Patterns of sex and PrEP in Bangkok MSM (HPTN 067/ADAPT Study) Tareerat Chemnasiri, Anchalee Varangrat, K. Rivet Amico, Supaporn Chaikummao, Anupong Chitwarakorn, Bonnie J. Dye, Robert M. Grant, Timothy H. Holtz, and the HPTN 067/ADAPT Study Team July 20 th, 2015

Qualitative component methods In August 2013 and March 2014, 38 HPTN 067/ADAPT MSM participants joined a qualitative evaluation: 32 participants joined in 6 focus-group discussions (FGDs) and 6 attended key-informant interviews (KIIs), 2 per each study regimen after they completed 34 weeks of study follow-up. We double-coded Thai transcripts and analyzed qualitative data using Atlas.ti (v.7.1) computer software. Grounded theory and content analysis were used to analyze the data.

Results Socio-demographic characteristics N=38% Age (years) Median = 30 Range = > Employment statusFull-time employment Part-time employment Not employed EducationCompleted primary school Completed technical training Not completed college Completed college Marital statusNever married38100

Patterns of sex Have sex frequently Prefer not to plan for sex Do not have control over planning for sex with sexual partners Self-perceived of having high HIV risk Pros Easily taken, can take with daily vitamins Able to set tablet-taking time regardless of sex No need to carry tablets No need to disclose about PrEP use Cons Concerns about long-term impacts and side effects Fear of being seen as being HIV-infected Difficult to use if sex were infrequent Difficulty to take daily for long period of time Routine change Tablet fatigue Affordability Daily regimen

“It would be awkward to take a tablet before or after sex. The sexual partner would ask what the tablet was for. But for daily dose, I could say it was dietary supplement. That’s easy.” (FGD/Daily arm) “I’m not at risk of getting HIV and I don’t do anything to make myself at risk. I don’t even have sex, why I need to take tablets daily.” (KII/Daily arm)

Patterns of sex Have infrequent sex events Inability to plan sex / have no control over planning for sex with sexual partners Pros Fewer doses (less concerns about side effects) Able to choose the day to take tablets (2 doses/week) No need to plan for sex (keep few tablets in pocket for post-sex dose after unexpected sex event) Cons Difficulty in linking routine activity with 2 tablet-taking days Complicated regimen (No more than 1 dose in a 2 hour window) Need to carry few tablets at all times Difficult to hide tablets from sexual partners Planning for sex made sex no longer enjoyable Time- driven regimen

“My boyfriend always controls when to have sex, even though it is not often. So, I continue to take tablet 2 days a week and just wait for the sex to happen.” (FGD/Time-driven arm) “I don’t plan for sex, I only carry tablets with me all the time.” (FGD/Time-driven arm)

Patterns of sex Have infrequent sex events Ability of sex planning / have control over planning for sex with sexual partners Pro Fewer doses (less concerns about side effects) Cons Need sex planning Need to carry tablets at all times (pre/post-sex dose) Difficult to hide tablets from sexual partners Regimen confusion (need to count by the hour) Complicated regimen (No more than 1 dose in a 2 hour window) Event- driven regimen

“I always ask for sex from my boyfriend. Sometimes, he says yes. Sometimes, he’s tired. But, if I’m really horny I would take a tablet and get what I want.” (FGD/Event-driven arm) “After coming back from the bar, I took a tablet at 2 am right before having sex and I had to wait 2 hours to take post sex dose at 4 am. I already fell asleep by then.” (KII/Event-driven arm)

Daily dose is the easiest regimen without ability of planning for sex, but there are concerns about long-term impact and affordability Non-daily PrEP would be another choice for those MSM who have infrequent sex events, capacity to plan for sex, and ability to take a post-sex dose Summary

Preferences for regimens varied within each group, highlighting the need for different PrEP regimen options for MSM. PrEP adherence counseling should be given to PrEP user in order to remind how important the adherence is and to ensure user’s understanding on how to take tablets correctly. Disseminating information about PrEP mitigates stigma and fosters more effective use. Conclusions Poster presentation # WELBPE23

The HIV Prevention Trials Network is sponsored by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the National Institute on Drug Abuse, all components of the U.S. National Institutes of Health. ACKNOWLEDGEMENTS The HPTN 067 Bangkok Study Team acknowledges: Our participants Study staff at Silom Community Thailand Ministry of Public Health Epidemiology Branch, Division of HIV/AIDS Prevention, CDC MSM Community Advisory Board FHI 360 SCHARP HPTN Laboratory Center