Uptake and outcomes of a novel community-based HIV postexposure prophylaxis (PEP) programme in rural Kenya and Uganda.

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Publisher: John Wiley & Sons, Inc.
Document Type: Report
Length: 3,454 words
Lexile Measure: 1540L

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Abstract :

Introduction: Antiretroviral-based HIV prevention, including pre-exposure prophylaxis (PrEP), is expanding in generalized epidemic settings, but additionalprevention options are needed for individuals with periodic, high-risk sexualexposures. Non-occupational post-exposure prophylaxis (PEP) is recommended in global guidelines. However, in Africa, awareness of and access to PEP for sexualexposures are limited. We assessed feasibility, acceptability, uptake and adherence in a pilot study of a patient-centred PEP programme with options for facility-or community-based service delivery. Methods: After population-levelHIV testing with universalaccess to PrEP for persons at elevated HIV risk (SEARCH Trial: NCT01864603), we conducted a pilot PEP study in five ruralcommunities in Kenya and Uganda between December 2018 and May 2019. We assessed barriers to PEP in the population and implemented an intervention to address these barriers, building on existing in-country PEP protocols. We used community leaders for sensitization. Test kits and medications were acquired through the Ministry of Health supply chain and healthcare providers based at the Ministry of Health clinics were trained on PEP delivery. Additionalintervention components were (a)PEP availability seven days/week, (b)PEP hotline staffed by providers and (c)option for out-of-facility medication delivery. We assessed implementation using the Proctor framework and measured seroconversions via repeat HIV testing. Successful"PEP completion" was defined as self-reported adherence over four weeks of therapy with post-PEP HIV testing. Results: Community leaders were able to sensitize and mobilize for PEP. The Ministry of Health supplied test kits and PEP medications; after training, healthcare providers delivered the 28-day regimen with high completion rates. Among 124 persons who sought PEP, 66% were female, 24% were [less than or equal to]25 years and 42% were fisherfolk. Of these, 20% reported exposure with a serodifferent partner, 72% with a new or existing relationship and 7% from transactional sex. 12% of all visits were conducted at out-of-facility community-based sites; 35% of participants had [greater than or equal to]1 out-of-facility visit. No serious adverse events were reported. Overall, 85% met the definition of PEP completion. There were no HIV seroconversions. Conclusions: Among individuals with elevated-risk exposures in rural East African communities, patient-centred PEP was feasible, acceptable and provides a promising addition to the current prevention toolkit. Keywords: post-exposure prophylaxis (PEP); pre-exposure prophylaxis (PrEP); HIV prevention; implementation; uptake; high-risk exposure

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Gale Document Number: GALE|A667867101