Parsons, VL;
(2016)
Understanding the acceptability and utility of early antiretroviral therapy to reduce transmission of HIV amongst men who have sex with men in the UK.
Doctoral thesis , UCL (University College London).
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Abstract
High viraemia in early HIV infection (EHI) may contribute disproportionately to onward transmission in men who have sex with men (MSM) but early antiretroviral therapy (ART) could minimise risk of transmission. The effectiveness of this strategy depends on viral load (VL) at presentation, sexual behaviour and ART acceptability, which are unknown. This thesis combines quantitative and qualitative methods to understand the acceptability and utility of early ART to reduce HIV transmission in UK MSM. Using UK Register of HIV Seroconverters data I examined temporal trends in ART initiation and VL at presentation, using Kaplan-Meier and logistic regression. An in-depth interview and cross-sectional survey explored and quantified men’s attitudes, beliefs and acceptability of early ART and sexual behaviour. Using logistic regression I examined factors associated with early ART initiation and high-risk sex post diagnosis. VL peaked in men presenting ~30 days post-seroconversion, plateauing ~day 100. Median(95% CI) time from seroconversion to ART initiation decreased, from 3.7(3.2,4.9) years pre-2000 to 1.4(1.3,1.7) in 2010-11. Early ART was acceptable; 67%(76/114) would have accepted it at diagnosis and 47%(55/116) had initiated it. ART initiation was more likely if men believed it had health benefits or their clinician recommended it. It was perceived to reduce transmission anxiety and provide holistic health benefits, but fear of toxicities and stigma were potential barriers to initiation. Transmission risk was low postdiagnosis; 32%(37/117) abstained from sex and 21%(24/117) exclusively used condoms. However, 35%(41/117) reported high-risk sex, associated with treatment optimism, ChemSex and higher partner numbers pre-diagnosis. Early ART was acceptable to MSM to prevent transmission, and for perceived holistic health benefits. It is unlikely, however, to be effective in reducing transmission risk during peak viraemia given the low proportion presenting at that stage. Expansion of HIV testing is required to identify MSM during that stage.
| Type: | Thesis (Doctoral) |
|---|---|
| Title: | Understanding the acceptability and utility of early antiretroviral therapy to reduce transmission of HIV amongst men who have sex with men in the UK |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| UCL classification: | 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 > Inst of Clinical Trials and Methodology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1524367 |
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