Sexualized alcohol and drug use among men who have sex with men and the PrEP retention in Thailand.

Introduction: Sexualized alcohol use (SAU) and sexualized drug use (SDU) involve the use of alcohol and/or drugs in sexual contexts, which may impact the HIV pre-exposure prophylaxis (PrEP) continuum of care. This study examines associations between SAU, SDU, and PrEP retention among Thai men who have sex with men (MSM), and explores the acceptability of mobile health interventions. Methods: A quantitative study with embedded qualitative data was employed, with one hundred MSM recruited from a community clinic to complete a survey assessing SAU, SDU, and other health risks. The psychosocial syndemic count was calculated based on symptoms of alcohol and drug use, depression, anxiety, and experiences of physical or sexual trauma. Factors associated with PrEP retention were analyzed using multivariable logistic regression. Additionally, thirty participants who reported SAU and SDU participated in semi-structured qualitative interviews. Rapid thematic analysis was performed to assess the acceptability of mobile health interventions aimed at improving the PrEP continuum. Results: In the sample, 27 % reported SAU only, 12 % SDU only, and 23 % combining SAU and SDU. SDU included alkyl nitrite (51.6 %), Cannabis (14.5 %), and stimulants (9.7 %). PrEP retention was not associated with syndemic count or SDU, but was associated with SAU and experiences of sexual violence. Qualitative interviews indicated enthusiasm for mobile health interventions, particularly those offering PrEP reminders, incentives for healthy behaviors, and improved PrEP access. Conclusion: SAU and sexual violence were identified as barriers to PrEP retention among MSM in Thailand, while SDU was not. Mobile health interventions emphasizing pro-health incentives and harm reduction may enhance PrEP adherence in this population.