Predictors of oral pre-exposure prophylaxis (PrEP) uptake among individuals in a HIV vaccine preparedness cohort in Masaka, Uganda

Kusemererwa, Sylvia; Kansiime, Sheila; Mutonyi, Gertrude; Aeron, Namirembe; Katana, Safina; Kitonsa, Jonathan; Kakande, Ayoub; Okello, Joseph Mugisha; Kaleebu, Pontiano; Ruzagira, Eugene

doi:10.1097/md.0000000000027719

Cited by 6 publications

(10 citation statements)

References 37 publications

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“…Predictors of protective adherence in our study included being older (aged over 35 years), which was also identified in other Sub-Saharan studies [19,20,45]. This age-related trend may be explained by the hope to increase in life expectancy when engaging in a high-risk occupation like sex work as women as seen in another Ugandan study [46].…”

Section: Plos Onesupporting

confidence: 80%

Self-reported and pill count measures of adherence to oral HIV PrEP among female sex workers living in South-Western Uganda

et al. 2022

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Background Female sex workers (FSWs) in Uganda are at high risk of HIV infection. Scaling up oral pre-exposure prophylaxis (PrEP) will reduce HIV incidence if high levels of adherence are maintained. This study evaluates PrEP adherence using clinic-based pill counts and self-reported measures, and factors associated with protective levels of adherence. Methods Participants were sex workers who had been taking PrEP for at least 5 months and were attending routine follow-up visits for PrEP care in fishing communities and along the Trans-African Highway. Participants who had a pill count showing at least 85% use since their last clinic visit and those who reported taking their PrEP every day in the last 5 months were categorised as having ‘protective adherence’. Spearman’s correlation and weighted kappa assessed the relationship between pill count and self-reported measures. Bivariate and multivariate logistic regression was used to determine factors associated with protective adherence as measured by pill count. Results We recruited 524 FSWs, with a median age of 29 years (IQR 23–35). Participants were recruited from fishing communities and Trans-African Highway towns (n = 297, 56.7%, and n = 227, 43.0%). Nearly three quarters (n = 372, 71.0%) of women were estimated to have protective adherence based on pill count (i.e., a pill count of >85%) and 50.4% by self-report in last 3 months. There was a strong positive association between self-reported measures and pill count measures (rest = 0.6453, 95% CI = 0.5924–0.6927) and a moderate agreement between self-reported measures and pill count measures, κ = 0.544 (95%CI = 0.4869–0.6011, p < 0.001). Factors associated with protective adherence included being aged 35 years or older (aOR = 2.40, 95% CI = 1.17–4.86), living in a fishing community (aOR = 1.45, 95% CI = 0.62–3.38), and having an STI in last 3 months (aOR = 1.64, 95% CI = 1.07–2.49). Conclusion Our findings indicate that PrEP-experienced FSWs attending clinical follow-up visits reported high protective levels of oral pre-exposure prophylaxis, as measured by both pill count and self-reported measures, and a moderate agreement between pill count and self-reported measures.

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Section: Plos Onesupporting

confidence: 80%

Self-reported and pill count measures of adherence to oral HIV PrEP among female sex workers living in South-Western Uganda

et al. 2022

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“…Some of these earlier studies were mostly conducted in relatively homogenous populations from small fairly well-defined geographical areas with the study procedures conducted within participants’ communities [ 8 ] or at study clinics that were located not too far away (10–40 km) [ 5 , 7 ]. In contrast, our study was conducted in a more heterogeneous population spread over a wide geographical area (up to 80 km from the study clinic) [ 10 ]. The national COVID-19 control measures that were instituted from March 2020 onwards also contributed to the high LTFU observed in this study.…”

Section: Discussionmentioning

confidence: 99%

“…We used data from an ongoing HIV vaccine-preparedness cohort study, “The PrEPVacc Registration Cohort Study”. The study was set up at sites in Tanzania, Mozambique, South Africa, and Uganda to prepare a population of HIV-negative individuals at risk of acquiring HIV for possible participation in the PrEPVacc HIV vaccine efficacy trial [ 9 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda

