How Can We Support the Use of Oral PrEP Among Young Women who Sell Sex? A PrEP Cascade Analysis

Hensen, Bernadette; Machingura, Fortunate; Busza, Joanna; Birdthistle, Isolde; Chabata, Sungai T; Chiyaka, Tarisai; Floyd, Sian; Jamali, Gracious; Mushati, Phillis; Hargreaves, James; Cowan, Frances M

doi:10.1097/qai.0000000000002733

Cited by 11 publications

(12 citation statements)

References 30 publications

(47 reference statements)

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“…A direct offer of on-site initiation of PrEP to AYP testing HIVnegative might have resulted in increased use. In Zimbabwe, a study with young women who sell sex found that PrEP use was associated with an active offer of PrEP [47]. In Kenya, programmatic data from 89 sites that offered PrEP found that few AGYW were screened for PrEP eligibility and this meant that they were not offered PrEP [48].…”

Section: Discussionmentioning

confidence: 99%

The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial

et al. 2023

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Background The growing population of adolescents and young people (AYP) aged 15 to 24 in sub-Saharan Africa face a high burden of HIV in many settings. Unintended pregnancies among adolescent girls in the region remain high. Nonetheless, the sexual and reproductive health (SRH) service needs of AYP have remained underserved. We conducted a cluster-randomised trial (CRT) to estimate the impact of community-based, peer-led SRH service provision on knowledge of HIV status and other SRH outcomes, including met need for contraceptives. Methods and findings Yathu Yathu was a cluster-randomised trial (CRT) conducted from 2019 to 2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones (approximately 2,350 AYP/zone) that were randomly allocated to the Yathu Yathu intervention or control arm. In each intervention zone, a community-based hub, staffed by peer support workers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15 to 24 were given a Yathu Yathu card, which allowed them to accrue points for accessing SRH services at the hub and health facility (intervention arm) or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive to use SRH services in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome: knowledge of HIV status (self-reporting living with HIV or HIV testing in the last 12 months) and secondary outcomes, including use of pre-exposure prophylaxis (PrEP) in the last 12 months, current use of antiretroviral therapy (ART), and met need for contraceptive services. The sampling was stratified on sex and age group, and we analysed data at cluster-level using a two-stage process recommended for CRTs with <15 clusters/arm. A total of 1,989 AYP consented to participate in the survey (50% male); consent was similar across arms (63% consent/arm). Across zones, knowledge of HIV status ranged from 63.6% to 81.2% in intervention zones and 35.4% to 63.0% in control zones. Adjusting for age, sex, and community, knowledge of HIV status was higher in the intervention arm compared to control (73.3% versus 48.4%, respectively, adjusted prevalence ratio (PR) 1.53 95% CI 1.36, 1.72; p < 0.001). By age and sex, results were similar. There was no evidence for impact on any secondary outcomes, including current use of ART and met need for contraceptives. There were no adverse events reported in either arm. A key limitation of our trial is that approximately 35% of the AYP randomly selected for participation in the endline survey could not be reached. Conclusions Delivering community-based, peer-led SRH services increased knowledge of HIV status among AYP, both males and females, compared with the control arm. Scaling up the highly effective Yathu Yathu strategy has the potential to make a substantial contribution to increasing access to HIV prevention and care services for young people. However, additional implementation research is needed to understand how to improve uptake of broader SRH services, beyond uptake of HIV testing. Trial registration ISRCTN75609016, clinicaltrials.gov number NCT04060420

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Section: Discussionmentioning

confidence: 99%

The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial

et al. 2023

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“…As shown in table 2, 11 included studies published between 2020 and 2022 (with the newly published relevant conference proceedings) described 6 implementation studies including HPTN 082 Study,27 36 Power cohort study,37 38 Determined Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) study in Zimbabwe,39 40 DREAMS study in South Africa,41 MPYA trial42 43 and 3Ps for Prevention study 44 45. The HPTN 082 and Power Cohort studies focused on how to increase PrEP uptake and continuation among high-risk AGYW.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, in the two DREAMS projects in South Africa41 and Zimbabwe,39 40 different strategies to increase PrEP uptake and continuation by young women who sell sex (comprising young female sex workers that sell sex and those that do but do not identify as such) were implemented in the context of other HIV prevention strategies. PrEP delivery through peer outreach approach was employed by the DREAMS project in South Africa while PrEP uptake and adherence was promoted through community empowerment and adherence support in Zimbabwe.…”

