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dc.contributor.authorAdeyemi, Olusegun Adewale
dc.date.accessioned2022-03-04T20:32:19Z
dc.date.available2022-03-04T20:32:19Z
dc.date.issued2021
dc.identifier.urihttp://hdl.handle.net/10713/18157
dc.descriptionUniversity of Maryland, Baltimore. Epidemiology and Preventive Medicine, Ph.D., 2021.en_US
dc.description.abstractIntroduction: HIV incidence among men who have sex with men (MSM) in Nigeria was 5.8-23.1/100 person years (PY) in 2019, exceeding the ≥ 3/100 PY recommended by the WHO for initiation of HIV pre exposure prophylaxis (PrEP). Objectives: To estimate the correlation between self-reported PrEP adherence (SRPA) and PrEP biomarkers (assay), to assess the association between perceived social support (SS) with protective PrEP adherence (PA), and to estimate the effect of PrEP use on behavioral outcomes. Methods: In this open-label, one-year follow-up, prospective cohort study, MSM living in Abuja were introduced to PrEP in clinic or community based setting for five scheduled visits (baseline, months 1, 3, 6, and 9). Clinical information and sexually transmitted infection (STI) samples were collected at each study visit. PrEP biomarker assays were conducted at month 3 and 9. The correlation between SRPA and assay results was estimated with Spearman’s correlation. Logistic regression estimated adjusted odds ratio (aOR) between SS (informational, instrumental and informational) and PA. A conditional logistic regression estimated aOR of STIs (Rectal and urethral Gonorrhea [NG] and Chlamydia) of behavioral outcomes (Condomless anal intercourse [CAI] and concurrent sex partnerships) comparing pre-PrEP versus Post-PrEP period. Results: Of 400 that initiated PrEP between April 2018 and May 2019, 219 had ≥1 assay, with median age 23 (interquartile range 20-27) years. Of this 219, sixty-six (30%, 95% CI: [0.24, 0.36]) had ≥1 PA. A total of 206 were eligible for pre-post-PrEP period analysis. In multivariable analysis, participants with perceived emotional SS had 42% increased odds (aOR: 1.42, 95% CI: [1.00, 2.00]) of PA. In the post-PrEP period, compared with pre-PrEP period, participants had 3.5 times increased odds (OR: 3.53, 95% CI: 1.10, 11.35) and 51% decreased odds (aOR: 0.49, 95% CI: 0.28, 0.84) of rectal NG diagnosis and reporting CAI, respectively, but no significant changes in prevalence of all STIs. Conclusion: There was no association between SRPA and assay; perceived emotional SS was a facilitator of PA. We demonstrated trends of PrEP associated sexual behavioral modifications but further studies are required. Our study findings have implications for PrEP implementation in Nigeria and similar settings.en_US
dc.language.isoen_USen_US
dc.subjectbehavioral risk compensationen_US
dc.subjectmen who have sex with men (MSM)en_US
dc.subjectPrEPen_US
dc.subjectPrEP adherenceen_US
dc.subject.meshSexual and Gender Minoritiesen_US
dc.subject.meshPre-Exposure Prophylaxisen_US
dc.subject.meshSocial Supporten_US
dc.titleBehavioral and Social Support Effects on Daily Oral Pre-exposure Prophylaxis use among Men who have sex with Men in Nigeriaen_US
dc.typedissertationen_US
dc.date.updated2022-02-04T17:05:46Z
dc.language.rfc3066en
dc.contributor.advisorCharurat, Manhattan
dc.contributor.advisorNowak, Rebecca G
dc.description.embargo08/04/2022
dc.contributor.orcid0000-0002-2051-002X
refterms.dateFOA2022-03-04T20:32:19Z


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