PEP for HIV prevention: are we missing opportunities to reduce new infections?

Ayieko, James; Petersen, Maya; Kamya, Moses R.; Havlir, Diane V.

doi:10.1002/jia2.25942

Cited by 9 publications

(11 citation statements)

References 14 publications

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“…Further study is needed to understand the optimal use of PEP in this priority population and its potential to serve as a bridge to other prevention options. 31 …”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Dynamic Choice HIV Prevention at Antenatal and Postnatal Care Clinics in Rural Uganda and Kenya

Kabami,

Koss,

Sunday

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Pregnant and postpartum women in Sub-Saharan Africa are at high risk of HIV acquisition. We evaluated a person-centered dynamic choice intervention for HIV prevention (DCP) among women attending antenatal and postnatal care. Setting: Rural Kenya and Uganda. Methods: Women (aged 15 years or older) at risk of HIV acquisition seen at antenatal and postnatal care clinics were individually randomized to DCP vs. standard of care (SEARCH; NCT04810650). The DCP intervention included structured client choice of product (daily oral pre-exposure prophylaxis or postexposure prophylaxis), service location (clinic or out of facility), and HIV testing modality (self-test or provider-administered), with option to switch over time and person-centered care (phone access to clinician, structured barrier assessment and counseling, and provider training). The primary outcome was biomedical prevention coverage—proportion of 48-week follow-up with self-reported pre-exposure prophylaxis or postexposure prophylaxis use, compared between arms using targeted maximum likelihood estimation. Results: Between April and July 2021, we enrolled 400 women (203 intervention and 197 control); 38% were pregnant, 52% were aged 15–24 years, and 94% reported no pre-exposure prophylaxis or postexposure prophylaxis use for ≥6 months before baseline. Among 384/400 participants (96%) with outcome ascertained, DCP increased biomedical prevention coverage 40% (95% CI: 34% to 47%; P < 0.001); the coverage was 70% in intervention vs. 29% in control. DCP also increased coverage during months at risk of HIV (81% in intervention, 43% in control; 38% absolute increase; 95% CI: 31% to 45%; P < 0.001). Conclusion: A person-centered dynamic choice intervention that provided flexibility in product, testing, and service location more than doubled biomedical HIV prevention coverage in a high-risk population already routinely offered access to biomedical prevention options.

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“…Further study is needed to understand the optimal use of PEP in this priority population and its potential to serve as a bridge to other prevention options. 31 …”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Dynamic Choice HIV Prevention at Antenatal and Postnatal Care Clinics in Rural Uganda and Kenya

Kabami,

Koss,

Sunday

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

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“…Although recent guidelines recommend the use of PEP in high-risk non-occupational exposure [ 47 , 48 , 49 ], it has not gained wide access and the level of awareness for PEP has remained low, even in countries where it has been available and fully covered for many decades [ 50 , 51 , 52 ]. Major barriers for low usage of PEP were found to be lack of awareness of healthcare workers, lack of awareness of those in need, lack of reimbursement, fear of side effects, and stigmatizing attitudes [ 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future

et al. 2023

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With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1–80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.

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“…In response to client and community concerns, we previously piloted offering PEP in community settings in rural Kenya and Uganda [9,41], where PEP has traditionally been offered only in cases of occupational exposure or gender-based violence. Offering PEP as part of routine sexual healthcare incorporates a product that can be started after (vs. before) an HIVexposure and taken for a more limited time (28 days).…”

Section: Discussionmentioning

confidence: 99%

“…Although oral PrEP use has expanded substantially in southern and eastern Africa in recent years, PrEP use remains below UNAIDS 2025 targets [1]. PEP use is largely limited to occupational exposures and gender-based violence, rather than use as an additional primary prevention choice [9]. Innovative delivery strategies are needed to optimize uptake of existing and forthcoming biomedical prevention options.…”

Section: Introductionmentioning

confidence: 99%

Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda

Koss,

Ayieko,

Kabami

et al. 2023

Aids

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Objective: HIV prevention service delivery models that offer product choices, and the option to change preferences over time, may increase prevention coverage. Outpatient departments in sub-Saharan Africa diagnose a high proportion of new HIV infections, but are an understudied entry point to biomedical prevention. Design: Individually randomized trial of dynamic choice HIV prevention (DCP) intervention vs. standard-of-care (SOC) among individuals with current/anticipated HIV exposure risk at outpatient departments in rural Kenya and Uganda (SEARCH; NCT04810650). Methods: Our DCP intervention included 1) product choice (oral pre-exposure prophylaxis [PrEP] or post-exposure prophylaxis [PEP]) with option to switch over time, 2) HIV provider- or self-testing, 3) service location choice (community vs. clinic-based), 4) provider training on patient-centered care. Primary outcome was proportion of follow-up covered by PrEP/PEP over 48 weeks assessed via self-report. Results: We enrolled 403 participants (61% women; median 27 years, IQR 22,37). In the DCP arm, 86% ever chose PrEP, 15% ever chose PEP over 48 weeks; selection of HIV self-testing increased from 26% to 51% and of out-of-facility visits from 8% to 52%. Among 376/403 (93%) with outcomes ascertained, time covered by PrEP/PEP was higher in DCP (47.5%) vs. SOC (18.3%); difference=29.2% (95%CI:22.7–35.7%; p < 0.001). Effects were similar among women and men (28.2% and 31.0% higher coverage in DCP, respectively) and larger during periods of self-reported HIV risk (DCP 64.9% vs. SOC 26.3%; difference=38.6%; 95%CI:31.0–46.2%; p < 0.001). Conclusion: A dynamic choice HIV prevention intervention resulted in two-fold greater time covered by biomedical prevention products compared to standard-of-care in general outpatient departments in eastern Africa.

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PEP for HIV prevention: are we missing opportunities to reduce new infections?

Cited by 9 publications

References 14 publications

Randomized Trial of Dynamic Choice HIV Prevention at Antenatal and Postnatal Care Clinics in Rural Uganda and Kenya

Randomized Trial of Dynamic Choice HIV Prevention at Antenatal and Postnatal Care Clinics in Rural Uganda and Kenya

PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future

Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda

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