@article{32747cd72d1b4e0fb81ca50fdad243d0,
title = "Uptake and retention on HIV pre-exposure prophylaxis among key and priority populations in South-Central Uganda",
abstract = "Introduction: Pre-exposure prophylaxis (PrEP) programmes have been initiated in sub-Saharan Africa to prevent HIV acquisition in key populations at increased risk. However, data on PrEP uptake and retention in high-risk African communities are limited. We evaluated PrEP uptake and retention in HIV hyperendemic fishing villages and trading centres in south-central Uganda between April 2018 and March 2019. Methods: PrEP eligibility was assessed using a national risk screening tool. Programme data were used to evaluate uptake and retention over 12 months. Multivariable modified Poisson regression estimated adjusted prevalence ratios (aPR) and 95% Confidence intervals (CIs) of uptake associated with covariates. We used Kaplan–Meier analysis to estimate retention and multivariable Cox regression to estimate adjusted relative hazards (aRH) and 95% CIs of discontinuation associated with covariates. Results and discussion: Of the 2985 HIV-negative individuals screened; 2750 (92.1 %) were eligible; of whom 2,536 (92.2%) accepted PrEP. Male (aPR = 0.91, 95% CI = 0.85 to 0.97) and female (aPR = 0.85, 95% CI = 0.77 to 0.94) fisher folk were less likely to accept compared to HIV-discordant couples. Median retention was 45.4 days for both men and women, whereas retention was higher among women (log rank, p < 0.001) overall. PrEP discontinuation was higher among female sex workers (aRH = 1.42, 95% CI = 1.09 to 1.83) and female fisher folk (aRH = 1.99, 95% CI = 1.46 to 2.72), compared to women in discordant couples. Male fisher folk (aRH = 1.37, 95% CI = 1.07 to 1.76) and male truck drivers (aRH = 1.49, 95% CI = 1.14 to 1.94) were more likely to discontinue compared to men in discordant couples. Women 30 to 34 years tended to have lower discontinuation rates compared to adolescents 15 to 19 years (RH = 0.78 [95% CI = 0.63 to 0.96]). Conclusions: PrEP uptake was high, but retention was very low especially among those at the highest risk of HIV: fisher folk, sex workers and truck drivers and adolescent girls. Research on reasons for PrEP discontinuation could help optimize retention.",
keywords = "HIV prevention, LMIC, PrEP, retention, risk factors, sex workers",
author = "Joseph Kagaayi and James Batte and Hadijja Nakawooya and Boniface Kigozi and Gertrude Nakigozi and Susanne Str{\"o}mdahl and Ekstr{\"o}m, {Anna Mia} and Chang, {Larry W.} and Ron Gray and Reynolds, {Steven J.} and Patrick Komaketch and Stella Alamo and David Serwadda",
note = "Funding Information: In 2017, PrEP (oral tenofovir disoproxil fumarate [TDF] and lamivudine [3TC]), was initiated in HIV hyperendemic fishing communities on Lake Victoria and trading centres in the south‐central districts including Rakai, Kyotera, Masaka and Lyantonde. This PrEP programme was implemented by the Rakai Health Sciences Program with support from the U.S. President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC) – Uganda. The programme enrolled HIV‐negative individuals with substantial HIV risk as determined by a risk screening tool developed collaboratively by the Uganda National AIDS Control Program, CDC‐Uganda and ICAP Columbia University in alignment with national PrEP guidelines [ 13 ]. Components of the risk assessment tool included the following: (1) vaginal sexual intercourse with more than one partner of unknown HIV status in the past six months; (2) vaginal sex without a condom in the past six months; (3) anal sexual intercourse in the past six months; (4) sex in exchange for money, goods or a service in the last six months; (5) Injecting drugs in the past six months; (6) diagnosis with an STI more than once in the past twelve months; (7) post‐exposure prophylaxis (PEP) for sexual exposure to HIV in the past six months; and (8) having an HIV‐infected sexual partner who was not on ART. Individuals were deemed to be at substantial risk if they reported at least one of the eight high‐risk sexual behaviours on the tool. Target groups included fisher folk, sex workers, truck drivers, HIV‐negative individuals in HIV‐discordant relationships and other individuals aged ≥15 years with substantial HIV risk including men who have sex with men (MSM) and adolescent girls and young women (15 to 24 years). Risk categories were mutually exclusive: Individuals who belonged to more than one category were classified in the dominant category where they spent most of their time. The other category included individuals with high‐risk behaviours, as indicated on the MoH assessment tool, who did not belong to any of the designated high‐risk categories. Funding Information: The study was funded by the Johns Hopkins University Center for AIDS Research (P30AI094189), the National Institute of Mental Health (R01MH107275), the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Fogarty International Center (D43TW01055), Karolinska Institutet, The Swedish Physicians Against AIDS Research Foundation, Rakai Health Sciences Program and the President?s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) (cooperative agreement number NU2GGH000817). Implementation of the service programme was done by the district health workers with the support and guidance of Rakai Health Sciences Program PrEP team, CDC-Uganda, Uganda Ministry of Health and ICAP at Columbia University. None declared. The study was funded by the Johns Hopkins University Center for AIDS Research (P30AI094189), the National Institute of Mental Health (R01MH107275), the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Fogarty International Center (D43TW01055), Karolinska Institutet, The Swedish Physicians Against AIDS Research Foundation, Rakai Health Sciences Program and the President?s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) (cooperative agreement number NU2GGH000817). Implementation of the service programme was done by the district health workers with the support and guidance of Rakai Health Sciences Program PrEP team, CDC-Uganda, Uganda Ministry of Health and ICAP at Columbia University. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies. Funding Information: The study was funded by the Johns Hopkins University Center for AIDS Research (P30AI094189), the National Institute of Mental Health (R01MH107275), the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Fogarty International Center (D43TW01055), Karolinska Institutet, The Swedish Physicians Against AIDS Research Foundation, Rakai Health Sciences Program and the President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) (cooperative agreement number NU2GGH000817). Implementation of the service programme was done by the district health workers with the support and guidance of Rakai Health Sciences Program PrEP team, CDC‐Uganda, Uganda Ministry of Health and ICAP at Columbia University. Publisher Copyright: {\textcopyright} 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.",
year = "2020",
month = aug,
day = "1",
doi = "10.1002/jia2.25588",
language = "English (US)",
volume = "23",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",
number = "8",
}