Oral pre-exposure prophylaxis uptake, adherence, and adverse events among South African men who have sex with men and transgender women.

Abstract

Background

HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women (TGW) in South Africa have not been widely implemented.

Objectives

The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility.

Method

In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP, and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations.

Results

Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305 days (interquartile range: 232-325 days). Across the follow-up time points, 57% - 72% of participants self-reported taking protective levels of PrEP and 59% - 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation.

Conclusion

Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.4102/sajhivmed.v23i1.1405

Publication Info

Bekker, Linda-Gail, Danielle Giovenco, Stefan Baral, Karen Dominguez, Rachel Valencia, Travis Sanchez, AD McNaghten, Ryan Zahn, et al. (2022). Oral pre-exposure prophylaxis uptake, adherence, and adverse events among South African men who have sex with men and transgender women. Southern African journal of HIV medicine, 23(1). p. 1405. 10.4102/sajhivmed.v23i1.1405 Retrieved from https://hdl.handle.net/10161/26411.

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