Abstract
IntroductionPre‐exposure prophylaxis (PrEP) programmes have been initiated in sub‐Saharan Africa to prevent HIV acquisition in key populations at increased risk. However, data on PrEP uptake and retention in high‐risk African communities are limited. We evaluated PrEP uptake and retention in HIV hyperendemic fishing villages and trading centres in south‐central Uganda between April 2018 and March 2019.MethodsPrEP eligibility was assessed using a national risk screening tool. Programme data were used to evaluate uptake and retention over 12 months. Multivariable modified Poisson regression estimated adjusted prevalence ratios (aPR) and 95% Confidence intervals (CIs) of uptake associated with covariates. We used Kaplan–Meier analysis to estimate retention and multivariable Cox regression to estimate adjusted relative hazards (aRH) and 95% CIs of discontinuation associated with covariates.Results and discussionOf the 2985 HIV‐negative individuals screened; 2750 (92.1 %) were eligible; of whom 2,536 (92.2%) accepted PrEP. Male (aPR = 0.91, 95% CI = 0.85 to 0.97) and female (aPR = 0.85, 95% CI = 0.77 to 0.94) fisher folk were less likely to accept compared to HIV‐discordant couples. Median retention was 45.4 days for both men and women, whereas retention was higher among women (log rank, p < 0.001) overall. PrEP discontinuation was higher among female sex workers (aRH = 1.42, 95% CI = 1.09 to 1.83) and female fisher folk (aRH = 1.99, 95% CI = 1.46 to 2.72), compared to women in discordant couples. Male fisher folk (aRH = 1.37, 95% CI = 1.07 to 1.76) and male truck drivers (aRH = 1.49, 95% CI = 1.14 to 1.94) were more likely to discontinue compared to men in discordant couples. Women 30 to 34 years tended to have lower discontinuation rates compared to adolescents 15 to 19 years (RH = 0.78 [95% CI = 0.63 to 0.96]).ConclusionsPrEP uptake was high, but retention was very low especially among those at the highest risk of HIV: fisher folk, sex workers and truck drivers and adolescent girls. Research on reasons for PrEP discontinuation could help optimize retention.
Highlights
Pre-exposure prophylaxis (PrEP) programmes have been initiated in sub-Saharan Africa to prevent HIV acquisition in key populations at increased risk
We evaluated PrEP uptake and retention in a programme implemented through government clinics in districts of South-central Uganda among individuals with high risk of HIV according to the Ugandan national HIV-risk categorization [13]
Of the 2,985 individuals screened for PrEP, 169 (5.6%) were HIV-positive
Summary
Pre-exposure prophylaxis (PrEP) programmes have been initiated in sub-Saharan Africa to prevent HIV acquisition in key populations at increased risk. PrEP discontinuation was higher among female sex workers (aRH = 1.42, 95% CI = 1.09 to 1.83) and female fisher folk (aRH = 1.99, 95% CI = 1.46 to 2.72), compared to women in discordant couples. Studies of populations with high HIV risk in sub-Saharan Africa (SSA) including sex workers, fisher folk and discordant couples reported 60-90 percent willingness to use PrEP [4,5,6,7,8] but subsequent demonstration projects found mixed results for PrEP uptake: high uptake (approximately 97%), retention (>90% by three months) and adherence (over 80%) were shown among HIVdiscordant couples [9,10] and men who have sex with men (MSMs) in Kenya [11]; whereas low uptake (approximately 18%) was observed in the Sustainable East Africa Research in Community Health (SEARCH) study [12]. We evaluated PrEP uptake and retention in a programme implemented through government clinics in districts of South-central Uganda among individuals with high risk of HIV according to the Ugandan national HIV-risk categorization [13]
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