A large cluster-randomised study which offered intensified healthcare, including PrEP, to 16 communities in Kenya and Uganda has reported a 74% reduction in HIV infections in people at high risk of HIV infection who started to take PrEP. This is the most impressive reduction in HIV infections yet reported from a PrEP programme in sub-Saharan Africa. Aidsmap reports that the results are being presented to the 23rd International AIDS Conference (AIDS 2020: Virtual) by Dr Catherine Koss of the University of California-San Francisco.
Since 2013, the SEARCH (Sustainable East Africa Research in Community Health) study has offered intensified healthcare, including universal HIV testing, antiretroviral therapy (ART) for those testing HIV positive and care for a number of other conditions such as diabetes and hypertension. During its first randomised phase it offered immediate HIV treatment to all testing positive in the 16 intervention communities, but only ART according to national criteria to 16 control communities.
This phase achieved significant rises in the proportion of people who were virally suppressed, achieving the UNAIDS 90-90-90 target by 2015, and there was an overall 11% drop in mortality in the intervention communities compared with the control communities. However, there was no difference in HIV incidence between intervention and control communities, partly because changing guidelines meant that ART uptake was high in the control arm too.
From 2016 onwards ART has been offered to all testing positive, but continued with additional support to the 16 intervention communities, including targeted PrEP, targeted HIV testing, and targeted care interventions including via the ‘health fairs’ and home-visiting set up in the first phase.
“These results”, Catherine Koss told the conference, “provide evidence that in generalised epidemic settings, offering universal access to PrEP – including to individuals outside of known risk groups – can reduce HIV incidence.”
The entire SEARCH study is closing this month, and forthcoming figures will show how much effect PrEP had in reducing HIV incidence among the group as a whole, whether or not they were offered it.
Abstract (not available online)
Koss, Catherine A et al: Lower than expected HIV incidence among men and women at elevated HIV risk in a population-based PrEP study in rural Kenya and Uganda: Interim results from the SEARCH study. 23rd International AIDS Conference, abstract no 875, 2020.
Full Aidsmap report