Correction to: Efficiency in PrEP Delivery: Estimating the Annual Costs of Oral PrEP in Zimbabwe

Abstract Background The uptake and adherence of daily oral PrEP has been poor in high-risk populations in South Africa including young people. We used qualitative research methods to explore user preferences for daily and on-demand oral PrEP use among young South Africans, and to inform the identification of critical attributes and attribute-levels for quantitative analysis of user preferences, i.e. a discrete choice experiment (DCE). Methods Data were collected between September and November 2018 from eight group discussions and 20 in-depth interviews with young people 13 to 24 years in Cape Town and Johannesburg. Using a convenience sampling strategy, participants were stratified by sex and age. Interviewers used a semi-structured interview guide to discuss several attributes (dosing regimen, location, costs, side effects, and protection period) for PrEP access and use. Group discussions and in-depth interviews were audio-recorded, transcribed verbatim and translated to English. We used framework analysis to explore context-specific attributes and attribute-levels for delivering oral PrEP in South Africa. The adolescent community advisory board, expert and study team opinions were consulted for the final DCE attributes and levels. Results We enrolled 74 participants who were 51% (n = 38/74) male, had a median age of 18.5 [Interquartile range = 16–21.25] years, 91% (n = 67/74) identified as heterosexual and 49% (n = 36/74) had not completed 12th grade education. Using the qualitative data, we identified five candidate attributes including (1) dosing regimen, (2) location to get PrEP, (3) cost, (4) route of administration and (5) frequency. After discussions with experts and the study team, we revised the DCE to include the following five attributes and levels: dosing regime: daily, and on-demand PrEP; location: private pharmacy, public clinic, mobile clinic, ATM); cost: free-of-charge, R50 (~2GBP), R265 (~12GBP); side effects: nausea, headache, rash; and duration of protection: fulltime protection versus when PrEP is used). Conclusions There is limited literature on qualitative research methods describing the step-by-step process of developing a DCE for PrEP in adolescents, especially in resource-constrained countries. We provide the process followed for the DCE technique to understand user preferences for daily and on-demand oral PrEP among young people in South Africa.

Download Full-text

Cost-Effectiveness Analysis of the Daily HIV Pre-Exposure Prophylaxis in Men who Have Sex with Men in Barcelona

10.20944/preprints202111.0295.v1 ◽

2021 ◽

Author(s):

Francesc López Seguí ◽

Unai Oyon Lerga ◽

Laura Laguna Marmol ◽

Pep Coll ◽

Angels Andreu ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Time Horizon ◽

Cost Savings ◽

Health Indicators ◽

Hiv Infections ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Oral Prep

Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia, a territory with extensive implementation. Methods: Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price). A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. Results: Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. Conclusions: The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.

Download Full-text

Factors Associated With Willingness to Use Oral Pre-exposure Prophylaxis (Prep) Among Fishing Communities in Peri-urban Kampala, Uganda

10.21203/rs.3.rs-265902/v1 ◽

2021 ◽

Author(s):

Bashir Ssuna ◽

Anne Katahoire ◽

Mari Armstrong-Hough ◽

Dennis Kalibbala ◽

Joan N Kalyango ◽

...

Keyword(s):

Focus Group ◽

Fishing Communities ◽

Key Populations ◽

Focus Group Discussions ◽

Group Discussions ◽

Factors Associated ◽

The Past ◽

Willingness To Use ◽

Exposure Prophylaxis ◽

Oral Prep

Abstract Background: The World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence. Objective: To examine the perceptions and factors associated with willingness to use oral PrEP among members of fishing communities in Uganda, a key population at risk of HIV. Methods: We conducted an explanatory sequential mixed-methods study at Ggaba fishing community from February to June 2019. Survey data were collected from a systematic random sample of 283 community members. We carried out bivariate tests of association of willingness to use PrEP with demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson regression model to describe factors associated with willingness to use PrEP. We purposively selected 16 participants for focus group discussions to contextualize survey findings, analysing data inductively and identifying emergent themes related to perceptions of PrEP. Key results: We enrolled 283 participants with a mean age of 31±8 years. Most (80.9%) were male. The majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months. Self-reported HIV prevalence was 6.4%. Most (80.6%, 95%CI 75.5-85.0) were willing in principle to use PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99, 95%CI 1.31-3.02, P= 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03-1.24, P=0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39-2.81, P<0.001). In focus group discussions, participants described pill burden, side-effects, drug safety, and accessibility as potential barriers to PrEP use. Conclusions and recommendations: Oral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and also address issues of access to drugs.

Download Full-text

A qualitative study to identify critical attributes and attribute-levels for a Discrete Choice Experiment on oral Pre-Exposure Prophylaxis (PrEP) delivery among young people in Cape Town and Johannesburg, South Africa.

