Sexual behavior and sexually transmitted infections among HIV pre-exposure prophylaxis users

Abstract

Pre-Exposure Prophylaxis (PrEP) is an HIV sexual prevention strategy for HIV-seronegative people. It consists of a pill containing antiretroviral (ARV) drugs with more than 90% efficacy among those with high adherence to medication. PrEP has been implementing worldwide as part of HIV prevention programs since 2015. However, there is the concern of the increased incidence of other Sexually Transmitted Infections (STIs), such as those caused by Chlamydia trachomatis (CT) and by Neisseria gonorrhea (NG), as a consequence of increased sexual risk behavior by its users. The presence of an STI may reduce the potential benefits of ARV-based prevention strategies because it increases the chance of HIV sexual transmission. Therefore, this study aims to analyze sexual behavior, self-perception of risk, and the incidence of STIs and HIV among people during three months of PrEP uptake. This is a prospective cohort study of mixed-method (quanti - qualitative) explanatory, with a pre and post-test research model. The study will carry out in a Specialized Care Service in Ribeirão Preto-SP. HIV-seronegative people using PrEP for the first time will fill the sample. Data will be collected monthly through individual interviews, and online surveys using the Research Electronic Data Capture (REDCap) platform. We will evaluate sex behavior, risky practices, and preventive strategies. During the pre and post-test interviews (in person), it will be collected urethral and anal swabs for the screening of Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae (NG). This material will be analyzed in the Virology Laboratory of the Faculty of Medicine of Ribeirão Preto (FMRP) through real-time PCR (RT-PCR), using commercial kits specific for each pathogen and the ABI 7500 FastTrack equipment. The investigation of syphilis and viral hepatitis will occur by the exams available on the Unified Health System. The qualitative data collection will take place on the day of the post-test. In-depth individual interviews will be conducted guided by a semi-structured script covering the knowledge about PrEP, motivation, and advantages for PrEP uptake, and self-perceived risk for HIV and other STIs. Data will be analyzed using descriptive statistics to characterize the participants. Other analyzes include Incidence Ratio (RI), Confidence Interval, descriptive analysis of position, and variability measurements. The study will be sent and appreciated by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing. (AU)