Original Research

Oral pre-exposure prophylaxis uptake, adherence, and adverse events among South African men who have sex with men and transgender women

Linda-Gail Bekker, Danielle Giovenco, Stefan Baral, Karen Dominguez, Rachel Valencia, Travis Sanchez, A.D. McNaghten, Ryan Zahn, Clarence S. Yah, Zinhle Sokhela, Richard Kaplan, Refliwe N. Phaswana-Mafuya, Chris Beyrer, Patrick S. Sullivan
Southern African Journal of HIV Medicine | Vol 23, No 1 | a1405 | DOI: https://doi.org/10.4102/sajhivmed.v23i1.1405 | © 2022 Linda-Gail Bekker, Danielle Giovenco, Stefan Baral, Karen Dominguez, Rachel Valencia, Travis Sanchez, A.D. McNaghten, Ryan Zahn, Clarence S. Yah, Zinhle Sokhela, Richard Kaplan, Refliwe N. Phaswana-Mafuya, Chris Beyrer, Patrick S. Sullivan | This work is licensed under CC Attribution 4.0
Submitted: 25 May 2022 | Published: 08 November 2022

About the author(s)

Linda-Gail Bekker, Desmond Tutu HIV Centre, Cape Town, South Africa; and, aculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Danielle Giovenco, Desmond Tutu HIV Centre, Cape Town, South Africa; and, International Health Institute, Brown University, Providence, United States of America
Stefan Baral, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
Karen Dominguez, Desmond Tutu HIV Centre, Cape Town, South Africa; and, Contraceptive Research and Development (CONRAD), Eastern Virginia Medical School, Norfolk, United States of America
Rachel Valencia, Department of Epidemiology, Emory University, Atlanta, United States of America
Travis Sanchez, Department of Epidemiology, Emory University, Atlanta, United States of America
A.D. McNaghten, Department of Epidemiology, Emory University, Atlanta, United States of America
Ryan Zahn, Department of Epidemiology, Emory University, Atlanta, United States of America
Clarence S. Yah, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Faculty of Health Sciences, School of Health System and Public Health, University of Pretoria, Pretoria, South Africa
Zinhle Sokhela, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Richard Kaplan, Desmond Tutu HIV Centre, Cape Town, South Africa
Refliwe N. Phaswana-Mafuya, South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
Chris Beyrer, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
Patrick S. Sullivan, Department of Epidemiology, Emory University, Atlanta, United States of America


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Abstract

Background: HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women (TGW) in South Africa have not been widely implemented.

Objectives: The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility.

Method: In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP, and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations.

Results: Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305 days (interquartile range: 232–325 days). Across the follow-up time points, 57% – 72% of participants self-reported taking protective levels of PrEP and 59% – 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation.

Conclusion: Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP.


Keywords

HIV; men who have sex with men; transgender women; sexually transmitted infections; pre-exposure prophylaxis; HIV prevention; South Africa

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