrEP, and 93% (317/341) reported missing fewer than five pills in the last 30 days. Among 252 participants who reported taking the Event Driven-PrEP regimen, 61.5% (155/252) reported high adherence. Income and having multiple sex partners were significant factors in PrEP adherence. Conclusion: We observed a higher adherence to daily PrEP compared to Event Driven-PrEP among a sample of MSM in China. Further research is needed to examine long-term PrEP adherence among MSM in China.