TUPEC438

Title

PrEP uptake, engagement, and adherence following population-wide HIV testing in rural Kenya and Uganda in the SEARCH study

Presenter

Gabriel Chamie

Authors

C. Koss¹, J. Ayieko², D. Kwarisiima³, M. Atukunda³, L. Balzer⁴, F. Mwangwa³, J. Peng¹, Y. Mwinike³, A. Owaraganise³, G. Chamie¹, V. Jain¹, J. Kabami³, N. Sang², C.S. Camlin¹, D. Black¹, T. Clark¹, C. Cohen¹, E. Bukusi², M. Petersen⁵, E. Charlebois¹, M. Kamya^3,6, D. Havlir¹, SEARCH Collaboration

Institutions

¹University of California, San Francisco, United States, ²Kenya Medical Research Institute, Nairobi, Kenya, ³Infectious Diseases Research Collaboration, Kampala, Uganda, ⁴University of Massachusetts, Amherst, United States, ⁵University of California, Berkeley, United States, ⁶Makerere University College of Health Sciences, Kampala, Uganda

Background: Optimal PrEP delivery approaches in sub-Saharan Africa are needed. We report population-level PrEP uptake and engagement following near-universal HIV testing in the ongoing SEARCH study (NCT01864603) in rural Kenya and Uganda.
Methods: Following community-level PrEP mobilization (outreach/education), we conducted HIV and multi-disease health campaigns/home-based testing and offered PrEP (TDF/FTC) to higher HIV-risk individuals (identified via self-assessed risk behavior, seroconversion risk score, or serodiscordance) at campaigns/nearby clinics. Overall and within higher-risk subgroups, we assessed PrEP uptake within 90 days of HIV testing. Among PrEP initiators, we assessed program engagement (visit attendance), medication refill, and self-reported 3-day adherence over 72 weeks.
Results: Among 71,825 HIV-uninfected residents in 16 communities, 3,488 (4.9%) initiated PrEP. Uptake among higher-risk young women 15-24 years was 413/2,362 (17%), young women using contraception 158/764 (21%); young men 508/2,385 (21%); discordant partners 594/1,551 (38%); fishing/bar/transport workers 509/2,241 (23%); mobile persons 179/1,121 (16%). We also observed 36% PrEP uptake (334/928) among men ≥45. Among 3,488 PrEP initiators, 82% started same-day; 50% were women, 28% aged 15-24. At weeks 4, 24, and 72 following PrEP initiation, program engagement was 64%, 56%, 55%, respectively (Figure). Week 24 engagement, refill, and adherence were higher among discordant partners (70%/56%/48%) and fishing/bar/transport workers (73%/43%/35%) than young women (54%/22%/17%), young men (42%/19%/13%), and mobile persons (31%/20%/18%). HIV testing was performed at 3,962/5,099 (78%) visits where participants had discontinued PrEP. Self-reported barriers to PrEP use included daily pill-taking, side effects, non-supportive partner, and travel.
Conclusions: PrEP implementation via a population-based approach resulted in over 3,000 PrEP starts; most were same-day. However, engagement and adherence were sub-optimal; only half remained on PrEP by week 4. Among those discontinuing PrEP, ongoing program engagement provided opportunities for repeat HIV testing and re-starting PrEP. Strategies to increase engagement and adherence are needed, particularly for youth and mobile populations, to maximize the benefits of PrEP.

[PrEP program engagement, refill, and self-reported adherence among 3,488 PrEP initiators]