PrEP consumption is high but decreases after three months in young African women

In a study on open Truvada as a daily pre-exposure prophylaxis (PrEP) aimed at preventing HIV among 427 African young women and girls, 95% initiated the HIV prevention strategy and most used it during first three months. However, the use of PrEP has fallen among participants in this critical population during a year of visits to follow-up clinics, although the incidence of HIV at 12 months is low. Preliminary results suggest that evidence-based, tailored adherence support strategies may be needed to sustainably engage young African women in consistent use of PrEP. The study, known as HPTN 082, was funded by the National Institute of Allergy and Infectious Diseases (NIAID) and by the National Institute of Mental Health (NIMH), two entities National Institutes of Health. The data was presented at the 10th International Society AIDS Conference on the science of HIV.

Young women and girls in sub-Saharan Africa account for 3 million of the 4 million people aged 15 to 26 living with HIV in the region. The NIH-sponsored HIV Prevention Trials Network (HPTN) reports that recent clinical trials have shown unacceptably high HIV incidence rates of 5-6% per year among young people. African women of this age group.

"Young women and girls in sub-Saharan Africa must be empowered to make informed choices about HIV prevention methods, including PrEP, that can protect the health of individuals and reverse the trend of HIV infection. HIV epidemic, "said Anthony, director of NIAID S. Fauci, MD" The new data suggests that we need to do more to help this population use PrEP daily as prescribed in order to effectively prevent the acquisition of HIV. HIV. "

HPTN researchers conducted the Phase 4 clinical trial, "Evaluating Daily Oral PrEP as a Primary Prevention Strategy for Young African Women: A Pilot Study." During visits to the clinic three months after the start of PrEP, 84% of the 371 study participants who had returned for follow-up had detectable levels of tenofovir diphosphate (TFV-DP), a metabolite of the drug. 39, one of the antiretrovirals of Truvada, in the blood, according to the dried blood. point badyzes. Of these participants, 25% had TFV-DP levels suggesting "strong adherence". At follow-up visits every six and twelve months, the investigators found that participants with detectable levels of bluetongue virus and fetal virus fell to 57% and 31%, respectively. Only 9% of young women had high-adhesion VTE-PDF rates at 12 months. In total, four women contracted HIV during the study. All had undetectable drug levels in the blood, suggesting limited adherence to PrEP.

"Multiple efficacy studies have shown that taking PrEP daily consistently provides a high level of protection against HIV acquisition," said Connie Celum, MD, MPH, protocol chair. HPTN 082 at the University of Washington in Seattle. "Unfortunately, as with all routine medications, especially for preventive purposes, daily compliance can be a challenge, and our results suggest that our participants initially adhered well to PrEP – the initial period to maintain their adherence to optimize their protection ".

In the study, HIV-negative women and girls – aged 16 to 25 – received HIV prevention counseling at an initial visit and were offered daily oral therapy. Truvada as PrEP. Participants who accepted PrEP and those who initially refused PrEP were followed for one year in clinics in Cape Town and Johannesburg, South Africa, and Harare, Zimbabwe. All participants who accepted PrEP received standard adherence support services, including counseling, peer club information, and SMS text messaging reminders. About half of the participants who accepted PrEP were randomized to also receive counseling including information on their drug-level outcomes throughout the clinical trial. The investigators found no difference in drug level between the two groups at three, six, or 12 months, indicating that drug level feedback did not improve PrEP compliance. .

The HPTN 082 team plans to conduct further badysis, including qualitative interviews with 75 participants in the study, to determine why some women have chosen to accept or decline the PrEP, and to identify specific compliance issues. Interviews may also indicate whether the risk behavior or perception of a participant's individual HIV risk changed throughout the study, which will allow for the eventual choice to continue or terminate the study. Use of PrEP.

"Our data provide useful information about the life of the participants in our study," said Sinead Delany-Moretlwe, MBCh.B., Ph.D., co-chair of HPTN Protocol 082 at the University of the Witwatersrand in Johannesburg , in South Africa. "In our future badyzes, we have the opportunity to capture more comprehensive information about the lives, badual behaviors, and compliance needs of these young women to better provide them with services and supports. strategies that suit them. "

In addition to indicating the need for more effective adherence support services, the findings also suggest that HIV prevention methods that are not based on daily compliance may be beneficial in this population. .

More information:
C Celum et al. PrEP adherence and the effect of feedback on drug level among young African women participating in HPTN 082. 10th International Conference on HIV Science, Mexico (2019).