Researchers in the College of Agriculture, Health and Natural Resources recently conducted a novel study assessing knowledge of and interest in a new injectable form of PrEP (pre-exposure prophylaxis) among men who have sex with men (MSM) in Malaysia.

Kiran Paudel, an incoming master’s student in allied health sciences, is the lead author on the paper, published in the Journal of Community Health. Assistant Professor Roman Shrestha, graduate student Kamal Gautam, and Sana Gupta ‘24 (CLAS), an undergraduate majoring in statistics, are co-authors.

PrEP is a medication that, when taken daily, protects against contracting HIV. PrEP was first approved by the FDA in 2012. In late 2021, the FDA approved a long-acting injectable (LAI) version of the drug that provides protection for two months.

LAI-PrEP is even more effective than daily oral pill options. A clinical trial found that within the population of participants taking the pill, there was a 1.2% rate of HIV contraction versus 0.4% in the group that received the injection.

In the UConn study, the researchers looked at a population of MSM in Malaysia, an understudied group that faces significant barriers to accessing PrEP due to cost and stigma surrounding HIV, which is more common among MSM than other groups.

In Malaysia, same-sex sexual behaviors are criminalized. This means MSM may be afraid to share information about their sexual activity with healthcare providers, who may refuse to treat them.

Further, patients might not want to pick PrEP up from the pharmacy, or bring it home where their family could see it.

“In addition to stigma about your sexual orientation, there’s stigma about HIV itself,” Gupta says. “People aren’t super willing to discuss engaging in risk behaviors with people who might be HIV-positive, because that in itself is a taboo.”

Another issue is the lack of trained providers who can prescribe PrEP, especially in rural areas of Malaysia. And even when there are providers, patients often do not know how to access them, or that PrEP is even an option.

“People do not know there’s a medication they can take to prevent HIV,” Shrestha says. “Or even if they are aware, they don’t have enough information to really make an informed decision.”

The team surveyed 870 Malaysian MSM asking about their interest in using LAI-PrEP.

Only 9% of participants had heard of LAI-PrEP, compared to 80% who had heard of the oral version. After learning about LAI-PrEP, 86% expressed interest in using it.

The injectable form could reduce stigma-related barriers to accessing PrEP since the injection would take place in the privacy of a medical clinic. Additionally, patients would only need to receive an injection every two months, as opposed to taking a daily pill.

“These are some of the reasons people might prefer using long-acting injectable PrEP over oral PrEP,” Paudel says.

There are also fewer side effects associated with LAI-PrEP. Oral PrEP can impact kidney function, meaning anyone with kidney problems cannot take it, a problem that doesn’t exist with the injectable form.

While there may be other barriers associated with LAI-PrEP, such as higher cost or aversion to needles, it promises to provide much better adherence than the oral form. Lack of adherence has been one of the main issues undermining oral PrEP’s potential.

LAI-PrEP is not yet available in Malaysia. But these findings will be an important tool to better inform the rollout of the drug in the coming years.

This work is part of Shrestha’s larger grant developing a mobile app that connects MSM patients with healthcare providers who can prescribe PrEP virtually. His team is currently preparing to launch a clinical trial to test the platform.

“The main goal is really to reduce that in-person interaction with the healthcare provider and provide this additional platform to access services without having to worry about stigma, discrimination, and other structural barriers,” Shrestha says.

This work relates to CAHNR’s Strategic Vision area focused on Enhancing Health and Well-Being Locally, Nationally, and Globally.

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