Sexuality

ImportanceHIV self-testing (HIVST) with online real-time support by human administrators (HIVST-OIC) is an evidence-based HIV intervention for men who have sex with men (MSM) but requires intensive resources to implement.ObjectiveTo investigate whether a novel HIVST service using a chatbot to deliver online real-time instruction and counseling support (HIVST-chatbot) is noninferior to the HIVST-OIC in increasing HIVST uptake and counseling support for MSM.Design, setting, and participantsA partially blinded, parallel-group, and noninferiority randomized clinical trial was conducted between April 16, 2023, and May 31, 2024, in Hong Kong, China. Eligible participants were Hong Kong-based, Chinese-speaking MSM 18 years or older who reported anal intercourse with men in the past 6 months and had access to WhatsApp. Participants were recruited via gay venues, online recruitment, and peer referrals and then randomized to the HIVST-chatbot or HIVST-OIC groups. Both intention-to-treat (ITT) and complete case analyses were performed. The noninferiority margin was set at 10 percentage points.InterventionsStandard-of-care pretest and posttest counseling was delivered by a chatbot for the HIVST-chatbot group and by trained human administrators in the HIVST-OIC group. Both groups received free HIVST kits.Main outcomes and measuresPrimary outcomes included self-reported HIVST uptake and receiving any counseling support along with HIVST, validated by the research team.ResultsA total of 531 participants (mean [SD] age, 34.8 [9.3] years) were randomized to either the HIVST-chatbot (n = 266) or HIVST-OIC (n = 265) groups. In ITT analysis, the HIVST-chatbot was noninferior to the HIVST-OIC in increasing HIVST uptake (216 [81.2%] vs 227 [85.7%]; proportion difference, -4.5 percentage points; 95% CI, -9.8 to 0.8 percentage points; 1-sided P = .10) and proportion of HIVST users who received counseling support (197 [91.2%] vs 142 [62.6%]; proportion difference, 28.7 percentage points; 95% CI, 22.5 to 34.8 percentage points; 1-sided P Conclusions and relevanceIn this randomized clinical trial, the HIVST-chatbot was noninferior to the HIVST-OIC in increasing HIVST uptake and counseling among HIVST users. These results suggest that the HIVST-chatbot might be an alternative to the evidence-based HIVST-OIC service for MSM.Trial registrationClinicalTrial.gov Identifier: NCT05796622.

BackgroundOral pre-exposure prophylaxis (PrEP) effectively prevents HIV but remains unevenly accessible across Europe. Long-acting PrEP (LA-PrEP), recently approved in Europe, offers new HIV protection options. However, no qualitative evidence is available to inform people's perceptions of this novel modality.ObjectiveThis study provides the first large-scale, qualitative evidence in English from 20 European countries on how men who have sex with men (MSM) and trans* individuals perceive LA-PrEP.MethodsWe analyzed open-ended responses from 3123 HIV-negative MSM and trans* individuals from 20 European countries who completed the PROTECT survey in English. Participants were asked to describe what LA-PrEP means to them using words or short phrases. We used word clouds for initial insights and structural topic modeling to identify topics and explore their relevance across socioeconomic status, migration background, oral PrEP use, and affordability and the association of these perceptions with LA-PrEP intention.ResultsThe responses reflected generally positive associations toward LA-PrEP, with the most frequently mentioned word being "safe," "freedom," and "convenient." However, some ambivalent and negative perceptions, such as "nothing," "unknown," "dunno," and "unnecessary," were also noted. Structural topic modeling identified 5 main response topics: safety, empowerment, convenience/reliability, peace of mind, and concerns/uncertainties. The empowerment offered by LA-PrEP was the most prominent topic, representing one third (28.1%) of the responses, followed by safety (21%), convenience and reliability (16%), and peace of mind (15%), while concerns/uncertainties made up 20%. Variation in the relevance of these topics was found, showing LA-PrEP being seen as more empowering (=.070, 95% CI 0.042-0.097) and convenient (=.057, 95% CI 0.034-0.081) by current oral PrEP users, but less empowering (=-.052, 95% CI -0.087 to 0.017) and convenient (=-.034, 95% CI -0.064 to 0.005) for individuals in countries with limited oral PrEP access and affordability. The topic of safety was more relevant among those with lower levels of education (=.052, 95% CI 0.022-0.083) and those living in a country where PrEP was not reimbursed (=.035, 95% CI 0.002-0.069), but less relevant among current oral PrEP users (=-.094, 95% CI -0.12 to 0.066). We also found that ambivalent and negative perceptions were less relevant among current oral PrEP users (=-.032, 95% CI -0.056 to 0.007) and were negatively associated with a lower intention to use LA-PrEP (=-.075, 95% CI -0.101 to 0.005).ConclusionsOur research showed that MSM and trans* individuals in Europe generally have a positive outlook on LA-PrEP, suggesting it is likely to be well accepted upon its introduction in Europe. However, a subset of the target population may be hesitant to adopt LA-PrEP, underscoring the need for alternative HIV prevention strategies tailored to these individuals. To support potential future LA-PrEP implementation in Europe and to maximize its impact, appropriate communication strategies are essential for supporting informed decision-making.

Long-acting injectable PrEP (LAI-PrEP) provides opportunities to expand HIV prevention coverage in the Netherlands. Understanding which Dutch gay, bisexual and other men who have sex with men (GBMSM) are interested in using LAI-PrEP when available can support HIV prevention efforts. Survey data was collected online via the PROTECT survey from 1,447 GBMSM in the Netherlands between October 2023 and March 2024. Multivariable logistic analysis was conducted to determine variables associated with GBMSM who intend to use LAI-PrEP when available. Interest and intention to use LAI-PrEP among Dutch GBMSM is high (76.1% and 73.9%) and among those currently on oral PrEP even higher (80.8% and 79.5%). GBMSM who intend to use LAI-PrEP have more sexual partners in the past 6 months (11-50 partners (aOR = 3.24; 95%CI: 1.54-6.85), 51-100 partners (aOR = 3.10; 95% CI: 1.20 to 8.30), more than 150 partners (aOR = 3.86; 95% CI: 1.74 to 8.67)), engage more in chemsex (aOR = 1.41; 95% CI: 1.00 to 2.01), are less likely to fear LAI-PrEP side effects (aOR = 0.83; 95% CI: 0.74 to 0.94;) or injection pain (aOR = 0.68; 95% CI: 0.61 to 0.75) and more likely to believe they are at risk of acquiring HIV (aOR = 1.23; 95% CI: 1.05 to 1.45). If made available in the Netherlands, many GBMSM are likely to commence using LAI-PrEP, particularly current oral PrEP users or discontinued users. Sexually active Dutch GBMSM, who are already protecting themselves, may be the first group to use LAI-PrEP.