Grant: Project Grant

Antiretroviral medication taken prior to HIV exposure to prevent infection is known as pre-exposure prophylaxis, or PrEP. Men who have sex with men (MSM) are the most affected HIV risk-group in Canada and among high-risk MSM. In randomized trials, PrEP has been shown to be about 90% effective in preventing HIV infection when taken regularly (at least 4 pills/week). On January 1, 2018, the BC Ministry of Health, through the BC Centre for Excellence (BC-CfE) in HIV/AIDS, began full public funding for PrEP for individuals at high risk of getting HIV. The initial uptake of PrEP thorugh this program has been very high -- more than 2000 individuals have accessed PrEP through the program as of June 2018. Nearly all (99%) PrEP users through this program are male and most (70%) live in Greater Vancouver. However, the impact of PrEP on the HIV epidemic among MSM will depend on uptake by those most at-risk. Further, behavioural risk compensation (e.g., decreased condom use) may result in higher incidence of other sexually transmitted infections (STIs). This study aims to: 1) evaluate determinants and trends of initiation of PrEP among of HIV-negative MSM over a four-year period from February 2017-December 2021, 2) compare new STIs, including syphilis, chlamydia, and gonorrhea, prior to and after PrEP initiation, and 3) determine factors associated with individuals who meet clinical eligibility criteria for PrEP but who have never initiated its use. This study will provide important evidence as to the success and/or challenges faced by scaling up a publicly funded program. Through our study team's position within the BC-CfE and existing collaborations with government and community agencies, these results will directly influence provincial and national policies regarding PrEP. Further, our results will inform health promotion and clinical interventions to support PrEP uptake and adherence among Canadian MSM.