Section: Resultsmentioning

confidence: 99%

“…Also, HTPN 08227 36 and Power Cohort Study37 reported high PrEP initiation rates of 95% and 94%, respectively, among AGYW that were approached and were found eligible to participate in the studies. The DREAM project in Zimbabwe led to higher PrEP initiation in the intervention arm compared with the control arm 39 40. The DREAM project in South Africa reported zero uptake of PrEP although PrEP awareness increased over the years of programme implementation41 (table 4).…”

Section: Resultsmentioning

confidence: 99%

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Interventions to increase the uptake and continuation of pre-exposure prophylaxis (PrEP) by adolescent girls and young women at high risk of HIV in low-income and middle-income countries: a scoping review

et al. 2022

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IntroductionEffective strategies to increase pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women (AGYW) who engage in sex work or transactional sex are sparsely reported. We aimed to describe the available evidence on strategies for improving the uptake and continuation of PrEP among AGYW who engage in sex work or transactional sex, or otherwise are at high risk of acquiring HIV, and report their implementation outcomes.MethodPubMed, Embase, CINAHL and Global Health were searched for studies describing strategies to increase uptake and continuation of PrEP for HIV prevention among AGYW at high risk of acquiring HIV in low-income and middle-income countries. Two independent reviewers screened citations for inclusion and performed data abstraction. Proctor’s framework was used to report the implementation outcomes of the interventions.ResultWe identified 1046 citations, and reviewed 69 full-text documents, of which we included 11 in the scoping review. A social marketing campaign was used in one study to create demand for PrEP. A decision support tool was used in one study to improve PrEP initiation. SMS reminders (two studies), drug-level feedback (two studies), peer group support (one study) and conditional economic incentives (one study) were used to improve PrEP continuation. Five studies reported adoption outcomes, two of which were high. Four studies reported sustainability outcomes; these were low or moderate. One study found private youth-friendly clinics a better fit for AGYW PrEP delivery compared with public hospitals, and prescription of PrEP by non-study staff in the hospital facility was low.ConclusionMultiple promising interventions have been used to deliver PrEP to AGYW at high risk of acquiring HIV; however, more information is needed to understand how these interventions would likely perform at scale outside of a research context.

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“…However, Descovy has not been approved for use by cisgender women although clinical trials in women are underway. Uptake and persistence with daily pill-taking by women have been low due to a range of barriers [ 4 , 5 , 6 ]. Adherence to product use plays a critical role in maintaining drug exposure required for prevention effectiveness [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of Nanoparticles-in-Film Technology to Achieve Extended In Vivo Exposure of MK-2048 for HIV Prevention

Tong

Patel

et al. 2022

Polymers

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MK-2048 is a second-generation integrase inhibitor active against HIV, which has been applied vaginally using ring formulations. In this work, a nanoparticle-in-film technology was developed as a discrete pre-exposure prophylactic product option against HIV for an extended duration of use. A film platform loaded with poly (lactic-co-glycolic acid) nanoparticles (PNP) encapsulating MK-2048 was engineered. MK-2048 PNPs were loaded into films that were manufactured via the solvent casting method. Physicochemical and mechanical properties, in vitro efficacy, Lactobacillus compatibility, in vitro and ex vivo permeability, and in vivo pharmacokinetics in macaques were evaluated. PNPs with a mean diameter of 382.2 nm and −15.2 mV zeta potential were obtained with 95.2% drug encapsulation efficiency. PNP films showed comparable in vitro efficacy to free MK-2048 (IC50 0.46 vs. 0.54 nM) and were found to have no impact on Lactobacillus. MK-2048 encapsulated in PNPs showed an increase in permeability (>4-fold) compared to the free MK-2048 in MDCKII cell lines. Furthermore, PNPs had higher ectocervical tissue permeability (1.7-fold) compared to free MK-2048. PNP films showed sustained drug levels for at least 3 weeks in the macaque vaginal fluid. This work demonstrates the synergy of integrating nanomedicine and polymeric film technology to achieve sustained vaginal drug delivery.

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How Can We Support the Use of Oral PrEP Among Young Women who Sell Sex? A PrEP Cascade Analysis

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 11 publications

References 30 publications

The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial

The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial

Interventions to increase the uptake and continuation of pre-exposure prophylaxis (PrEP) by adolescent girls and young women at high risk of HIV in low-income and middle-income countries: a scoping review

Development and Evaluation of Nanoparticles-in-Film Technology to Achieve Extended In Vivo Exposure of MK-2048 for HIV Prevention

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