Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

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“I wish to remain HIV negative”: Pre-exposure prophylaxis adherence and persistence in transgender women and men who have sex with men in coastal Kenya

PLoS ONE ◽

10.1371/journal.pone.0244226 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244226

Author(s):

Makobu Kimani ◽

Elise M. van der Elst ◽

Oscar Chirro ◽

Elizabeth Wahome ◽

Fauz Ibrahim ◽

...

Keyword(s):

Risk Behaviour ◽

Healthcare Services ◽

Transgender Women ◽

Situational Factors ◽

Sub Saharan Africa ◽

Sexual Risk Behaviour ◽

Sub Saharan ◽

Sex With Men ◽

Hiv Acquisition ◽

Exposure Prophylaxis

Background Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. Methods Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700–1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. Results Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. Conclusion While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.

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Biomedical prevention: what is the current status?

Asian Biomedicine ◽

10.2478/abm-2010-0089 ◽

2010 ◽

Vol 4 (5) ◽

pp. 679-682

Author(s):

David D. Celentano ◽

Wendy W. Davis ◽

Chris C. Beyrer

Keyword(s):

Male Circumcision ◽

Hiv Transmission ◽

Sub Saharan Africa ◽

Current Status ◽

Post Exposure Prophylaxis ◽

Biomedical Hiv Prevention ◽

Hiv Prevention Strategies ◽

Biomedical Prevention ◽

Sub Saharan ◽

Exposure Prophylaxis

Abstract Biomedical HIV prevention strategies for primary or secondary prevention of HIV transmission can be seen as an adjunct to behavioral prevention approaches. These interventions include vaccination, female controlled vaginal microbicides, male circumcision, treatment of sexually transmitted infections that cause genital ulceration, Pre-Exposure Prophylaxis (PREP) and Post-Exposure Prophylaxis (PEP). This article reviews results from recent randomized controlled trials of novel biomedical prevention approaches and discusses interpretation of the results. The only intervention consistently demonstrating reductions in HIV transmission was adult male circumcision in Sub-Saharan Africa. Results of PREP trials will be available in the next several years.

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Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up

International Journal of STD & AIDS ◽

10.1177/0956462418787896 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1432-1443 ◽

Cited By ~ 6

Author(s):

Jason B Reed ◽

Rupa R Patel ◽

Rachel Baggaley

Keyword(s):

Male Circumcision ◽

Scale Up ◽

Health Impact ◽

Lessons Learned ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Prep Implementation ◽

Sub Saharan ◽

Exposure Prophylaxis

Oral pre-exposure prophylaxis (PrEP) has the ability to curb HIV incidence worldwide and bring us closer to ending the HIV epidemic. Scale up of PrEP service delivery has many similar challenges to those faced by voluntary medical male circumcision (VMMC) services roll-out. This article outlines ten important lessons learned during the scale up of VMMC services in sub-Saharan Africa and their application to current oral PrEP implementation efforts to promote faster expansion for public health impact.

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Impact of Endemic Infections on HIV Susceptibility in Sub-Saharan Africa

Tropical Diseases Travel Medicine and Vaccines ◽

10.1186/s40794-019-0097-5 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

Sergey Yegorov ◽

Vineet Joag ◽

Ronald M. Galiwango ◽

Sara V. Good ◽

Brenda Okech ◽

...

Keyword(s):

Hiv Transmission ◽

Current Knowledge ◽

Sub Saharan Africa ◽

Hiv Susceptibility ◽

Immune Parameters ◽

Immunological Mechanisms ◽

Immunodeficiency Virus ◽

Sub Saharan ◽

Hiv Acquisition ◽

Endemic Infections

AbstractHuman immunodeficiency virus (HIV) remains a leading cause of global morbidity with the highest burden in Sub-Saharan Africa (SSA). For reasons that are incompletely understood, the likelihood of HIV transmission is several fold higher in SSA than in higher income countries, and most of these infections are acquired by young women. Residents of SSA are also exposed to a variety of endemic infections, such as malaria and various helminthiases that could influence mucosal and systemic immunology. Since these immune parameters are important determinants of HIV acquisition and progression, this review explores the possible effects of endemic infections on HIV susceptibility and summarizes current knowledge of the epidemiology and underlying immunological mechanisms by which endemic infections could impact HIV acquisition. A better understanding of the interaction between endemic infections and HIV may enhance HIV prevention programs in SSA.

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Maternal PrEP use in HIV-uninfected pregnant women in South Africa: Role of Stigma in PrEP initiation, retention and adherence

10.1101/2020.11.24.20237867 ◽

2020 ◽

Author(s):

Alexander Moran ◽

Nyiko Mashele ◽

Rufaro Mvududu ◽

Pamina Gorbach ◽

Linda-Gail Bekker ◽

...

