Universal access to PrEP has slowed HIV in African communities

A universal access program offering HIV prevention at community-based HIV testing sites in rural African communities has significantly reduced the incidence of HIV infections compared to expected infections, especially among women, said a researcher.

An interim analysis found that the HIV incidence rate ratio was 0.35 per 100 person-years (95% CI 0.22-0.49) among those who started pre-exposure HIV prophylaxis oral (PrEP), which was 74% lower than matched controls before the availability of PrEP in these communities, reported Catherine Koss, MD, University of California, San Francisco (UCSF).

Disaggregating this data by sex, women experienced a 76% reduction in expected HIV incidence, while men experienced a 40% reduction in incidence.

Oral PrEP does not have the greatest history for women, particularly with Descovy (emtricitabine and tenofovir alafenamide, or F / TAF), the latest oral PrEP option in the United States, not approved by the FDA only for transgender men and women, as data was not available for cisgender women.

In a press conference at the Virtual International AIDS Conference, Monica Gandhi, MD, also from UCSF, who moderated the session but was not involved in the research, stressed the importance of the results in women.

“It’s amazing how effective it was for women because … there were questions about women versus men, and I think as part of a community offering … women can adhere to PrEP and have massive reductions in HIV incidence, ”she said. .

Koss noted that although oral PrEP is very effective, “we need better, lower-barrier approaches to childbirth in sub-Saharan Africa.”

She noted that community HIV testing, unlike testing in a health facility, is a more accessible alternative for young adults and men, and that it “provides an opportunity to offer and engage people to take PrEP ”.

The Study on Sustainable Research in East Africa in Community Health (SEARCH) examined 16 communities in rural Kenya and Uganda that provided universal access and an inclusive approach to PrEP for people at increased risk of HIV, including couples in serodiscordant partnerships and those in self-identified as high risk.

This program featured an on-site, same-day PrEP start-up during community testing at health fairs, as well as a flexible care delivery model that included follow-up visits to clinics or community sites, where patients are people could undergo repeat tests for HIV and PrEP. refills, Koss said.

Of the 74,541 people at risk, 5,447 (35%) started PrEP. About half of the people starting PrEP were women, about 30% were between 15 and 24 years old, about 20% had an HIV-differentiated partner, and half were married and monogamous. Of the men, about half were circumcised.

While 83% of participants stopped PrEP at least once, half of those who stopped later started again.

There were 25 seroconversions observed among those who initiated PrEP. The incidence in females was 0.46 per 100 person-years and 0.23 per 100 in males. About 70% reported non-adherence to PrEP more than 30 days before the seroconversion visit.

Koss said he then looked at what the incidence of HIV might look like without PrEP, using the propensity score match of eight out of 16 of those communities. The data came from annual population-based tests conducted in 2015-2017, before PrEP was available.

On this basis, the expected ratio of the HIV incidence rate of the matched controls was 0.92, while the actual incidence observed in the cohort was 0.26 (95% CI 0.09-0.75 , P= 0.01). Stratified by sex, the ratio of incidence rates for females is expected to be 1.52 vs. 0.40 (95% CI 0.04-0.79, P= 0.02). However, the difference in incidence rate in men was not significant (IRR 0.40 vs 0.24, respectively, P= 0.54).

“This shows in generalized epidemic settings, providing universal access to PrEP can reduce the incidence of HIV,” said Koss. “Going forward, comprehensive HIV testing linked to treatment and prevention, including PrEP … [is a] promising approach to accelerate the reduction of new infections. “

  • Molly Walker is associate editor and covers infectious diseases for MedPage Today. She is the recipient of the J2 Achievement Award 2020 for her COVID-19 coverage. To follow

Disclosures

This study found support from NIH and the Gilead Research Scholars Program on HIV.

Gilead Sciences donated the study drug (tenofovir disoproxil fumarate / emtricitabine) to the SEARCH study.


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