Event-driven dosing of HIV preexposure prophylaxis (PrEP) using a 2-1-1 regimen is efficacious for men who have sex with men (MSM). However, data are limited on the prevalence, correlates, and patterns of non-daily PrEP use in the U.S.
Nationwide online survey.
We distributed a survey to assess experiences with PrEP, including non-daily use, in May 2019 on geosocial networking sites commonly used by MSM.
Among 9,697 respondents, mean age was 43 years, 67% were non-Hispanic white, and 90% were MSM. Nearly all (91.0%) had heard of PrEP, 40.1% ever used PrEP, and 33.3% used PrEP in the last 6 months. Most (60.6%) were interested in non-daily PrEP. Those without health insurance and those with higher incomes were more likely to be interested in non-daily PrEP. Of the 3,232 who used PrEP in the past 6 months, 176 (5.4%) reported non-daily use. Fewer sexual partners, frequent sex planning, and substance use were associated with non-daily use. Common reasons for non-daily use were inconsistent sexual activity (59%) and cost (49%). The most prevalent regimen was event-driven (48.3%); of those, 64.7% used 2-1-1. Of non-daily users, 24.0% used PrEP on a regular schedule but not every day, including only on weekends or days starting with T or S.
Given substantial interest in non-daily PrEP, and use of non-daily strategies that have not been evaluated in clinical studies, there is a need for U.S. public health authorities to provide guidance on safe and effective non-daily dosing for MSM.