Study shows higher PrEP adherence among young women in Africa than previously reported

March 06, 2024

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Key takeaways:

• Among adolescent and young women in Africa enrolled in INSIGHT, 95.6% initiated PrEP.
• Almost 90% of them were still coming back for refills 6 months later.

DENVER — New data from a cohort of adolescent and young women in sub-Saharan Africa showed a higher level of HIV PrEP adherence than has been reported in previous studies, researchers said.

Around 96% of participants initiated PrEP, and nearly 90% of them were still coming back for refills 6 months later, although urine tests showed adherence was lower than that.

Data derived from Mirembe B, et al. Abstract 167. Presented at: Conference on Retroviruses and Opportunistic Infections; March 3-6, 2024; Denver.

“PrEP is still the most available option that we have to prevent HIV. We have long-acting methods, but the availability is uncertain,” Brenda G. Mirembe, MBChB, MSc, senior investigator at the Makerere University — Johns Hopkins University Research Collaboration, said during a press conference at the Conference on Retroviruses and Opportunistic Infections. “We need to continue understanding PrEP uptake, adherence and persistence.”

Mirembe and colleagues enrolled 3,087 PrEP-interested sexually active adolescent girls and young women aged 16 to 30 years at 20 sites in six sub-Saharan African countries between August 2022 and July 2023. They followed up with participants at 1, 3 and 6 months after enrollment, during which they offered PrEP and adherence counseling.

According to data presented at the meeting, 95.6% of participants initiated PrEP at baseline. During follow-up appointments, 95.7% of patients received PrEP refills at 1 month, 94.4% at 3 months, and 88.8% at 6 months. The main reasons participants gave for PrEP discontinuation were side effects, a perception that they were at low risk, and peer influence.

The researchers also tested participants’ urine for tenofovir (TFV) at follow-up appointments and detected the PrEP drug in 77.5%, 79.6% and 64.1% of samples at 1, 3 and 6 months, respectively. Self-reported good, very good or excellent adherence coincided with positive results from the urine tests (OR = 8.5; 95% CI, 7.4-9.8).

Mirembe said the urine tests seemed to motivate participants to use PrEP better and could be studied further as a PrEP adherence strategy.

Researchers also presented data on HIV incidence from the INSIGHT study. For this part of the study, they enrolled women aged 16 to 30 years between August and December of 2022 from the 15 sites.

Participants were not prescreened for HIV “so that we could get women who had HIV in order to determine whether the infections were present or not,” Irene Mukui, MBChB, a medical epidemiologist at the University of Washington’s Drugs for Neglected Disease Initiative, said during the press conference.

“This is important is because, given that we have very effective HIV prevention products, any assessment of efficacy for new products cannot use a placebo, because you cannot give people nothing when you have an efficacious product. So, one option is to look at people who already have HIV and determine how recent the infection is,” Mukui said.

At screening, all patients were asked about their HIV testing history and prior results, and the researchers determined HIV incidence estimates from patients in South Africa and Eswatini, where recency testing has been completed.

In total, 2,682 women were screened and 119 (4.4%) tested positive for HIV, among whom six were classified as recent infections for an estimated HIV incidence rate (IR) of 0.71 (95% CI, 0.14-1.28).

Among the 2,487 who tested negative and were followed for 6 months, 97% accepted PrEP. There were 17 incident infections (IR = 1.23/100 person-years; 95% CI, 0.77-1.97).

Additionally, 71% of patients in the cohort self-reported an HIV test within the past 6 months, including 51 who were positive for HIV at screening. Among these 51 possible new infections, a viral load was obtained for 39, and it was less than 1,000 copies/mL in 59% of them, suggesting they had initiated ART.

“We have to think about possible recruitment strategies for future trials, in terms of how to motivate women who already know their HIV status and have been recently infected to actually come in for HIV prevention trials,” Mukui said.

References:

• Donnell D, et al. Abstract 171. Presented at: Conference on Retroviruses and Opportunistic Infections; March 3-6, 2024; Denver.
• Mirembe B, et al. Abstract 167. Presented at: Conference on Retroviruses and Opportunistic Infections; March 3-6, 2024; Denver.

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