Nicolette Naidoo

This session reviewed emerging evidence from interventions aimed at improving PrEP use, specifically drug level feedback and ascertainment following DBS, integration of PrEP with MCH and Family Planning services whilst identifying factors associated with PrEP discontinuation and restart among priority and key populations (adolescents, MSM and transgender respectively).

Connie Cellum demonstrated that although 95% of young women initiated PrEP in the HPTN 082 trial, adherence did not increase following drug level feedback. Emilia Jalil showed 48% PrEP uptake among transgender women participating in the PrEParadas study; however social vulnerability and risky behaviour was associated with poor PrEP engagement and adherence. Benjamin Bavinton reported that PrEP discontinuation for ≥3 months was significantly associated with younger age, lower partner numbers and less condomless anal intercourse in the previous week among MSM in the EPIC-NSW study. Victor Omollo confirmed that PrEP uptake was high among African AGYW in the POWER trial but interruptions were common, often intentional, with a quarter re-initiating PrEP typically within 2 months. Jilian Pintye demonstrated that integration of PrEP with MCH/FP services and real world adherence measurement is achievable but important to note that partner status was associated with detectable drug levels.

This session clearly demonstrated the need for more research to determine effective adherence support strategies to sustain PrEP use among adolescent and key populations. This must be complemented with robust POC assays to estimate drug levels. In evaluating PrEP programs, interruptions, reasons for discontinuation, and re-initiation patterns should be monitored to assess the delivery and impact of PrEP. Further to this, better measures and definitions of continuation in the context of changing risk profiles and autonomous decision making around PrEP interruption is needed.