10.21203/rs.3.rs-39709/v2 ◽

2020 ◽

Author(s):

Janan Janine Dietrich ◽

Millicent Atujuna ◽

Gugulethu Tshabalala ◽

Stefanie Hornschuh ◽

Mamakiri Mulaudzi ◽

...

Keyword(s):

South Africa ◽

Young People ◽

Choice Experiment ◽

User Preferences ◽

Dosing Regimen ◽

On Demand ◽

Study Team ◽

Attribute Levels ◽

Depth Interviews ◽

Oral Prep

Abstract Background The uptake and adherence of daily oral PrEP has been poor in high-risk populations in South Africa including young people. We used qualitative research methods to explore user preferences for daily and on-demand oral PrEP use among young South Africans, and to inform the identification of critical attributes and attribute-levels for quantitative analysis of user preferences, i.e. a discrete choice experiment (DCE). MethodsData were collected between September and November 2018 from eight group discussions and 20 in-depth interviews with young people 13 to 24 years in Cape Town and Johannesburg. Using a convenience sampling strategy, participants were stratified by sex and age. Interviewers used a semi-structured interview guide to discuss several attributes (dosing regimen, location, costs, side effects, and protection period) for PrEP access and use. Groups discussions and in-depth interviews were audio-recorded, transcribed verbatim and translated to English. We used framework analysis to explore context-specific attributes and attribute-levels for delivering oral PrEP in South Africa. The adolescent community advisory board, expert and study team opinions were consulted for the final DCE attributes and levels. ResultsWe enrolled 74 participants who were 51% (n=38/74) male, had a median age of 18.5 [Interquartile range=16-21.25] years, 91% (n=67/74) identified as heterosexual and 49% (n=36/74) had not completed 12th grade education. Using the qualitative data, we identified five candidate attributes including (1) dosing regimen, (2) location to get PrEP, (3) cost, (4) route of administration and (5) frequency. After discussions with experts and the study team, we revised the DCE to include the following five attributes and levels: dosing regime: daily, and on-demand PrEP; location: private pharmacy, public clinic, mobile clinic, ATM); cost: free-of-charge, R50 (~2GBP), R265 (~12GBP); side effects: nausea, headache, rash; and duration of protection: fulltime protection versus when PrEP is used). ConclusionsThere is limited literature on qualitative research methods describing the step-by-step process of developing a DCE for PrEP in adolescents, especially in resource-constrained countries. We provide the process followed for the DCE technique to understand user preferences for daily and on-demand oral PrEP among young people in South Africa.

Download Full-text

Motivated Reasoning and HIV Risk? Views on Relationships, Trust, and Risk from Young Women in Cape Town, South Africa, and Implications for Oral PrEP

AIDS and Behavior ◽

10.1007/s10461-018-2044-2 ◽

2018 ◽

Vol 22 (11) ◽

pp. 3468-3479 ◽

Cited By ~ 9

Author(s):

Miriam Hartmann ◽

Margaret McConnell ◽

Linda-Gail Bekker ◽

Connie Celum ◽

Thola Bennie ◽

...

Keyword(s):

South Africa ◽

Young Women ◽

Hiv Risk ◽

Cape Town ◽

Motivated Reasoning ◽

Oral Prep

Download Full-text

Pre-exposure prophylaxis during the SARS-CoV-2 pandemic: can PrEP prevent COVID-19-related symptoms?

Epidemiology and Infection ◽

10.1017/s0950268820002253 ◽

2020 ◽

Vol 148 ◽

Author(s):

Danilo Euclides Fernandes ◽

Paulo Roberto Abrão Ferreira ◽

Gianna Mastroianni Kirsztajn

Keyword(s):

Body Mass Index ◽

Protective Effect ◽

Gay Men ◽

Phone Call ◽

Social Distancing ◽

Digital Investigation ◽

Exposure Prophylaxis ◽

E Mail ◽

Oral Prep

Abstract It has been speculated that some drugs can be used against SARS-CoV-2. As for antiretrovirals, the follow-up of pre-exposure prophylaxis (PrEP) users during the coronavirus disease 2019 (COVID-19) outbreak may help to understand the potential protective effect of PrEP against SARS-CoV-2. We aimed to identify associations between oral PrEP use and COVID-19-related symptoms self-reporting. Phone call interviews or digital investigation (through WhatsApp® or e-mail) about oral PrEP regular use, social distancing, exposure to suspected or confirmed cases of SARS-CoV-2 infection and COVID-19-related symptoms. Among 108 individuals, the majority were cisgender, white and gay men. Although most of the individuals engaged in social distancing (68.52%), they kept on taking PrEP (75.93%). Few people have had contact with suspected or confirmed cases of COVID-19 (12.04%), but some had COVID-19-related symptoms the month before the interview (27.78%) including rhinorrheoa (56.67%), cough (53.33%), asthaenia (50.00%) and headache (43.33%). Also, oral PrEP was associated with lower self-reporting COVID-19-symptoms (OR 0.26, 95% CI 0.07–0.96, P = 0.04; h = 0.92) even after controlling confounders as social distancing, age, body-mass index and morbidities . In our sample, the regular use of oral PrEP was associated with lower self-reporting of COVID-19-related symptoms during the outbreak in São Paulo, Brazil.

