Bernadette Hensen

This session focused on PrEP implementation in health facilities in South Africa and Kenya, exploring who initiates and is retained on PrEP. Costs of delivering PrEP in Haiti and cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa were presented, and interim results of the ANRS Prevenir study.

ACCESS in South Africa showed missed opportunities for offering PrEP at health facilities, with 56% of study participants (MSM, FSW, and individuals not identifying as either) never offered PrEP. In Kenya, retention on PrEP at 6mths was 15% or less among MSM, FSW and young women initiated on PrEP. Both presentations highlighted side effects and low perceived risk as reasons why individuals did not initiate/continue PrEP. Bad encounters at health facilities were also cited as reasons for discontinuation in Kenya. In MCH clinics in Kenya, PRIYA found that 22% of women offered were initiated on PrEP. Using the Spectrum model, EQUIP shows that higher PrEP coverage in Haiti averts more infections than lower coverage and condom but is costly. A cost effectiveness study suggests MPTs likely cost-effective among younger women (16-24) and FSWs+. In Paris, interim results from ANRS Prevenir Study shows no new infections with on-demand or daily PrEP.

Perceived risk is an important driver of PrEP initiation and continuation. Strategies to support individuals to understand their risk are needed. Perceived risk is not the only driver, health facility-level factors and contexts within which individuals live need to be considered if individuals are to initiate and continue PrEP when needed. There remains a need to identify who to offer PrEP to. Points were raised that initiating individuals on PrEP alone not enough considering issues of adherence. We also need to remember that PrEP isn’t the only prevention option – need to identify what works for individuals.

Michael Marco

PRELIMINARY ANRS PREVENIR (PREP) STUDY RESULTS. Randomized controlled trials (RCTs) have documented high efficacy of PrEP in preventing HIV-infection with proper adherence to Truvada. Two of the seminal RCTs in MSM were iPrEX and ANRS IPERGAY (“on-demand” PrEP). There are, however, limited data on the effectiveness on-demand PrEP.

ANRS Prevenir is an ongoing prospective cohort study in the Paris region which has been enrolling high-risk individuals (98.9% MSM) onto PrEP. Daily and on-demand PrEP is offered to eligible participants. All are tested for HIV at baseline, and at month-1 and every 3 months thereafter. Daily sexual behavior is recorder via ACASI, and all cohort members are counseled on proper adherence. Of the 1,594 participants, 724 (45.4%) chose daily PrEP and 870 (54.6%) opted for it on-demand. More sexual partners and condomless sex acts have been observed in the daily PrEP group. To date, HIV incidence in both the daily and on-demand group has been zero. No participant has discontinued PrEP due to drug-related adverse events.

Zero HIV infections recorded to date from these preliminary results are very impressive. As of now, it is reassuring that these real-world results are mimicking what we saw in the MSM PrEP RTCs. It is very peculiar that while the cohort was open to heterosexuals and transgender persons, they only make up 1.1%. It is unclear if this is a case of poor outreach, a half-heated, gratuitous gesture to these patient populations, or both.