Keyword(s):

Pregnant Women ◽

Sub Saharan Africa ◽

Antenatal Visit ◽

Sub Saharan ◽

Anticipated Stigma ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis ◽

The Relationship

AbstractPregnant women in sub-Saharan Africa are at high risk of HIV acquisition and require effective methods to prevent HIV. In a cohort of pregnant women offered pre-exposure prophylaxis (PrEP), we evaluate the relationship between internalized and anticipated stigma and PrEP initiation at first antenatal visit, 3-month continuation and adherence using multivariable logistic regression. High internalized and anticipated PrEP stigma are associated with lower PrEP initiation at first antenatal visit (aOR internalized stigma=0.06; 95%CI=0.03-0.12 & aOR anticipated stigma=0.53; 95%CI=0.29-0.97) compared to women with low reported stigma, after controlling for covariates. Women whose partners have not been tested for HIV or whose serostatus remains unknown have 1.6-times odds of PrEP retention at 3-months compared to women whose partners have been tested (aOR=1.60; 95%CI=1.02-2.52) after adjusting for covariates. PrEP counseling and maternal PrEP interventions must consider individual- and relational-level interventions to overcome anticipated PrEP stigma and other barriers to PrEP initiation and adherence.

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PrEP as a Lifestyle and Investment for Adolescent Girls and Young Women in Sub-Saharan Africa

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219831011 ◽

2019 ◽

Vol 18 ◽

pp. 232595821983101 ◽

Cited By ~ 7

Author(s):

Jessica E. Haberer ◽

Nelly Mugo ◽

Jared M. Baeten ◽

Maria Pyra ◽

Elizabeth Bukusi ◽

...

Keyword(s):

Adolescent Girls ◽

Young Women ◽

Sub Saharan Africa ◽

Lifestyle Choice ◽

Hiv Epidemic ◽

Sub Saharan ◽

The Many ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Exposure Prophylaxis

Adolescent girls and young women (AGYW) are highly affected by the HIV epidemic, yet standard approaches to pre-exposure prophylaxis (PrEP) delivery will not meet their needs. This commentary highlights key characteristics of AGYW related to PrEP use and delivery, including typical neurocognitive development, lack of experience with sustained medication use, and the social and connected nature of AGYW’s lives. We then suggest ways for programs to embrace these characteristics, such as presenting PrEP as a lifestyle choice and not a biomedical tool, making access to PrEP simple and easy, and recognizing the many influences AGYW face in taking PrEP. We also suggest ways for programs to identify AGYW at the highest risk of HIV acquisition. Adolescent girls and young women have an important role to play in ending the HIV epidemic and they deserve considerable, tailored investment.

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Ask the Way From Those Who Have Walked It Before – Grandmothers’ Roles in Health-related Decision Making and HIV Pre-exposure Prophylaxis (PrEP) Use Among Pregnant and Breastfeeding Women in Africa

10.21203/rs.3.rs-459256/v1 ◽

2021 ◽

Author(s):

Krishnaveni Reddy ◽

Doreen Kemigisha ◽

Miria Chitukuta ◽

Sufia Dadabhai ◽

Florence Mathebula ◽

...

Keyword(s):

Hiv Prevention ◽

Sub Saharan Africa ◽

Sources Of Information ◽

Maternal Experience ◽

Biomedical Hiv Prevention ◽

Health Related ◽

Sub Saharan ◽

Hiv Acquisition ◽

The Right ◽

Exposure Prophylaxis

Abstract Background: HIV acquisition among pregnant and breastfeeding women in sub-Saharan Africa (SSA) and vertical transmission rates remain high despite established strategies for HIV prevention. Methods: We explored grandmothers’ (mothers/mothers-in-law) influence on pregnant and breastfeeding women’s health-related decisions and their potential to support use of HIV prevention products utilizing qualitative data collected from grandmothers, HIV-uninfected, currently/recently pregnant or breastfeeding women and male partners of currently/recently pregnant or breastfeeding women during the MTN-041/MAMMA study. Results: Grandmothers were described as important sources of information, playing both supportive and influencer roles, due to personal maternal experience and generational knowledge. Grandmothers expressed willingness to support pre-exposure prophylaxis (PrEP) use and agreed with other groups that this decision should be made by women themselves and/or with partners. Conclusion: With the right framing and approach, grandmothers’ supportive roles can optimise uptake and adherence to biomedical HIV prevention and reduce HIV acquisition among pregnant and breastfeeding women in these communities.

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