Kabarambi

Kansiime

Kusemererwa

et al. 2022

IJERPH

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Background: High participant retention is essential to achieve adequate statistical power for clinical trials. We assessed participant retention and predictors of loss to follow-up (LTFU) in an HIV vaccine-preparedness study in Masaka, Uganda. Methods: Between July 2018 and March 2021, HIV sero-negative adults (18–45 years) at high risk of HIV infection were identified through HIV counselling and testing (HCT) from sex-work hotspots along the trans-African highway and fishing communities along the shores of Lake Victoria. Study procedures included collection of baseline socio-demographic data, quarterly HCT, and 6-monthly collection of sexual risk behaviour data. Retention strategies included collection of detailed locator data, short clinic visits (1–2 h), flexible reimbursement for transport costs, immediate (≤7 days) follow-up of missed visits via phone and/or home visits, and community engagement meetings. LTFU was defined as missing ≥2 sequential study visits. Poisson regression models were used to identify baseline factors associated with LTFU. Results: 672 participants were included in this analysis. Of these, 336 (50%) were female and 390 (58%) were ≤24 years. The median follow-up time was 11 months (range: 0–31 months). A total 214 (32%) participants were LTFU over 607.8 person-years of observation (PYO), a rate of 35.2/100 PYO. LTFU was higher in younger participants (18–24 years versus 35–45 years, adjusted rate ratio (aRR) = 1.29, 95% confidence interval (CI) 0.80–2.11), although this difference was not significant. Female sex (aRR = 2.07, 95% CI, 1.51–2.84), and recreational drug use (aRR = 1.61, 95% CI, 1.12–2.34) were significantly associated with increased LTFU. Engagement in transactional sex was associated with increased LTFU (aRR = 1.36, 95% CI, 0.97–1.90) but this difference was not significant. LTFU was higher in 2020–2021 (the period of COVID-19 restrictions) compared to 2018–2019 (aRR = 1.54, 1.17–2.03). Being Muslim or other (aRR = 0.68, 95% CI 0.47–0.97) and self-identification as a sex worker (aRR = 0.47, 95% CI, 0.31–0.72) were associated with reduced LTFU. Conclusion: We observed a high LTFU rate in this cohort. LTFU was highest among women, younger persons, recreational drug users, and persons who engage in transactional sex. Efforts to design retention strategies should focus on these subpopulations.

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“…At enrolment and quarterly visits, individuals received HCT and for those that tested HIV‐negative, counselling on and referrals for PrEP where it was available [ 16 , 18 ]. Oral Truvada (TDF/FTC) was available on site in Durban and through referral to a local provider in Masaka from 2018 when the PrEPVacc registration cohort was initiated.…”

Section: Methodsmentioning

confidence: 99%

“…The target population for the PrEPVacc registration cohort study comprised adults (18-45 years) at high-risk of HIV infection, that is, female sex workers (FSW), and female and male fisher folk in Masaka, Uganda; female bar workers and FSW in Dar es Salaam and Mbeya, Tanzania; men who have sex with men (MSM), FSW and other at risk individuals from the general population in Maputo, Mozambique; and the general population in areas of known high HIV incidence in Durban, South Africa [17].…”

Section: Study Design and Populationmentioning

confidence: 99%

Developing HIV risk prediction tools in four African settings

Kansiime

Hansen

Hayes

et al. 2023

Tropical Med Int Health

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ObjectiveHIV risk prediction tools are a critical component of efforts to end the HIV pandemic. We aimed to create and validate tools for identifying individuals at highest risk of prevalent and incident HIV in an African setting.MethodsWe used Logistic regression and Poisson regression to determine risk factors for HIV prevalence and incidence in a multi‐country HIV vaccine trial preparedness cohort study among individuals at high risk of HIV, and used the identified factors to create and validate tools that predict HIV risk. We also assessed the performance of the VOICE risk score in predicting HIV incidence among women in the cohort.ResultsThe prevalent HIV prediction tool created had good predictive ability [area under the curve (AUC) = 0.70, 95% CI 0.66–0.74]. It included the following participant variables: age, sex, recreational drug use, unprotected male‐to‐male anal sex, a sexual partner who had other partners, transactional sex and having a partner who was a long‐distance truck driver/miner. It was not possible to create a valid HIV incidence prediction tool. Participants with high VOICE risk scores (≥7) had slightly higher HIV incidence but this tool performed poorly within our study (AUC = 0.58, 95% CI 0.51–0.64: Harrell's concordance index = 0.59).ConclusionWe created a prevalent HIV prediction tool that could be used to increase efficiency in diagnosis of HIV and linkage to care in sub‐Saharan Africa. Existing incident HIV prediction tools may need modification to include context‐specific predictors such as calendar period, participant occupation, study site, before adoption in settings different from those in which they were developed.

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Predictors of oral pre-exposure prophylaxis (PrEP) uptake among individuals in a HIV vaccine preparedness cohort in Masaka, Uganda

Cited by 6 publications

References 37 publications

Self-reported and pill count measures of adherence to oral HIV PrEP among female sex workers living in South-Western Uganda

Self-reported and pill count measures of adherence to oral HIV PrEP among female sex workers living in South-Western Uganda

Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda

Developing HIV risk prediction tools in four African settings

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