Download Full-text

Prepared for PrEP: preferences for HIV pre-exposure prophylaxis among Chinese men who have sex with men in an online national survey

BMC Infectious Diseases ◽

10.1186/s12879-019-4692-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Wenting Huang ◽

Dan Wu ◽

Jason J. Ong ◽

M. Kumi Smith ◽

Fan Yang ◽

...

Keyword(s):

National Survey ◽

Secondary Analysis ◽

Chinese Men ◽

Sex With Men ◽

Partner Types ◽

Long Acting ◽

Negotiated Safety ◽

Exposure Prophylaxis ◽

Larger Sample ◽

Oral Prep

Abstract Background Pre-exposure prophylaxis (PrEP) is not widely available in China. Previous studies reported low awareness and inconclusive findings on the acceptability of PrEP among Chinese men who have sex with men (MSM). Methods We conducted a secondary analysis of an online national survey comparing preferences for oral and long-acting injectable PrEP among MSM and identifying correlates of preferences. The study did not collect detailed information about partner types that may influence negotiated safety and PrEP uptake. Results Nine-hundred and seventy-nine men from the larger sample of 1045 men responded to the PrEP survey questions. Most men (81.9%) had never heard of PrEP, but reported interest in using PrEP. More participants chose injectable PrEP (36.3%) as their preferred formulation than oral PrEP (24.6%). Men who had at least two HIV tests (adjusted OR = 1.36, 95%CI 1.04, 1.78) more commonly preferred injectable PrEP. Conclusion Our findings may help inform PrEP messaging in areas where PrEP has yet to be scaled up.

Download Full-text

Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City

AIDS and Behavior ◽

10.1007/s10461-018-2102-9 ◽

2018 ◽

Vol 22 (11) ◽

pp. 3627-3636 ◽

Cited By ~ 28

Author(s):

Christine Tagliaferri Rael ◽

Michelle Martinez ◽

Rebecca Giguere ◽

Walter Bockting ◽

Caitlin MacCrate ◽

...

Keyword(s):

New York ◽

New York City ◽

York City ◽

Transgender Women ◽

Barriers And Facilitators ◽

Oral Prep

Download Full-text

Sa1711 Colon Irrigation Prep Outcomes, One Year in Review: an Effective, Well Tolerated Low-Risk Alternative to Standard Oral Prep

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.562 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB250

Author(s):

Harish K. Gagneja ◽

Parth J. Parekh ◽

Dawn B. Burleson ◽

David A. Johnson

Keyword(s):

Low Risk ◽

One Year ◽

Colon Irrigation ◽

Oral Prep

Download Full-text

Integrating Oral PrEP Into Family Planning Services for Women in Sub-saharan Africa: Findings From a Multi-Country Landscape Analysis

Frontiers in Reproductive Health ◽

10.3389/frph.2021.667823 ◽

2021 ◽

Vol 3 ◽

Author(s):

Neeraja Bhavaraju ◽

Rose Wilcher ◽

Regeru Njoroge Regeru ◽

Saiqa Mullick ◽

Imelda Mahaka ◽

...

Keyword(s):

Family Planning ◽

Service Delivery ◽

Health Care Providers ◽

Sub Saharan Africa ◽

Management Service ◽

Care Providers ◽

Road Map ◽

Sub Saharan ◽

Exposure Prophylaxis ◽

Oral Prep

Integration of HIV and family planning (FP) services is a renewed focus area for national policymakers, donors, and implementers in sub-Saharan Africa as a result of high HIV incidence among general-population women, especially adolescent girls and young women (AGYW), and the perception that integrating HIV pre-exposure prophylaxis (PrEP) into FP services may be an effective way to provide comprehensive HIV and FP services to this population. We conducted a focused desk review to develop a PrEP-FP integration framework across five key categories: plans and policies, resource management, service delivery, PrEP use, and monitoring and reporting. The framework was refined via interviews with 30 stakeholders across seven countries at varying stages of oral PrEP rollout: Kenya, Lesotho, Malawi, South Africa, Uganda, Zambia, and Zimbabwe. After refining the framework, we developed a PrEP-FP integration matrix and assessed country-specific progress to identify common enablers of and barriers to PrEP-FP integration. None of the countries included in our analysis had made substantial progress toward integrated PrEP-FP service delivery. Although the countries made progress in one or two categories, integration was often impeded by lack of advancement in other areas. Our framework offers policymakers, program implementers, and health care providers a road map for strategically assessing and monitoring progress toward PrEP-FP integration in their contexts.

Download Full-text