High PrEP uptake, adherence, persistence and effectiveness outcomes among young Thai men and transgender women who sell sex in Bangkok and Pattaya, Thailand: findings from the open-label combination HIV prevention effectiveness (COPE) study

Brian W Weir; Andrea L Wirtz; Tareerat Chemnasiri; Stefan D Baral; Michele Decker; Chen Dun; Sandra Hsu Hnin Mon; Chaiwat Ungsedhapand; Eileen F Dunne; Joseph Woodring; Sarika Pattanasin; Wichuda Sukwicha; Michael C Thigpen; Anchalee Varangrat; Anchalee Warapornmongkholkul; Siobhan O'Connor; Julie P Ngo; Noor Qaragholi; Haley I Sisel; Jasmine M Truong; Surang Janyam; Danai Linjongrat; Somchai Sriplienchan; Pachara Sirivongrangson; James F Rooney; Patrick Sullivan; Boosbun Chua-Intra; Andrew C Hickey; Chris Beyrer; COPE Study Teamabcdefghijklmn; COPE Study Team

doi:10.1016/j.lansea.2023.100217

High PrEP uptake, adherence, persistence and effectiveness outcomes among young Thai men and transgender women who sell sex in Bangkok and Pattaya, Thailand: findings from the open-label combination HIV prevention effectiveness (COPE) study

Lancet Reg Health Southeast Asia. 2023 May 25:15:100217. doi: 10.1016/j.lansea.2023.100217. eCollection 2023 Aug.

Authors

Brian W Weir^{1

2}, Andrea L Wirtz¹, Tareerat Chemnasiri^{3

4}, Stefan D Baral¹, Michele Decker^{1

5}, Chen Dun^{1

2}, Sandra Hsu Hnin Mon¹, Chaiwat Ungsedhapand^{3

4}, Eileen F Dunne^{3

4}, Joseph Woodring^{3

4}, Sarika Pattanasin^{3

4}, Wichuda Sukwicha^{3

4}, Michael C Thigpen^{3

4}, Anchalee Varangrat^{3

4}, Anchalee Warapornmongkholkul^{3

4}, Siobhan O'Connor³, Julie P Ngo^{1

6}, Noor Qaragholi¹, Haley I Sisel^{1

6}, Jasmine M Truong¹, Surang Janyam⁷, Danai Linjongrat⁸, Somchai Sriplienchan⁷, Pachara Sirivongrangson⁴, James F Rooney⁹, Patrick Sullivan¹⁰, Boosbun Chua-Intra⁴, Andrew C Hickey^{3

