Uptake and retention on HIV pre‐exposure prophylaxis among key and priority populations in South‐Central Uganda

Abstract

Introduction Pre‐exposure prophylaxis (PrEP) programmes have been initiated in sub‐Saharan Africa to prevent HIV acquisition in key populations at increased risk. However, data on PrEP uptake and retention in high‐risk African communities are limited. We evaluated PrEP uptake and retention in HIV hyperendemic fishing villages and trading centres in south‐central Uganda between April 2018 and March 2019. Methods PrEP eligibility was assessed using a national risk screening tool. Programme data were used to evaluate uptake and retention over 12 months. Multivariable modified Poisson regression estimated adjusted prevalence ratios (aPR) and 95% Confidence intervals (CIs) of uptake associated with covariates. We used Kaplan–Meier analysis to estimate retention and multivariable Cox regression to estimate adjusted relative hazards (aRH) and 95% CIs of discontinuation associated with covariates. Results and discussion Of the 2985 HIV‐negative individuals screened; 2750 (92.1 %) were eligible; of whom 2,536 (92.2%) accepted PrEP. Male (aPR = 0.91, 95% CI = 0.85 to 0.97) and female (aPR = 0.85, 95% CI = 0.77 to 0.94) fisher folk were less likely to accept compared to HIV‐discordant couples. Median retention was 45.4 days for both men and women, whereas retention was higher among women (log rank, p < 0.001) overall. PrEP discontinuation was higher among female sex workers (aRH = 1.42, 95% CI = 1.09 to 1.83) and female fisher folk (aRH = 1.99, 95% CI = 1.46 to 2.72), compared to women in discordant couples. Male fisher folk (aRH = 1.37, 95% CI = 1.07 to 1.76) and male truck drivers (aRH = 1.49, 95% CI = 1.14 to 1.94) were more likely to discontinue compared to men in discordant couples. Women 30 to 34 years tended to have lower discontinuation rates compared to adolescents 15 to 19 years (RH = 0.78 [95% CI = 0.63 to 0.96]). Conclusions PrEP uptake was high, but retention was very low especially among those at the highest risk of HIV: fisher folk, sex workers and truck drivers and adolescent girls. Research on reasons for PrEP discontinuation could help optimize retention.

HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda

“…Indeed, half of those who stopped PrEP later restarted taking it, suggesting that some participants may have been attempting to match PrEP use to periods of risk [32]. As PrEP programs extend eligibility criteria beyond specific risk groups to persons at substantial risk in the general population [21] and expand services outside of health facilities [33] (e.g., at drop-in centers [34]), our model and other low-barrier approaches to PrEP delivery could be adapted and scaled up.…”

Women at high risk of HIV-infection in Kampala, Uganda, and their candidacy for PrEP

“…Being recognised as being at risk of HIV infection is an indicator for being eligible for PrEP uptake ( Fearon et al, 2019 ; Hill et al, 2020 ; Kagaayi et al, 2020 ; Muhumuza et al, 2021 ; Nakku-Joloba et al, 2019 ), a message endorsed by the language of the guidelines. Indeed, HIV prevention cascades often start with the identification of those at risk of becoming infected with HIV ( Hargreaves et al, 2016 ; Schaefer et al, 2019 ).…”

Does medical male circumcision result in sexual risk compensation in Africa?

“…[1][2][3] This approach has greatly contributed to HIV incidence reduction in men in both agrarian and highrisk communities in Africa. 4,5 A longitudinal study of the general population in Rakai District, Uganda, assessed the effect of combination prevention on HIV acquisition between 2011 and 2016, finding a 48% decline of HIV incidence after combination HIV prevention had been introduced. However, the decline observed in circumcised men was significantly greater (57%) than in uncircumcised men (49%).…”

“…4 Similar patterns of decline in circumcised and uncircumcised men following combination HIV prevention were observed in HIV hyperendemic communities along Lake Victoria, in Uganda. 5 Despite the growing evidence for the effectiveness of MMC in reducing HIV acquisition, there are advocacy groups, researchers, religious groups, and policy makers who have resisted the promotion of MMC programmes in Africa. This resistance has had adverse effects on the expansion and uptake of circumcision programmes in some African countries.…”