Preventive drug regimen in at-risk group increases PrEP uptake — Eswatini

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A promotional programme designed to educate patients on HIV risk and prevention saw use of a preventive drug regimen among at-risk groups in Africa increase by more than 50%, according to a study. During the 18-month trial in the small, southern African nation of Eswatini, 34% of those in the study started pre-exposure proplylaxis (PrEP), which involves giving antiviral drugs to those at risk for HIV before they’re exposed to the virus to prevent infection, the researchers said.

A promotional campaign that included an educational booklet and a T-shirt increased participation in PrEP by 55%, they said.

The educational booklet highlighted the importance of PrEP and the HIV risks for pregnant women and sex workers, among others. The T-shirt carried the message, “What if there was a pill that could prevent HIV?” on the front and “Actually there is: Pre-Exposure Prophylaxis. Ask me for more information about PrEP” on the back.

Although the study focused on the population of one African nation, the approach also could be successful anywhere HIV prevalence is high and use of PrEp remains low, researchers said.

“I think our research applies to countries, and regions within countries, that have a very high HIV incidence in the general population,” study co-author Dr Pascal Geldsetzer at the division of primary care and population health, department of medicine, Stanford University School of Medicine and the Heidelberg Institute of Global Health (HIGH), Heidelberg University, said.

“In these settings, PrEP offered at primary care facilities, or in the community, to anyone who is at at least a minimal risk of acquiring HIV … could have a substantial effect on the course of the epidemic,” said Geldsetzer, an assistant professor of medicine at Stanford.

Geldsetzer and his colleagues said that the promotional programme they used was intended to increase trust within the community of clinic workers and boost PrEP participation rates.

The study focused on PrEP participation, retention and retention rates among 1,538 people who received care at six clinics in the nation, researchers said.

The clinics offered PrEP to anyone over age 16 who had at least a minimal risk of infection, and gradually rolled out a promotional program that included videos, booklets and other materials designed to raise awareness of HIV prevention options.

Eventually, all study participants saw the promotional materials. However, to assess the value for increased PrEP use, participants at three clinics received them earlier than those at the other three.

Over 18 months, 517 of the study participants, or 34%, started PrEP, and about one-third of these participants attended all of their scheduled appointments during their first six months on the regimen, the data showed.

Participants who received the promotional materials were 55% more likely to start PrEP and stick with the regimen than those who did not, the researchers found.

“(Our) promotion package had a small, but significant, positive effect on PrEP uptake,” Geldsetzer said. “Patients, clinicians and policymakers generally felt that PrEP promotion and delivery should be expanded beyond healthcare facilities to the community to reach men, as well as women, who don’t frequently attend clinic-based care.

Abstract
Clinical trials have shown that antiretroviral drugs used as pre-exposure prophylaxis (PrEP) are highly effective for preventing HIV acquisition. PrEP efforts, including in sub-Saharan Africa, have almost exclusively focused on certain priority groups, particularly female sex workers, men having sex with men, pregnant women, serodiscordant couples, and young women. As part of a PrEP demonstration project involving the general population at six primary health care facilities in Eswatini (formerly Swaziland), we conducted a randomized trial of a health care facility–based PrEP promotion package designed to increase PrEP uptake. Over the 18-month study duration, 33.6% (517 of 1538) of adults identified by health care workers as being at risk of acquiring HIV took up PrEP, and 30.0% of these individuals attended all scheduled appointments during the first 6 months after initiation of PrEP. The PrEP promotion package was associated with a 55% (95% confidence interval, 15 to 110%; P = 0.036) relative increase in the number of individuals taking up PrEP, with an absolute increase of 2.2 individuals per month per health care facility. When asked how PrEP uptake could be improved in 217 accompanying in-depth qualitative interviews, interviewees recommended an expansion of PrEP promotion activities beyond health care facilities to communities. Although a health care facility–based promotion package improved PrEP uptake, both uptake and retention remained low. Expanding promotion activities to the community is needed to achieve greater PrEP coverage among adults at risk of HIV infection in Eswatini and similar settings.

Authors
Pascal Geldsetzer, Kate Bärnighausen, Anita Hettema, Shannon A McMahon, Shona Dalal, Rachel P Chase, Catherine E Oldenburg, Stefan Kohler, Simiao Chen, Phiwayinkhosi Dlamini, Mxolisi Mavuso, Allison B Hughey, Sindy Matse, Till Bärnighausen

 

UPI Health material

 

Science Translational Medicine abstract

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