Abstract
BackgroundThe use of antiviral medications by HIV negative people to prevent acquisition of HIV or pre-exposure prophylaxis (PrEP) has shown promising results in recent trials. To understand the potential impact of PrEP for HIV prevention, in addition to efficacy data, we need to understand both the acceptability of PrEP among members of potential user groups and the factors likely to determine uptake.Methods and findingsSurveys of willingness to use PrEP products were conducted with 1,790 members of potential user groups (FSWs, MSM, IDUs, SDCs and young women) in seven countries: Peru, Ukraine, India, Kenya, Botswana, Uganda and South Africa. Analyses of variance were used to assess levels of acceptance across different user groups and countries. Conjoint analysis was used to examine the attitudes and preferences towards hypothetical and known attributes of PrEP programs and medications. Overall, members of potential user groups were willing to consider taking PrEP (61% reported that they would definitely use PrEP). Current results demonstrate that key user groups in different countries perceived PrEP as giving them new possibilities in their lives and would consider using it as soon as it becomes available. These results were maintained when subjects were reminded of potential side effects, the need to combine condom use with PrEP, and for regular HIV testing. Across populations, route of administration was considered the most important attribute of the presented alternatives.ConclusionsDespite multiple conceivable barriers, there was a general willingness to adopt PrEP in key populations, which suggests that if efficacious and affordable, it could be a useful tool in HIV prevention. There would be a willingness to experience inconvenience and expense at the levels included in the survey. The results suggest that delivery in a long lasting injection would be a good target in drug development.
Highlights
HIV remains a significant global health problem, with an estimated 2.6 million people newly infected in 2009, challenging both national and international decision makers to identify effective prevention interventions
Despite multiple conceivable barriers, there was a general willingness to adopt pre-exposure prophylaxis (PrEP) in key populations, which suggests that if efficacious and affordable, it could be a useful tool in HIV prevention
The Partners PrEP study in Kenya and Uganda showed that two different antiretroviral regimes significantly prevented HIV transmission among serodiscordant couples. 62% and 73% fewer HIV infections were observed in the tenofovir and Truvada arms of the trial, respectively, compared to those participants who received placebo [5]
Summary
HIV remains a significant global health problem, with an estimated 2.6 million people newly infected in 2009, challenging both national and international decision makers to identify effective prevention interventions. The landscape of HIV prevention has been dramatically altered by recent trials of antiretroviral based prevention methods Treatment of those with HIV significantly reduced the risk of transmission to uninfected partners by 96% in the HPTN-052 trial, which was stopped early due to efficacy [2]. Another and potentially complementary approach is preexposure prophylaxis (PrEP), the use of antiretroviral medications to reduce the risk of HIV infection in people who are HIV negative. To understand the potential impact of PrEP for HIV prevention, in addition to efficacy data, we need to understand both the acceptability of PrEP among members of potential user groups and the factors likely to determine uptake
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