Makobu Kimani1, Elise M van der Elst1, Oscar Chirro1, Elizabeth Wahome1, Fauz Ibrahim2, Nana Mukuria1, Tobias F Rinke de Wit3, Susan M Graham4, Don Operario5, Eduard J Sanders1,6. 1. KEMRI-Wellcome Trust Research Program, Kilifi, Kenya. 2. Department of Health, Kilifi County, Kilifi, Kenya. 3. Department of Global Health, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands. 4. Department of Global Health, University of Washington, Seattle, Washington, United States of America. 5. Department of Public Health, Brown University, Providence, Rhode Island, United States of America. 6. Nufield Department of Medicine, Oxford University, Oxford, United Kingdom.
Abstract
BACKGROUND: Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. METHODS: Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700-1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. RESULTS: Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. CONCLUSION: While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.
BACKGROUND: Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. METHODS: Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700-1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. RESULTS: Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. CONCLUSION: While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.
Authors: Elske Hoornenborg; Liza Coyer; Roel C A Achterbergh; Amy Matser; Maarten F Schim van der Loeff; Anders Boyd; Yvonne T H P van Duijnhoven; Sylvia Bruisten; Paul Oostvogel; Udi Davidovich; Arjan Hogewoning; Maria Prins; Henry J C de Vries Journal: Lancet HIV Date: 2019-06-06 Impact factor: 12.767
Authors: Jared M Baeten; Deborah Donnell; Patrick Ndase; Nelly R Mugo; James D Campbell; Jonathan Wangisi; Jordan W Tappero; Elizabeth A Bukusi; Craig R Cohen; Elly Katabira; Allan Ronald; Elioda Tumwesigye; Edwin Were; Kenneth H Fife; James Kiarie; Carey Farquhar; Grace John-Stewart; Aloysious Kakia; Josephine Odoyo; Akasiima Mucunguzi; Edith Nakku-Joloba; Rogers Twesigye; Kenneth Ngure; Cosmas Apaka; Harrison Tamooh; Fridah Gabona; Andrew Mujugira; Dana Panteleeff; Katherine K Thomas; Lara Kidoguchi; Meighan Krows; Jennifer Revall; Susan Morrison; Harald Haugen; Mira Emmanuel-Ogier; Lisa Ondrejcek; Robert W Coombs; Lisa Frenkel; Craig Hendrix; Namandjé N Bumpus; David Bangsberg; Jessica E Haberer; Wendy S Stevens; Jairam R Lingappa; Connie Celum Journal: N Engl J Med Date: 2012-07-11 Impact factor: 91.245
Authors: Elisabeth Maria Van der Elst; Judie Mbogua; Don Operario; Gaudensia Mutua; Caroline Kuo; Peter Mugo; Jennifer Kanungi; Sagri Singh; Jessica Haberer; Frances Priddy; Eduard Joachim Sanders Journal: AIDS Behav Date: 2013-07
Authors: Daniel Grace; Jody Jollimore; Paul MacPherson; Matthew J P Strang; Darrell H S Tan Journal: AIDS Patient Care STDS Date: 2017-11-29 Impact factor: 5.078
Authors: Josephine B Odoyo; Jennifer F Morton; Kenneth Ngure; Gabrielle O'Malley; Kenneth K Mugwanya; Elizabeth Irungu; Merceline Awuor; Annabell Dolla; Fernandos Ongolly; Elizabeth A Bukusi; Nelly R Mugo; Jared M Baeten Journal: J Int AIDS Soc Date: 2019-07 Impact factor: 5.396
Authors: Patrick S Sullivan; Nancy Phaswana-Mafuya; Stefan D Baral; Rachel Valencia; Ryan Zahn; Karen Dominguez; Clarence S Yah; Jeb Jones; Lesego B Kgatitswe; A D McNaghten; Aaron J Siegler; Travis H Sanchez; Linda-Gail Bekker Journal: J Int AIDS Soc Date: 2020-10 Impact factor: 5.396
Authors: Susan M Graham; Duncan O Okall; Supriya D Mehta; Eve Obondi; George Ng'ety; Elijah Ochieng; Laura Jadwin-Cakmak; K Rivet Amico; Gary W Harper; Robert C Bailey; Fredrick O Otieno Journal: AIDS Behav Date: 2022-10-11
Authors: Erin E Cooney; Sari L Reisner; Haneefa T Saleem; Keri N Althoff; S Wilson Beckham; Asa Radix; Christopher M Cannon; Jason S Schneider; J Sonya Haw; Allan E Rodriguez; Andrew J Wawrzyniak; Tonia C Poteat; Kenneth H Mayer; Chris Beyrer; Andrea L Wirtz Journal: Ann Epidemiol Date: 2022-04-06 Impact factor: 6.996
Authors: Laura Jadwin-Cakmak; Kendall Lauber; Elijah Ochieng Odhiambo; Ben Collins; Edwin Gumbe; Gabriella A Norwitz; Teddy Aloo; Katherine A Lewis; Felix Okutah; K Rivet Amico; Kennedy Olango; Wilson Odero; Susan M Graham; Gary W Harper Journal: Int J Environ Res Public Health Date: 2022-02-01 Impact factor: 4.614
Authors: August Eubanks; Bakary Coulibaly; Bintou Dembélé Keita; Camille Anoma; Ter Tiero Elias Dah; Ephrem Mensah; Sékou Kaba; Kpassou Julien Lokrou; Faïçal Rodrigue Ouedraogo; Alèda M Fidèle Badjassim; Gwenaëlle Maradan; Michel Bourrelly; Marion Mora; Lucas Riegel; Daniela Rojas Castro; Issifou Yaya; Bruno Spire; Christian Laurent; Luis Sagaon-Teyssier Journal: BMC Public Health Date: 2022-09-29 Impact factor: 4.135
Authors: Andrew Mujugira; Agnes Nakyanzi; Maria S Nabaggala; Timothy R Muwonge; Timothy Ssebuliba; Monica Bagaya; Olivia Nampewo; Oliver Sapiri; Kikulwe R Nyanzi; Felix Bambia; Rogers Nsubuga; David M Serwadda; Norma C Ware; Jared M Baeten; Jessica E Haberer Journal: J Acquir Immune Defic Syndr Date: 2022-04-01 Impact factor: 3.771
Authors: Makobu Kimani; Eduard J Sanders; Oscar Chirro; Nana Mukuria; Shally Mahmoud; Tobias F Rinke de Wit; Susan M Graham; Don Operario; Elise M van der Elst Journal: Int Health Date: 2022-05-02 Impact factor: 3.131