Daily Oral Pre-exposure Prophylaxis (PrEP) Continuation Among Women from Durban, South Africa, Who Initiated PrEP as Standard of Care for HIV Prevention in a Clinical Trial

Abstract

HIV incidence among women in Eastern and Southern Africa remains unacceptably high, highlighting the need for effective HIV prevention options, including pre-exposure prophylaxis (PrEP). The Evidence for Contraceptive Options and HIV Outcomes trial offered daily oral PrEP to participants during the latter part of the clinical trial as an additional HIV prevention choice. We explored daily oral PrEP continuation at trial exit among women enrolled from Durban, South Africa who initiated oral PrEP at the trial site. Of the 132 women initiating oral PrEP, 87% reported continuation of oral PrEP at month 1, 80% at month 3, and 75% continued using oral PrEP at their final trial visit and were referred to off-site facilities for ongoing oral PrEP access. The median duration of oral PrEP use in trial participants who used oral PrEP was 91 days (IQR 87 to 142 days). Women who disclosed their oral PrEP use to someone had increased odds of continuing oral PrEP at trial exit. Women who reported > 1 sex partner and those who felt they would probably or definitely get infected with HIV had reduced odds of continuing oral PrEP at trial exit. Of those discontinuing oral PrEP (n = 32), > 50% discontinued within the first month, and the most common reason for discontinuation was reporting side effects. The high rates of oral PrEP continuation in our study are encouraging and our findings can be utilized by other clinical trials providing oral PrEP as standard of care for HIV prevention and by oral PrEP implementation programmes.

Point-of-Care Sexually Transmitted Infection Testing Improves HIV Preexposure Prophylaxis Initiation in Pregnant Women in Antenatal Care in Cape Town, South Africa, 2019 to 2021

“…Behavioral economic theories have shown that individuals tend to make decisions based on information received more recently, 28 and although this effect might have been beneficial to get women initiated on PrEP, it may have biased women against fully considering the implications and demands of PrEP continuation. This finding supports several studies that show that barriers to PrEP initiation are different to barriers to PrEP continuation, [29][30][31] and suggest that, although POC STI testing might improve PrEP initiation in PPW, PrEP adherence and continuation counseling is critical to improve long-term outcomes in this population. This study did not include a biomarker for PrEP adherence and relied on self-report and pill count, which is an imperfect measure of PrEP adherence.…”

Willingness to use long-acting injectable PrEP among HIV-negative/unknown men who have sex with men in mainland China: A cross-sectional online survey

“…In mainland China, for example, the cost of daily oral PrEP is around CNY 780–2000 (USD 111–285) per month. Another reason for poor uptake is concern about adverse effects of PrEP such as nausea, vomiting, and abdominal pain [ 67 ]. Someone concerned about adverse effects is unlikely to take action to use PrEP, since like all medications, PrEP may cause side effects.…”

Willingness to use long-acting injectable PrEP among HIV- negative/unknown men who have sex with men in China: a national multicenter online survey

“…In mainland China, for example, the cost of daily oral PrEP is around CNY 780-2000 (USD 111-285) per month. Another reason for poor uptake is concern about adverse effects of PrEP such as nausea, vomiting, and abdominal pain [49]. Furthermore, due to traditional cultural beliefs about medicine, it is widely acknowledged in China that all drugs have some toxicity and that individuals are unwilling to take medicine until they have symptoms, which also acts as a roadblock to PrEP uptake among MSM at high risk of HIV infection [50].…”