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Background: Proper implementation of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) requires a clear understanding of the reasons why MSM choose one PrEP-dosing regimen over another in real-life settings. Therefore, we aimed to gain insight into the motives for choosing or switching between daily and event-driven PrEP or (temporarily) stopping PrEP use.
Methods: We used data from the Amsterdam PrEP (AmPrEP) demonstration study (June 2015-February 2017), where both daily and event-driven PrEP (dPrEP and edPrEP, respectively) are offered. MSM''s motives to choose a regimen were measured at baseline among 376 participants of whom 273 chose dPrEP and 103 chose edPrEP. Motives to switch or stop were recorded at every 3-monthly follow-up visit. Standardized closed- and open-end items were used. Open answers were coded and analyzed following qualitative research methods.
Results: Among the reasons to use dPrEP were the convenience of daily routine (n=133), perceived higher dPrEP efficacy (n=34), and fear of side-effects relating to edPrEP re-initiation (n=5). Perceived toxicity and burden of daily medication were reasons to choose edPrEP (n=38). Infection risk was also considered: dPrEP was preferred for unplanned and/or frequent sexual risk behavior (n=79), while edPrEP was chosen when risk was more predictable (n=57). Some chose for, or switched to, edPrEP to inhibit sexual risk behavior (n=4), while others chose for, or switched to, dPrEP to gain more sexual freedom (n=17). Other reasons to switch to edPrEP included experiencing side-effects (n=14), having less sex than anticipated (n=20), experimenting with another regimen (n=2) and receiving negative reactions from the environment (n=1). Doubts about edPrEP''s safety (n=2), inability to plan sex (n=13) and desire for more structure (n=9) were motivators to switch to dPrEP. Motives to temporarily stop dPrEP (n=99) were situational (e.g. medical issues or vacations). Changed life circumstances (n=2) and reduced sexual risk (n=6) were motives to completely stop with PrEP use (n=12).
Conclusions: A great variety of personal and contextual factors determine the choices for PrEP regimens, related switches and stops. In order to successfully support future PrEP users, a tailored approach, addressing choices for PrEP regimens as a continuum of flexible and changeable choices, is essential.