Effectiveness among MSM of an HIV PrEP program developed in a Parisian sexual health center

Background HIV pre-exposure prophylaxis (PrEP) is highly effective but depends on patients' adherence and follow-up. To enhance follow-up quality and care engagement, the PrEP program developed in our Parisian sexual health center offers accompanying measures throughout the patients' course of care, relying notably on an identified and easily accessible referent. This trained paramedic counselor in sexual health provides support in organizing appointments, phone and email follow-up to answer daily questions, as well as one-on-one sessions of therapeutic support and counseling. This study aimed to assess the effectiveness of such a PrEP program among men who have sex with men (MSM). Methods This retrospective observational study included all MSM who initiated PrEP for the first time between 1 August 2018 and 30 June 2019 in the Fernand-Widal hospital sexual health center, Paris, France. Sociodemographic characteristics, sexual practices including very high risk situations (chemsex practice and/or sexually transmitted diseases at initiation and/or history of post-exposure prophylaxis [PEP]) and course of care during the first year were described. A novel metric developed by Hendrickson et al., the PrEP success ratio at 12 months, was used to assess effectiveness of PrEP. Results Among the 125 MSM included in this study, the median age was 33 and most had only male partners. At initiation, 58% were considered at very high risk of HIV infection, mainly due to a history of PEP. During the first year, patients attended a median of 3 visits (Q1-Q3, 2-4). At 12 months, 96% (95% CI, 92.6 to 99.4) of patients had a successful PrEP course, with no reported seroconversion. Conclusions This experiment highlights the possibility of achieving a high PrEP success ratio among MSM in a real-world setting. The accompanying measures set up in our sexual health center could explain the effectiveness of our PrEP program in comparison with previous studies. Key messages In a Parisian sexual health center that developed an HIV PrEP program with a trained paramedic counselor in sexual health, 96% of MSM achieved a successful PrEP course at 12 months. Accompanying measures for PrEP users could play a key role in achieving high PrEP success among MSM.