Study published on Lancet HIV indicates on-site PrEP access reduces HIV incidence by half

SOUTH AFRICA – A clinical trial of on-site access to PrEP reduces HIV incidence by around 50%, a study of South African women published in The Lancet HIV illustrates.

Pre-exposure prophylaxis (PrEP), is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use.

South Africa was the first country in the region to fully approve pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs to protect HIV-negative people from HIV before potential exposure to the virus.

“Lowering the barriers to PrEP access by providing PrEP prescriptions during clinical visits and having medication in the study pharmacies may be effective in reducing HIV risk in women in Africa,” Deborah Donnell, PhD, affiliate professor of global health and health services at the University of Washington, told Healio.

This is the first study that has examined the effect of simply providing ready access to PrEP in women in South Africa on HIV incidence. Women in the study were at high risk for HIV.

According to avert, East and Southern Africa is the region hardest hit by HIV. It is home to around 6.2% of the world’s population but over half (54%) of the total number of people living with HIV in the world (20.6 million people).

In 2018, there were 800,000 new HIV infections, just under half of the global total.

South Africa accounted for more than a quarter (240,000) of the region’s new infections in 2018. Of the 19.6 million adults living with HIV in the region in 2018, 12 million are women and 7.6 million are men.

Donnell and colleagues conducted a nested, interrupted time-series study of 2,124 women from South Africa from nine sites where access to oral PrEP was initiated between March 13 and June 12, 2018.

The women were a part of the ECHO trial, which evaluated the effects of contraceptive methods on HIV acquisition.

The researchers compared HIV incidence before and after PrEP access was introduced at the sites, and they confirmed HIV infection using two rapid HIV tests for each participant.

26% of the women reported PrEP use whereby results showed that 12 HIV seroconversions occurred in 556 person-years (2.16%) after on-site PrEP access was introduced, compared with 133 seroconversions in 2,860 person-years (4.65%) before it was offered.

“We looked for any evidence of a sudden change in HIV incidence for any other time and could not find any,” Donnell said.

It is estimated that around 84,000 people in the region used PrEP at least once in 2018. PrEP use is highest in Kenya, at more than 31,000 people, followed by South Africa (around 8,000), Uganda and Lesotho (around 7,000 each).