BACKGROUND: HIV prevalence remains high among MSM. Preventive options such as oral PrEP have low uptake, especially in Sub-Saharan Africa. Several studies (Zimbabwe, Kenya, and Zambia) have shown one-, two- and three-month continuation rates of below 50%. Population Solutions for Health, PSI, and the Ministry of Health and Child Care piloted event-driven PrEP (Prep 2-1-1) among men who have sex with men (MSM) using WHO guidelines. PrEP 2-1-1 involves taking two pills of Truvada two to 24 hours before unprotected sex, another one 24 hours after the initial dose then the last pill 24 hours after the subsequent dose. The pilot sought to measure continuation rates, adherence, and seroconversion to inform method scale-up.
METHODS: A prospective cohort design recruited 381 MSM from Harare and Bulawayo between January – September 2022. Participants were followed at one, two- and three months post-baseline. PrEP continuation point estimates and proportions of clients reporting correctly taking pills according to the WHO PrEP 2-1-1 guidelines were calculated including 95% confidence intervals. Qualitative insights from MSM on their experience on PrEP 2-1-1 were documented.
RESULTS: Of 381 study participants, continuation rates were 82.9% (1 month), 79.5% (2 months), and 73.8% (3 months). Dosing adherence was high and improved significantly over time on PrEP 2-1-1 (see graph below). Two out of 381 clients tested positive at a 3-month follow-up. Study participants appreciated PrEP 2-1-1 convenience in minimizing pill burden and side effects. Service providers were confident in scaling up.

CONCLUSIONS: Eligible MSM demonstrated high PrEP 2-1-1 continuation rates [MM1] and improved dosing adherence over time. PrEP 2-1-1 is effective as evidenced by a few seroconversions. In a resource-limited environment, event-driven PrEP should [MA2] be scaled up as a feasible and effective HIV prevention option among eligible MSM.

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