Abstract:
BACKGROUND : HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for
men who have sex with men (MSM) and transgender women (TGW) in South Africa have not
been widely implemented.
OBJECTIVES : The authors examined oral PrEP uptake, adherence, and adverse events among
HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility.
METHOD : In 2015, MSM and TGW in two South African cities were offered a comprehensive
package of HIV prevention services, including daily oral PrEP, and were followed for one year.
Different models of PrEP delivery were used at each site. Adherence was measured using
self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations.
RESULTS : Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom
67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5
possible days (93% protected days). The median time from PrEP initiation to discontinuation
or study end was 305 days (interquartile range: 232–325 days). Across the follow-up time
points, 57% – 72% of participants self-reported taking protective levels of PrEP and 59% – 74%
were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP
concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild,
were the most commonly cited reason by participants for early PrEP discontinuation.
CONCLUSION : Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP
can be successfully delivered to South African MSM and TGW in diverse programmatic
contexts. Biologic adherence measures suggest MSM and TGW may experience challenges
taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking
is recommended to support South African MSM and TGW in achieving protection with PrEP.
Description:
DATA AVAILABILITY : Data that support the findings may contain identifying or sensitive patient information. To preserve participant confidentiality, these data cannot be shared publicly. The principal investigator of this study, P.S.S. (pssulli@emory. edu), can be contacted with requests to access these data.