Abstract
HIV endpoint-driven clinical trials in Africa enroll women who are at heightened risk of acquiring HIV. In 2017, the South African Medical Research Council recommended the provision of oral pre-exposure prophylaxis (PrEP) in HIV prevention trials, at which time the Evidence for Contraceptive Options and HIV Outcomes trial was ongoing and began to provide PrEP on-site at some trial sites. We interviewed 132 women who initiated PrEP on-site at the Durban, South Africa trial site to explore PrEP use, and conducted phone-based interviews 4–6 months post-trial exit to explore post-trial PrEP access. PrEP uptake was high (42.6%). Among women initiating PrEP on-site, 87.9% felt at risk of acquiring HIV. Most women (> 90%) heard of PrEP for the first time from study staff and three-quarters who initiated PrEP on-site continued at trial-exit. PrEP use declined post-trial exit with more than 50% of women discontinuing PrEP, and barriers relating to access emerged.
Highlights
South Africa (SA) has the largest HIV epidemic in the world [1]
132 (132 of 138, 95.7%) women who initiated pre-exposure prophylaxis (PrEP) on-site consented to participate in the ancillary study
A quarter (33, 25.0%) had Chlamydia trachomatis and three (2.3%) had Nesseria gonorrhoeae detected at enrolment into the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial
Summary
South Africa (SA) has the largest HIV epidemic in the world [1]. In 2018, there were 7.7 million people living with HIV and 240,000 new infections, with women more disproportionately affected than men, and more than double the number of new infections occurring in young women (15–24 years) compared to men in the same age group [2]. In 2015, the World Health Organization (WHO) made the recommendation that daily oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) should be used as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches [3]. SA began its PrEP rollout to select sex worker sites in 2016, and later expanded to include additional key populations, including men who have sex with men (MSM), serodiscordant couples, and adolescent girls and young women [4]. Since 2018, access to PrEP in SA has expanded and PrEP is currently available in public sector health facilities within the country [5], in addition to demonstration projects and observational studies [6]
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