PrEP use and HIV seroconversion rates in adolescent girls and young women from Kenya and South Africa: the POWER demonstration project.
PrEP use and HIV seroconversion rates in adolescent girls and young women from Kenya and South Africa: the POWER demonstration project.
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DOI：
10.1002/jia2.25962
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发表时间：
2022-07
影响因子：
6
通讯作者：
Baeten, Jared M.
中科院分区：
文献类型：
--
作者：
Celum, Connie L.;Bukusi, Elizabeth A.;Bekker, Linda Gail;Delany-Moretlwe, Sinead;Kidoguchi, Lara;Omollo, Victor;Rousseau, Elzette;Travill, Danielle;Morton, Jennifer F.;Mogaka, Felix;O'Malley, Gabrielle;Barnabee, Gena;van der Straten, Ariane;Donnell, Deborah;Parikh, Urvi M.;Kudrick, Lauren;Anderson, Peter L.;Haberer, Jessica E.;Wu, Linxuan;Heffron, Renee;Johnson, Rachel;Morrison, Susan;Baeten, Jared M.
非洲少女和年轻女性 (AGYW) 的艾滋病毒感染率仍然很高。本研究的主要目的是评估非洲 AGYW 提供的暴露前预防 (PrEP) 的启动、使用、持续性和 HIV 感染情况，以便为 PrEP 的扩大提供信息。 POWER 是一项前瞻性实施科学评估，针对肯尼亚基苏木的计划生育诊所以及南非开普敦和约翰内斯堡的青少年和初级保健诊所中性活跃的 16-25 岁 HIV 阴性 AGYW 进行 PrEP 实施。随访在第 1 个月和每季度进行一次，持续长达 36 个月。 PrEP 用户是根据第 1 个月的补充来定义的。使用 Kaplan-Meier 生存分析对 AGYW 第 1 个月就诊的 PrEP 持续性进行评估，评估第 6 个月的 PrEP 持续性，将非持续性定义为每日给药的 PrEP 可用性差距≥15 天。通过测量血液替诺福韦二磷酸 (TFV-DP) 水平，在先前就诊时提供的 PrEP 供应足以满足每日给药的子集中评估了 PrEP 的执行情况。 2017年6月至2020年9月，注册了2550名AGYW（基苏木1000人，开普敦787人，约翰内斯堡763人）。中位年龄为 21 岁，66% 的性伴侣艾滋病毒感染状况未知，29% 的人患有衣原体感染，10% 的人患有淋病。总体而言，2397 人 (94%) 开始了 PrEP，749 人 (31%) 在 1 个月时进行了补充。在 PrEP 开始后能够达到 6 个月随访的 AGYW 中，128/646 (20%) 坚持使用 PrEP 6 个月，另有 92/646 (14%) 出现间隙并重新启动 PrEP。 TFV-DP 水平表明 47% (91/193) 平均每周服用 ≥4 剂。观察到 16 例 HIV 血清转化（发病率为 2.2/100 人年，95% CI 1.2, 3.5）； 13 名 (81%) 血清转化者在血清转化之前的研究间隔内没有分配 PrEP，或者 TFV-DP 水平表明在前 6 周内每周剂量<4 剂。在这项针对非洲 AGYW 的 PrEP 与初级保健和生殖健康服务整合的研究中，对 PrEP 的需求很高。尽管 PrEP 的使用在前几个月有所下降，但仍有很大一部分在 6 个月内使用了 PrEP。 需要制定策略来简化 PrEP 实施、支持依从性并提供长效 PrEP 选择，以提高持久性和 HIV 保护。
HIV incidence remains high among African adolescent girls and young women (AGYW). The primary objective of this study is to assess pre‐exposure prophylaxis (PrEP) initiation, use, persistence and HIV acquisition among African AGYW offered PrEP in order to inform PrEP scale‐up. POWER was a prospective implementation science evaluation of PrEP delivery for sexually active HIV‐negative AGYW ages 16–25 in family planning clinics in Kisumu, Kenya and youth and primary healthcare clinics in Cape Town and Johannesburg, South Africa. Follow‐up visits occurred at month 1 and quarterly for up to 36 months. PrEP users were defined based on the month 1 refill. PrEP persistence through month 6 was assessed using Kaplan–Meier survival analysis among AGYW with a month 1 visit, defining non‐persistence as an ≥15 day gap in PrEP availability for daily dosing. PrEP execution was evaluated in a subset with PrEP supply from the prior visit sufficient for daily dosing by measuring blood tenofovir diphosphate (TFV‐DP) levels. From June 2017 to September 2020, 2550 AGYW were enrolled (1000 in Kisumu, 787 in Cape Town and 763 in Johannesburg). Median age was 21 years, 66% had a sexual partner of unknown HIV status, and 29% had chlamydia and 10% gonorrhoea. Overall, 2397 (94%) initiated PrEP and 749 (31%) had a refill at 1 month. Of AGYW who could reach 6 months of post‐PrEP initiation follow‐up, 128/646 (20%) persisted with PrEP for 6 months and an additional 92/646 (14%) had a gap and restarted PrEP. TFV‐DP levels indicated that 47% (91/193) took an average of ≥4 doses/week. Sixteen HIV seroconversions were observed (incidence 2.2 per 100 person‐years, 95% CI 1.2, 3.5); 13 (81%) seroconverters either did not have PrEP dispensed in the study interval prior to seroconversion or TFV‐DP levels indicated <4 doses/week in the prior 6 weeks. In this study of PrEP integration with primary care and reproductive health services for African AGYW, demand for PrEP was high. Although PrEP use decreased in the first months, an important fraction used PrEP through 6 months. Strategies are needed to simplify PrEP delivery, support adherence and offer long‐acting PrEP options to improve persistence and HIV protection.
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DOI：
10.1097/qai.0000000000000172
发表时间：
2014-07-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Donnell D;Baeten JM;Bumpus NN;Brantley J;Bangsberg DR;Haberer JE;Mujugira A;Mugo N;Ndase P;Hendrix C;Celum C
通讯作者：
Celum C
影响因子：
168.9
作者：
Baeten, Jared M.;Donnell, Deborah;Stringer, Jeffrey
通讯作者：
Stringer, Jeffrey
影响因子：
1.7
作者：
Bekker, Linda-Gail;Rebe, Kevin;Eakles, Robyn
通讯作者：
Eakles, Robyn
影响因子：
6
作者：
Celum CL;Gill K;Morton JF;Stein G;Myers L;Thomas KK;McConnell M;van der Straten A;Baeten JM;Duyver M;Mendel E;Naidoo K;Dallimore J;Wiesner L;Bekker LG
通讯作者：
Bekker LG
影响因子：
4.4
作者：
O'Rourke S;Hartmann M;Myers L;Lawrence N;Gill K;Morton JF;Celum CL;Bekker LG;van der Straten A
通讯作者：
van der Straten A