4}, Chris Beyrer^{1

11}; COPE Study Teamabcdefghijklmn; COPE Study Team

Collaborators

Chris Beyrer, Andrea Wirtz, Brian Weir, Stefan Baral, Michele Decker, Sandra Hsu Hnin Mon, James Case, Chen Dun, Jasmine Truong, Noor Qaragholi, Julie Ngo, Haley Sisel, Pachara Sirivongrangson, Boosbun Chua-Intra, Anupong Chitwarakorn, Wasin Matsee, Pratakpong Wongkiti, Chidanan Krasan, Anchana Chainuwong, Nauwarat Imlimtharn, Potcharawan Reansoi, Teeraparp Watanatanyaporn, Jarupa Nuamlert, Supannikar Namwong, Jutarat Phetnark, Wachirawit Supasa, Siriporn Sueayot, Andrew Hickey, Michael Thigpen, Eileen Dunne, Joseph Woodring, Christie Vu, Siobhan O'Connor, Patrick Flaherty, Timothy Holtz, Tareerat Chemnasiri, Anchalee Varangrat, Anchalee Warapornmongkholkul, Anekpong Chanthaweesirirat, Warunee Thienkrua, Wichuda Sukwicha, Pitthaya Disprayoon, Kanjana Kamkong, Dararat Worrajittanon, Supawadee Na-Pompet, Chonlanot Sariwatta, Patnaree Oungprasertgul, Phanurassamee Sittidech, Jirawat Suksamosorn, Kesinee Sujina, Chaiwat Ungsedhapand, Wannee Chonwattana, Nichnawee Kamchaithep, Sarika Pattanasin, Nongkran Tatakham, Pikunchai Luechai, Philip Mock, Betsy Cadwell, Ram Shrestha, Baranee Balmongkol, Boonyos Raengsakulrach, Wanna Leelawiwat, Wanna Suwannaphan, Achara Sriinsut, Punneeporn Wasinrapee, Pornchanok Chanathalay, Nutthawoot Promda, Santi Winaitham, Oranuch Kongpechsatit, Kusuma Auethavornanan, Jaray Tongtoyai, Pairote Tararut, Atitaya McNamara, Famui Mueanpai, Natthaga Sakulploy, Kanokpan Pancharoen, Chariya Utenpitak, Caroline Fukuda, Thitima Cherdtrakulkiat, Tanyawarin Janthiraj, Anuwat Sriporn, Natee Prathummart, Patsaraporn Khongsom, Navakarn Navanuch, Rinda Wongbenchaporn, Chanya Peerapatdit, Pechpailin Khlaimanee, Patcharat Niyamakom, Narongritt Tippanont, Somsak Yafant, Tatchai Ruanpang, Siripak Pongthai, Kamolnetr Okanurak, Aronrag Meeyai, Danai Linjongrat, Phubet Panpet, Orawan Fungfoosri, Prisana Boonyawan, Theeranat Sangprasert, Natthawirojn Inthanin, Teppanan Sangiamjit, Somporn Saiwaew, Konlawat Pawong, Surang Janyam, Chamrong Phaengnongyang, Atachai Phunkron, Denchai Srikrongthong, Thanaphat Dokrak, Phathranis Meekrua, Saman Sumalu, Cawee Kanlose, Prasopsuk Thapwong, Kritsanapol Kaewboonta, Pornpichit Brutrat, Waris Watthanayeam, Apichat Udomjirasirichot, Somchai Sriplienchan, Midnight Poonkasetwattana, Silapakhon Kongsakul, Michael Badorrek, Andrey Tran, Ryan Figueiredo, Safir Soeparna, Wattana Keiangpa, Apiwit Tibamrung, Sunadda Samana, Hidayah Syahputra, Worapon Rattanawarawong, Patrick Sullivan, Rachel Valencia, Usha Sharma, Adeola Adeyeye, James Rooney, Pojjana Hunchangsith, Tanyaporn Wansom, Thomas Guadamuz, Annette Sohn

Affiliations

¹ Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁴ Division of HIV Prevention, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
⁵ Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁷ Service Workers in Group Foundation (SWING), Bangkok and Pattaya, Thailand.
⁸ Rainbow Sky Association of Thailand (RSAT), Bangkok, Thailand.
⁹ Medical Affairs, Gilead Sciences, Foster City, CA, USA.
¹⁰ Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
¹¹ Duke Global Health Institute, Duke University, Durham, NC, USA.

Abstract

Background: Daily oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection, but no study has evaluated combination prevention interventions with PrEP for transgender women (TGW) and men who have sex with men (MSM) who sell sex.

Methods: The Combination Prevention Effectiveness (COPE) study was a community-based, non-randomized implementation study in Bangkok and Pattaya, Thailand. Participants were HIV-negative MSM and TGW aged 18-26 years who reported exchanging sex with men in the prior 12 months and who met 2014 U.S. Public Health Service PrEP eligibility criteria. The intervention included quarterly HIV testing, semiannual testing for sexually transmitted infections, provision of condoms with lubricant, and the opportunity to initiate or end daily oral PrEP use at any time during study participation. Participants taking PrEP received monthly adherence counseling and short message service reminders. The primary outcome was HIV incidence rate ratio (IRR) on PrEP vs. not on PrEP. Secondary outcomes were PrEP initiation, PrEP use at 12 months, and PrEP adherence.

Findings: From October 2017 to August 2019, 846 participants were enrolled: 531 (62.8%) immediately initiated PrEP; 104 (12.3%) subsequently initiated PrEP, and 211 (24.9%) never initiated PrEP. Among those initiating PrEP within 30 days of enrollment; 85.9% were on PrEP at the 12-months. When taking PrEP, participants reported adherent PrEP use at 94.2% of quarterly assessments. Ten HIV seroconversions occurred without PrEP use (incidence rate [IR] = 3.42 per 100 person-years [PY]; 95% CI = 1.64-6.30), while zero cases occurred with PrEP use (IR = 0.0 per 100PY; 95% CI = 0.0-0.62), with IRR = 0.0 (95% CI = 0.0-0.22; p < 0.001).

Interpretation: Young Thai MSM and TGW who exchange sex can have high PrEP uptake, persistence and adherence, and low HIV incidence when offered in supportive community-based settings.

Funding: U.S. National Institute of Allergy and Infectious Diseases; Centers for Disease Control and Prevention.

Keywords: HIV; Men who have sex with men; Pre-exposure prophylaxis; Prevention; Sex work; Thailand; Transgender persons.