We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Early Adopters of Human Immunodeficiency Virus Preexposure Prophylaxis in a Population-based Combination Prevention Study in Rural Kenya and Uganda.
- Authors
Koss, Catherine A; Ayieko, James; Mwangwa, Florence; Owaraganise, Asiphas; Kwarisiima, Dalsone; Balzer, Laura B; Plenty, Albert; Sang, Norton; Kabami, Jane; Ruel, Theodore D
- Abstract
Background Global guidelines recommend preexposure prophylaxis (PrEP) for individuals with substantial human immunodeficiency virus (HIV) risk. Data on PrEP uptake in sub-Saharan Africa outside of clinical trials are limited. We report on "early adopters" of PrEP in the Sustainable East Africa Research in Community Health (SEARCH) study in rural Uganda and Kenya. Methods After community mobilization and PrEP education, population-based HIV testing was conducted. HIV-uninfected adults were offered PrEP based on an empirically derived HIV risk score or self-identified HIV risk (if not identified by score). Using logistic regression, we analyzed predictors of early PrEP adoption (starting PrEP within 30 days vs delayed/no start) among adults identified for PrEP. Results Of 21212 HIV-uninfected adults in 5 communities, 4064 were identified for PrEP (2991 by empiric risk score, 1073 by self-identified risk). Seven hundred and thirty nine individuals started PrEP within 30 days (11% of those identified by risk score; 39% of self-identified); 77% on the same day. Among adults identified by risk score, predictors of early adoption included male sex (adjusted odds ratio 1.53; 95% confidence interval, 1.09–2.15), polygamy (1.92; 1.27–2.90), serodiscordant spouse (3.89; 1.18–12.76), self-perceived HIV risk (1.66; 1.28–2.14), and testing at health campaign versus home (5.24; 3.33–8.26). Among individuals who self-identified for PrEP, predictors of early adoption included older age (2.30; 1.29–4.08) and serodiscordance (2.61; 1.01–6.76). Conclusions Implementation of PrEP incorporating a population-based empiric risk score, self-identified risk, and rapid initiation, is feasible in rural East Africa. Strategies are needed to overcome barriers to PrEP uptake, particularly among women and youth. Clinical Trials Registration NCT01864603.
- Subjects
KENYA; UGANDA; DIAGNOSIS of HIV infections; HIV prevention; HIV infection risk factors; COMMUNITY health services; CONFIDENCE intervals; HEALTH promotion; HIV-positive persons; MARRIAGE; PREVENTIVE medicine; RURAL conditions; LOGISTIC regression analysis; ODDS ratio; ATTITUDES toward illness
- Publication
Clinical Infectious Diseases, 2018, Vol 67, Issue 12, p1853
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciy390