{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:24:34Z","timestamp":1791491074359,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess frequency and predictors of switching between being on and off PrEP and being lost to follow\u2010up (LTFU) among men who have sex with men (MSM) and transgender women (TGW) with access to PrEP services in Sub\u2010Saharan Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective cohort study of MSM and TGW from coastal Kenya who initiated daily oral PrEP from June 2017 to June 2019. Participants were followed monthly for HIV\u20101 testing, PrEP refill, risk assessment and risk reduction counselling. Follow\u2010up was censored at the last visit before 30 June 2019, or the last HIV\u20101\u2010negative visit (for those with HIV\u20101\u00a0seroconversion), whichever occurred first. We estimated transition intensities (TI) and predictors of switching: (i) between being off and on PrEP; and (ii) from either PrEP state and being LTFU (i.e. not returning to the clinic for &gt;\u00a090\u00a0days) using a multi\u2010state Markov model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 134 participants starting PrEP were followed for a median of 20.3\u00a0months [interquartile range (IQR): 7.7\u201322.1]. A total of 49 (36.6%) people stopped PrEP 73 times [TI =\u00a00.6\/person\u2010year (PY), 95% confidence interval (CI):\u00a00.5\u20130.7] and, of these, 25 (51.0%) restarted PrEP 38 times (TI =\u00a01.2\/PY, 95% CI: 0.9\u20131.7). In multivariable analysis, stopping PrEP was related to anal sex \u2264\u00a03\u00a0months, substance\u2010use disorder and travelling. Restarting PrEP was related to non\u2010Christian or non\u2010Muslim religion and travelling. A total of 54 participants were LTFU: on PrEP (<jats:italic>n<\/jats:italic>\u00a0=\u00a047, TI = 0.3\/PY, 95% CI: 0.3\u20130.5) and off PrEP (<jats:italic>n<\/jats:italic>\u00a0=\u00a07, TI = 0.2\/PY, 95% CI: 0.1\u20130.4). In multivariable analysis, becoming LTFU while on PrEP was associated with secondary education or higher, living in the area for \u2264\u00a01\u00a0year, residence outside the immediate clinic area and alcohol\u2010use disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Switching between being on and off PrEP or becoming LTFU while on PrEP was frequent among individuals at risk of HIV\u20101 acquisition. Alternative PrEP options (e.g. event\u2010driven PrEP) may need to be considered for MSM and TGW with PrEP\u2010taking challenges, while improved engagement with care is needed for all MSM and TGW regardless of PrEP regimen.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.13237","type":"journal-article","created":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T03:43:33Z","timestamp":1643341413000},"page":"750-763","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Stopping and restarting PrEP and loss to follow\u2010up among PrEP\u2010taking men who have sex with men and transgender women at risk of HIV\u20101 participating in a prospective cohort study in Kenya"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8386-7555","authenticated-orcid":false,"given":"Elizabeth","family":"Wahome","sequence":"first","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Boyd","sequence":"additional","affiliation":[{"name":"Public Health Service of Amsterdam Department of Infectious Diseases Amsterdam The Netherlands"},{"name":"Stichting HIV Monitoring Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander N.","family":"Thiong\u2019o","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khamisi","family":"Mohamed","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Oduor","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evans","family":"Gichuru","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Mwambi","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"van der Elst","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"},{"name":"Department of Global Health University of Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Graham","sequence":"additional","affiliation":[{"name":"Departments of Global Health, Medicine, and Epidemiology University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Prins","sequence":"additional","affiliation":[{"name":"Public Health Service of Amsterdam Department of Infectious Diseases Amsterdam The Netherlands"},{"name":"Amsterdam UMC Department of Infectious Diseases Amsterdam Institute for Infection and Immunity (AII) University of Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1062-8921","authenticated-orcid":false,"given":"Eduard J.","family":"Sanders","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme Centre for Geographic Medicine Research\u2013Coast Kilifi Kenya"},{"name":"Department of Global Health University of Amsterdam Amsterdam The Netherlands"},{"name":"Nuffield Department of Medicine University of Oxford Headington UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"WHO.WHO expands recommendation on oral pre\u2010exposure prophylaxis of HIV infection (PrEP) 2015.https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/197906\/WHO_HIV_2015.48_eng.pdf;jsessionid=BFF6CD3A70A75369CCE21F417B37C330?sequence=1. Accessed July 28 2020."},{"key":"e_1_2_9_3_1","volume-title":"Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya","author":"National AIDS & STI Control Program (NASCOP) MoH","year":"2018"},{"key":"e_1_2_9_4_1","unstructured":"AVAC.PrEPWatch: AVAC; 2020.https:\/\/www.prepwatch.org\/. Accessed July 28 2020."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000647"},{"key":"e_1_2_9_6_1","volume-title":"Pre\u2010exposure prophylaxis adherence and persistence in Kenyan MSM and transgender women","author":"Makobu Kimani EvdE"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228620"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2020.100541"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3463-4"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2020.100541"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25250"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282f2704a"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.16.4.18748"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofw253"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000846"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-018-2141-2"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v038.i08"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-012-0317-8"},{"issue":"211","key":"e_1_2_9_19_1","first-page":"261","article-title":"The effect of mobility on HIV\u2010related healthcare access and use for female sex workers: a systematic review","volume":"2018","author":"Davey C","year":"1982","journal-title":"Soc Sci Med"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/13691058.2016.1164899"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25439"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0234720"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/09581596.2018.1447647"},{"key":"e_1_2_9_24_1","unstructured":"WHO.What\u2019s the 2+1+1? Event\u2010driven oral pre\u2010exposure prophylaxis to prevent HIV for men who have sex with men: update to WHO\u2019s recommendation on oral PrEP 2019.https:\/\/www.who.int\/hiv\/pub\/prep\/211\/en\/. Accessed December 10 2020."},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25593"},{"issue":"6","key":"e_1_2_9_26_1","doi-asserted-by":"crossref","first-page":"e25598","DOI":"10.1002\/jia2.25598","article-title":"Enrolment characteristics associated with retention among HIV negative Kenyan gay, bisexual and other men who have sex with men enrolled in the Anza Mapema cohort study","volume":"23","author":"Kunzweiler C","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2018.1515471"}],"container-title":["HIV Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.13237","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hiv.13237","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.13237","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T11:35:29Z","timestamp":1700134529000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.13237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,27]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1111\/hiv.13237"],"URL":"https:\/\/doi.org\/10.1111\/hiv.13237","archive":["Portico"],"relation":{},"ISSN":["1464-2662","1468-1293"],"issn-type":[{"value":"1464-2662","type":"print"},{"value":"1468-1293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,27]]},"assertion":[{"value":"2021-08-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}