Exploring the Use of Oral Pre-exposure Prophylaxis (PrEP) Among Women from Durban, South Africa as Part of the HIV Prevention Package in a Clinical Trial

Abstract

HIV endpoint-driven clinical trials in Africa enroll women who are at heightened risk of acquiring HIV. In 2017, the South African Medical Research Council recommended the provision of oral pre-exposure prophylaxis (PrEP) in HIV prevention trials, at which time the Evidence for Contraceptive Options and HIV Outcomes trial was ongoing and began to provide PrEP on-site at some trial sites. We interviewed 132 women who initiated PrEP on-site at the Durban, South Africa trial site to explore PrEP use, and conducted phone-based interviews 4–6 months post-trial exit to explore post-trial PrEP access. PrEP uptake was high (42.6%). Among women initiating PrEP on-site, 87.9% felt at risk of acquiring HIV. Most women (> 90%) heard of PrEP for the first time from study staff and three-quarters who initiated PrEP on-site continued at trial-exit. PrEP use declined post-trial exit with more than 50% of women discontinuing PrEP, and barriers relating to access emerged.

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

“…Self-reported adherence to oral PrEP was collected over the prior 30 days among women who reported ongoing oral PrEP use (had used oral PrEP within the prior 30 days) at the time of the questionnaire. As previously reported, 37% of women reported no missed doses in the prior 30 days [17].…”

“…Women who disclosed oral PrEP use continued oral PrEP more than those who did not disclose, whilst women who reported having more than one sexual partner and those who felt that they had a high risk of HIV infection had reduced odds of continuing oral PrEP at the final study visit. As reported previously, 43% of women who were eligible for oral PrEP when it became available, had initiated oral PrEP onsite [17]. We found that the proportion of women continuing oral PrEP at month 1 and month 3 in our study was higher than in some studies conducted among AGYW in South Africa and Kenya [8,10] such as the DREAMS study in Kenya, where only 37% of AGYW who initiated oral PrEP, persisted with PrEP use at month 3 [8].…”

Barriers to Oral HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Pregnant and Post-partum Women from Cape Town, South Africa

“…In our study, we found that all women had disclosed PrEP use, and most women disclosed to their partners. Disclosure of PrEP use has varied in recent studies, for example in HPTN082, only 40% of women planned to disclose PrEP use [ 24 ], while in the ECHO trial, at one research site, 90% of women had disclosed PrEP use [ 25 ]. Reasons for high rates of disclosure among our study participants might be because women in our study were older, pregnant, and reported close, supportive relationships with family members and partners, which might be different to other populations such as adolescent girls and young women.…”

Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia

“…The feasibility of integration has been demonstrated within this ECHO study experience and other studies (5,20,21). The first step in the implementation of PrEP at KHC is representative of strong political will.…”