New PrEP Seguro Pilot Trial Results Show That Conditional Economic Incentives Can Increase PrEP Adherence Among HIV-Negative Male Sex Workers in Mexico
The primary results of the PrEP Seguro Randomized Pilot Trial are now available online and show that providing tiered financial incentives conditional on TFV concentration in scalp hair samples led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence.
Click here to learn more about PrEP Seguro.
About PrEP Seguro
The need for PrEP among male sex workers
When taken as prescribed oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention. Male sex workers (MSWs) – men who sell sex to other men – can benefit from PrEP because of their high risk of contracting HIV. However, MSWs often face unique difficulties adhering to routine medications and sustaining preventive behaviors.
Our research finds high HIV risk in this population: In Mexico, the prevalence of HIV is 0.3% in the general adult population and 18.2% among MSWs; HIV incidence among MSW is 5 per 100 person-years, and HIV incidence for their sex partners is 8 per 100 person-years. High rates of condomless sex (>30%) for which MSWs get paid more; and low rates of HIV/STI testing are common.
The Potential of Incentives for PrEP Adherence
Behavioural economics explores how human behaviour is influenced by biases in decision-making. For MSWs, their day-to-day constraints can contribute to heavily discounting future health and to suboptimal HIV prevention activities.
Growing evidence supports the role of incentive-based interventions and conditional economic incentives (CEIs), specifically, for the uptake of and adherence to HIV prevention programs. However, CEIs have not yet been tested as a way to improve PrEP adherence behaviors specifically among male sex workers.
Incentives may help reduce present-biased preferences by making HIV prevention behaviors (i.e., taking daily oral PrEP) more feasible. That is, MSWs may choose to continue taking PrEP because they are nudged by the incentive which may be more salient than the potentially negative health outcomes in the far future.
More details about PrEP Seguro
PrEP Seguro enrolled 110 male sex workers across two sites in Mexico (Clínica Especializada Condesa (CEC) in Mexico City and SETAC in Puerto Vallarta). Enrollment began in May 2019 and the last follow-up visit occurred in August 2021.
The PrEP Seguro pilot RCT was a sub-study conducted within the Implementation PrEP (ImPrEP) demonstration project. ImPrEP was a prospective, single-arm, open-label, multicenter PrEP implementation study that assessed the feasibility of immediately offering daily oral PrEP in Brazil (n=3,928 at 14 HIV and sexually transmitted infection (STI) clinics), Mexico (n=3,288 from 4 sites), and Peru (n=2,293 from 10 HIV and STI clinics).
Who funds PrEP Seguro
This study is funded by the National Institutes of Mental Health (NIMH) of the U.S. National Institutes of Health: award number R34MH114664, ClinicalTrials.gov identification code NCT03674983.
