A Markov transition analysis to study changes in HIV prevention strategies among men who have sex with men in the French ANRS-PREVENIR cohort

A Markov transition analysis to study changes in HIV prevention strategies among men who have sex with men in the French ANRS-PREVENIR cohort. A Markov transition analysis to study changes in HIV prevention strategies among men who have sex with men in the French ANRS-PREVENIR cohort Article Open access Published: 30 October 2026 Cite this article You have full access to this open access article Download PDF View saved research A Markov transition analysis to study changes in HIV prevention strategies among men who have sex with men in the French ANRS-PREVENIR cohort Download PDF Abstract Despite various biomedical and behavioral prevention strategies, new HIV seroconversions are disproportionately higher among gay and bisexual men who have sex with men (GBMSM). Using data from the French PrEP cohort ANRS-PREVENIR, this study aimed to investigate prevention strategies among this population and to analyze factors that may shape GBMSMs’ sexual behaviors.

We defined three protection states as follows: self-dependent protection (SDP), which covered condom and/or PrEP use, partner-dependent protection (PDP), whereby the partner self-declared being either seronegative or seropositive with an undetectable viral load, and no protection (NP). We constructed a composite variable reflecting the degree of concordance between actual and perceived risk. A continuous-time multi-state Markov model was used to determine transition probabilities between protection states over time.

Hazard ratios and their 95% confidence intervals (HR(95%CI)) were computed to identify factors associated with transitions. Irrespective of the protection state at baseline (i.e., SDP, PDP, NP), the highest Markov transition probabilities were to transition from one state to the same state at the next follow-up visit over the entire study period; specifically, the probability [95%CI] was 0.920 [0.916,0.924] for SDP, 0.783 [0.769,0.797] for PDP, and 0.584 [0.546,0.615] for NP. Event-driven PrEP (3.34(2.89–3.85)) and PrEP naivety (1.19(1.04–1.36)) were associated with an increased probability of transitioning from SDP to PDP.

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