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Trump's final legacy may be overseeing the most federal executions in years. Cat group livid over Newcastle's botched 'Rambo-style' cull. The predictors considered included sociodemographic factors, mental health, lifestyle factors, and sexual health and behaviours reported in past questionnaires associated with subsequent PrEP initiation. We did an additional cross-sectional analysis to examine factors associated with being on PrEP, using all available baseline and annual questionnaires. We used GEE models with a logit link function, adjusted for age as a continuous variable.


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Also, separately among PrEP users, we analysed factors associated with reporting non-prescribed PrEP ie, PrEP obtained via the internet, friends, or others sources using all available annual questionnaires in which PrEP use was reported. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

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The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Baseline sociodemographic, health and lifestyle characteristics, sexual behaviour, and PrEP and PEP use among participants who completed the baseline, follow-up, and annual questionnaires in the AURAH2 study, — Data are from baseline paper questionnaire. Condomless sex refers to condomless anal sex.

A higher proportion of participants who were older, had greater financial security, and with more stable housing status continued on the study than did those who were younger, who only sometimes or did not have money to cover basic needs and who had unstable or no housing table 1.

The number of follow-up questionnaires 4-monthly and annual completed by the end of the study period was To describe PrEP and PEP awareness at enrolment by calendar period of baseline questionnaire, we used data from of participants who completed a baseline questionnaire one questionnaire was excluded from the analysis due to missing data. To describe changes in past 12 month PrEP and PEP use over calendar time, we used data from questionnaires baseline and annual follow-up from participants.

By contrast, some fluctuation was seen in the trend of past month use of PEP. Prevalence of condomless sex with two or more partners and prevalence of PrEP use among these men, — Condomless sex is condomless anal sex. The proportion of respondents who reported PrEP use who also reported sourcing their PrEP from the internet increased over time. To examine factors associated with initiating PrEP, we restricted our analysis to the participants who reported no previous PrEP use in the baseline questionnaire and who completed at least one annual follow-up questionnaire data from questionnaires.

The PrEP initiation rate increased substantially from to Compared with the category of younger than 25 years, rate of PrEP initiation was increased in the age categories of 40—44 years and age 45 years and older. In age-adjusted models, non-employment and unstable housing were significantly associated with a reduced rate of PrEP initiation compared with being a homeowner.

Behavioural factors associated with higher rates of PrEP initiation within the past 12 months were having a recent HIV test; reporting condomless sex; condomless sex with two or more partners, group sex, use of non-injected chemsex-related drugs, and use of PEP in the past 12 months table 2. Longitudinal analysis of factors associated with initiating PrEP and cross-sectional analysis of factors associated with being on PrEP in the previous 12 months.

Ethnicity, sexual identity, education, employment, money status, and housing status are fixed variables; age, lifestyle characteristics, and HIV-risk behaviour are time-varying variables. To assess factors associated with reporting PrEP use in the previous year, we used data from questionnaires representing respondents baseline and follow-up; table 2.

In particular, older age and later calendar year were strongly associated with increased use of PrEP, while unstable or other housing was associated with less use of PrEP than being a homeowner. Behavioural factors associated with reporting the use of PrEP were a recent HIV test, reporting condomless sex, condomless sex with two or more partners, group sex, non-injection chemsex-related drugs use, and PEP use.

Introduction

Country of birth and ethnicity, sexual identity, education, ongoing relationship, higher alcohol use, STI diagnosis, and symptoms of depression and anxiety were not associated with initiation of PrEP or use of PrEP table 2. In an additional analysis we looked at the association between health and behavioural factors and source of PrEP amongst those reporting use questionnaires from participants. The PrEP Impact trial started recruitment in and the rate of PrEP initiation among the men in our study, who at least at baseline had attended these study sites, increased by more than twenty times in —18 compared with before The high proportion of men accessing PrEP online despite the PrEP Impact trial opening for enrolment might have been because available places were rapidly filled and recruitment was closed temporarily.

Substantial advocacy efforts from community-based organisations have also contributed to some men accessing PrEP online. In our analysis, older age was independently associated with being more likely to initiate PrEP, with the rate of initiation among men aged 40 years and older being four times higher than among those younger than 25 years.


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This finding was similar to that in a cohort in Amsterdam in which the median age among men initiating PrEP was 40 years, 14 and a cohort in Australia in which rates of PrEP initiation were highest among men aged 40 years and older. Previous research in the UK has shown that lower socioeconomic situation is associated with worse HIV treatment outcomes among individuals living with HIV. High-risk sexual behaviours such as condomless sex, condomless sex with two or more partners, group sex, and using non-injection chemsex-related drugs were also associated with PrEP use, indicating appropriate use of PrEP by these men.

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Similar to our findings, a recent national online prospective study in Australia reported that younger age, less use of illicit party or sex drugs, and lower engagement in HIV sexual risk behaviours such as group sex or any condomless sex, were independently associated with non-uptake of PrEP. These data would support the national roll-out of PrEP in England. Our study has some limitations. Men in this cohort were recruited from three sexual health clinics in urban areas in southeast England, and so the sample size was relatively small and these men might not be representative of the broader MSM population in England and the UK.

Trends in use and predictors of PrEP initiation might also differ among MSM who are not engaged with sexual health clinics.


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Additionally, the sample comprised predominantly men who were highly educated, employed, in a stable economic situation, of white ethnicity, and with access to the internet follow-up questionnaires were only available online, therefore to complete the questionnaires participants needed an internet connection , which might not allow generalisability to all MSM living in England.

However, the Australian prospective cohort study that used a more diverse sample of MSM reached similar findings as were observed in our study. Recall bias and social desirability bias might be evident in these self-reported data; however, the study collected sensitive and personal data through an online follow-up questionnaire, which might have reduced such bias. In summary, this study provides important data for PrEP implementation in England.

PrEP use has increased substantially over the past 5 years, with a high proportion of PrEP being obtained via the internet.

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Our data suggest that men engaging in sexual behaviour related to high HIV risk, who are older, and those of higher socioeconomic status are significantly more likely to use PrEP. To transition participants of the PrEP Impact trial onto the nationally commissioned programme, an interim supply of PrEP will be made available by the trial for participants with an ongoing need for PrEP and who attend services where the national programme has not yet commenced. The results of our study can inform the implementation of the national programme by highlighted patient groups who might be at increased risk of HIV infection but less likely to be aware of or using PrEP and who could benefit most from public health outreach and advice.

Improving access to PrEP via routine commissioning by NHS England could increase PrEP use among all eligible MSM and reduce socioeconomic disparities, if it is accompanied by an understanding of these disparities and tailoring of public health message and services to address them. Any personally identifiable data cannot be made publicly available to protect participants privacy.

All other relevant data are available upon request to the corresponding author. SC contributed to the conception of the analysis, interpretation of data, and final approval of the manuscript. NH did all analyses and drafted the manuscript. All authors contributed to the conception of this analysis and participated in interpretation of data, revising, and final approval of the manuscript.

AC reports personal fees and other from Gilead Sciences conference and educational travel bursaries, and consultancy fees , personal fees from ViiV Healthcare conference travel bursaries and consultancy fees outside of the submitted work. All other authors declare no competing interests. Read article at publisher's site DOI : To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

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