Novel metric for evaluating pre-exposure prophylaxis programme effectiveness in real-world settings

Hendrickson, Cheryl; Long, Lawrence; Vijver, David van de; Boucher, Charles A.; O’Bra, Heidi; Claassen, Cassidy W.; Njelesani, Mwansa; Moyo, Crispin; Mumba, Daliso; Subedar, Hasina; Mulenga, Lloyd; Rosen, Sydney; Nichols, Brooke E

doi:10.1016/s2352-3018(19)30344-3

Cited by 13 publications

(12 citation statements)

References 9 publications

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“…Therefore, metrics such as continuation and loss to follow-up, though relevant for ART, need to be reconceived for oral PrEP [ 89 , 90 , 93 , 94 ]. In recent years, HIV prevention researchers have developed the concept of “prevention effective adherence,” with high adherence to oral PrEP during periods of risk as the goal that should guide oral PrEP counseling, follow-up, and monitoring [ 22 ].…”

Section: Effective Usementioning

confidence: 99%

Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

Bhavaraju¹,

Shears²,

Schwartz

et al. 2021

Curr HIV/AIDS Rep

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Purpose of review Clinical trials have found that the dapivirine vaginal ring (DVR) is safe to use and effective at reducing women’s risk of acquiring HIV infection. As countries prepare for the introduction of this novel long-acting, woman-controlled prevention method, an examination of key learnings from oral pre-exposure prophylaxis (PrEP) delivery will help programs leverage successful innovations and approaches to support DVR scale-up and expand the method mix for HIV prevention. Recent findings Intensive efforts over the past 5 years have yielded lessons on how to facilitate access to oral PrEP; expand service delivery for PrEP; address the knowledge, attitudes, and skills providers need to support PrEP initiation and effective use; develop messaging that builds community and partner support and combats stigma; and understand the cyclical nature of PrEP use. Summary Evidence from oral PrEP introduction and scale-up can help inform and expedite DVR introduction.

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Section: Effective Usementioning

confidence: 99%

Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

Bhavaraju¹,

Shears²,

Schwartz

et al. 2021

Curr HIV/AIDS Rep

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“…A richer understanding of how women might be using PrEP intermittently is needed, along with better monitoring and evaluation methods that can identify patterns of effective PrEP use in circumstances of periodic or intermittent risk. 33,34 Recent data suggest this approach may be highly effective: In a recent study in Uganda and Kenya, PrEP initiation was associated with a 76% reduction in HIV incidence among women, regardless of subsequent adherence; in addition, refills and adherence rates were higher during periods of self-reported risk. 35 Reported IPV decreased in both arms of this study.…”

Section: Discussionmentioning

confidence: 99%

The CHARISMA Randomized Controlled Trial: A Relationship-Focused Counseling Intervention Integrated Within Oral PrEP Delivery for HIV Prevention Among Women in Johannesburg, South Africa

Montgomery¹,

Roberts²,

Reddy

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Consistent use of oral pre-exposure prophylaxis (PrEP) has been a challenge among women, particularly when in relationships with lack of partner support or intimate partner violence (IPV).Methods:We conducted a randomized controlled trial (RCT) of an empowerment counseling intervention called “CHARISMA” delivered to women within a PrEP demonstration project in Johannesburg, South Africa. The trial tested the effectiveness of CHARISMA to increase PrEP adherence; decrease social harms and IPV; and improve partnership dynamics (eg, communication, disclosure and support) compared with those who received the standard of care counselling support and referrals. Four hundred seven HIV-seronegative, nonpregnant women aged 18–45 years were enrolled for 6 months of PrEP use, with 203 randomized (1:1) to the intervention. All participants reporting IPV received counseling and referrals that followed the WHO five-step Listen, Inquire, Validate, Enhance Safety, and Support approach.Results:This RCT did not identify statistically significant differences between study arms for PrEP adherence or relationship dynamics, with the exception of an increase in PrEP disclosure among intervention arm women. In our study, we cannot determine whether the lack of detectable findings may have been because of lack of intervention effect, strength of standard of care services, low risk in the study population, or other factors.Conclusions:Addressing IPV and relationship dynamics remain important factors influencing HIV risk, and addressing these within the context of PrEP delivery is an important synergistic opportunity. CHARISMA was highly acceptable to participants, and further adaptation and testing of the intervention to other populations and settings will augment the evidence base.

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“…This data can also be used to compare different strategies for PrEP roll-out, using our recently developed programme evaluation metric, which allows for comparison of PrEP programmes serving KPs and PPs. 36…”

Section: Discussionmentioning

confidence: 99%

Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up

et al. 2021

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IntroductionDaily pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but not yet widely deployed in sub-Saharan Africa. We describe how Zambia developed PrEP health policy and then successfully implemented national PrEP service delivery.Policy developmentZambia introduced PrEP as a key strategy for HIV prevention in 2016, and established a National PrEP Task Force to lead policy advocacy and development. The Task Force was composed of government representatives, regulatory agencies, international donors, implementation partners and civil society organisations. Following an implementation pilot, PrEP was rolled out nationally using risk-based criteria alongside a national HIV prevention campaign.National Scale-upIn the first year of implementation, ending September 2018, 3626 persons initiated PrEP. By September 2019, the number of people starting PrEP increased by over sixfold to 23 327 persons at 728 sites across all ten Zambian provinces. In the first 2 years, 26 953 clients initiated PrEP in Zambia, of whom 31% were from key and priority populations. Continuation remains low at 25% and 11% at 6 and 12 months, respectively.Lessons learntRisk-based criteria for PrEP ensures access to those most in need of HIV prevention. Healthcare worker training in PrEP service delivery and health needs of key and priority populations is crucial. PrEP expansion into primary healthcare clinics and community education is required to reach full potential. Additional work is needed to understand and address low PrEP continuation. Finally, a task force of key stakeholders can rapidly develop and implement health policy, which may serve as a model for countries seeking to implement PrEP.

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Novel metric for evaluating pre-exposure prophylaxis programme effectiveness in real-world settings

Cited by 13 publications

References 9 publications

Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

The CHARISMA Randomized Controlled Trial: A Relationship-Focused Counseling Intervention Integrated Within Oral PrEP Delivery for HIV Prevention Among Women in Johannesburg, South Africa

Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up

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