White, Ellen;
(2020)
HIV pre-exposure prophylaxis: additional insights through secondary analyses of the PROUD trial.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
This thesis utilises data from PROUD, a randomised controlled trial to evaluate pre-exposure prophylaxis (PrEP) for HIV prevention. PROUD randomised 544 HIV-negative men who have sex with men (MSM) to receive PrEP immediately or deferred for a year. The trial demonstrated that PrEP was highly effective at preventing HIV transmission. In this thesis, I consider four further questions: (1) Who should access PrEP? (2) How appropriate are epidemiological measures that are commonly used for PrEP and other prevention strategies? (3) Is PrEP-use associated with an increased risk of sexually transmitted infections (STIs)? and (4) What is the risk of hepatitis C (HCV) among PrEP-users? The highest risk of HIV acquisition was associated with a rectal STI or syphilis diagnosis in the previous year, or reporting condomless receptive intercourse with two or more partners in the previous three months. MSM meeting these criteria are therefore in most need of PrEP. STI diagnoses were more common among PrEP-users, found in both the randomised and pre-/post-PrEP comparisons. It was unclear whether this was driven by a difference in screening or sexual behaviour. Regardless, PrEP-using MSM are at high risk of STIs, and frequent screening in a PrEP programme would likely help control onward transmission. HCV incidence was high and increased during the four-year period of follow-up, doubling in the final year. Risk varied according to reported risk factors. Thus, the current recommendation of quarterly HCV screening for all PrEP-using MSM may not be appropriate unless there is a localised epidemic. My findings show that MSM seeking PrEP have a high but heterogeneous risk of sexually transmitted diseases, with variation according to individual- and population-level risk factors. PrEP programmes need to allocate sufficient provisions to screen for and treat other clinical outcomes, including STIs and HCV.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | HIV pre-exposure prophylaxis: additional insights through secondary analyses of the PROUD trial |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | PrEP, pre-exposure prophylaxis, Men who have sex with men, MSM |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10091955 |
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