Guideline

Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection

Linda-Gail Bekker, Kevin Rebe, Francois Venter, Gary Maartens, Michelle Moorhouse, Francesca Conradie, Carole Wallis, Vivian Black, Beth Harley, Robyn Eakle
Southern African Journal of HIV Medicine | Vol 17, No 1 | a455 | DOI: https://doi.org/10.4102/sajhivmed.v17i1.455 | © 2016 Linda-Gail Bekker, Kevin Rebe, Francois Venter, Gary Maartens, Michelle Moorhouse, Francesca Conradie, Carole Wallis, Vivian Black, Beth Harley, Robyn Eakle | This work is licensed under CC Attribution 4.0
Submitted: 09 December 2015 | Published: 09 March 2016

About the author(s)

Linda-Gail Bekker, The Desmond Tutu HIV Centre, University of Cape Town, South Africa
Kevin Rebe, Anova Health Institute, Johannesburg, South Africa
Francois Venter, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
Gary Maartens, Department of Medicine, University of Cape Town, South Africa
Michelle Moorhouse, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
Francesca Conradie, Right to Care and Clinical HIV Research Unit, University of the Witwatersrand, South Africa
Carole Wallis, BARC, Johannesburg, South Africa; Lancet Laboratories, Johannesburg, South Africa
Vivian Black, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
Beth Harley, City Health, City of Cape Town, South Africa
Robyn Eakle, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa

Abstract

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.

Keywords

Pre-exposure prophylaxis, clinical guideline

Metrics

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55. Women’s Perceptions of HIV- and Sexuality-Related Stigma in Relation to PrEP: Qualitative Findings from the Masibambane Study, Durban, South Africa
S. Bergam, A. D. Harrison, N. Benghu, S. Khumalo, N. Tesfay, T. Exner, L. Miller, C. Dolezal, J. Hanass-Hancock, S. Hoffman
AIDS and Behavior  vol: 26  issue: 9  first page: 2881  year: 2022  
doi: 10.1007/s10461-022-03632-6

56. Going global: the adoption of the World Health Organization’s enabling recommendation on oral pre-exposure prophylaxis for HIV
Ioannis Hodges-Mameletzis, Shona Dalal, Busisiwe Msimanga-Radebe, Michelle Rodolph, Rachel Baggaley
Sexual Health  vol: 15  issue: 6  first page: 489  year: 2018  
doi: 10.1071/SH18125

57. Lessons from PrEP: A Qualitative Study Investigating How Clinical and Policy Experts Weigh Ethics and Evidence When Evaluating Preventive Medications for Use in Pregnant and Breastfeeding Women
Kristin M. Beima-Sofie, Susan Brown Trinidad, Kenneth Ngure, Renee Heffron, Jared M. Baeten, Grace C. John-Stewart, Maureen Kelley
AIDS and Behavior  vol: 23  issue: 7  first page: 1858  year: 2019  
doi: 10.1007/s10461-018-2361-5

58. Interventions to improve daily medication use among adolescents and young adults: what can we learn for youth pre-exposure prophylaxis services?
Jennifer Velloza, Bill Kapogiannis, Linda-Gail Bekker, Connie Celum, Sybil Hosek, Sinead Delany-Moretlwe, Rachel Baggaley, Shona Dalal
AIDS  vol: 35  issue: 3  first page: 463  year: 2021  
doi: 10.1097/QAD.0000000000002777

59. The Community PrEP Study: a randomized control trial leveraging community-based platforms to improve access and adherence to pre-exposure prophylaxis to prevent HIV among adolescent girls and young women in South Africa—study protocol
Andrew Medina-Marino, Dana Bezuidenhout, Sybil Hosek, Ruanne V. Barnabas, Millicent Atujuna, Charl Bezuidenhout, Phuti Ngwepe, Remco P.H. Peters, Francesca Little, Connie L. Celum, Joseph Daniels, Linda-Gail Bekker
Trials  vol: 22  issue: 1  year: 2021  
doi: 10.1186/s13063-021-05402-6

60. Making ward-based outreach teams an effective component of human immunodeficiency virus programmes in South Africa
Nireshni Naidoo, Jean Railton, Geoffrey Jobson, Nthabiseng Matlakala, Gert Marincowitz, James A. McIntyre, Helen Struthers, Remco P.H. Peters
Southern African Journal of HIV Medicine  vol: 19  issue: 1  year: 2018  
doi: 10.4102/sajhivmed.v19i1.778

61. Youth-friendly services was the magic: Experiences of adolescent girls and young women in the community PrEP study, South Africa
Emily Krogstad Mudzingwa, Lindsey de Vos, Lauren Fynn, Millicent Atujuna, Ingrid T. Katz, Sybil Hosek, Connie Celum, Joseph Daniels, Linda-Gail Bekker, Andrew Medina-Marino
Global Public Health  vol: 19  issue: 1  year: 2024  
doi: 10.1080/17441692.2024.2349918

62. Knowledge, attitudes, and associated factors towards HIV pre-exposure prophylaxis among health care providers
Getachew Mekonnen, Tiliksew Liknaw, Alemayehu Anley, Abebe Dilie Afenigus
Scientific Reports  vol: 14  issue: 1  year: 2024  
doi: 10.1038/s41598-024-56371-0

63. Estimating the budget impact of adopting tenofovir/emtricitabine for pre-exposure prophylaxis of HIV in the public health sector in Namibia (2021 – 2023)
Enos Moyo, Leela Barham, Malizgani Mhango, Godfrey Musuka, Tafadzwa Dzinamarira
Journal of Infection and Public Health  vol: 15  issue: 10  first page: 1147  year: 2022  
doi: 10.1016/j.jiph.2022.09.003

64. Ethical considerations in developing an evidence base for pre-exposure prophylaxis in pregnant women
Kristen A. Sullivan, Anne D. Lyerly
Reproductive Health  vol: 14  issue: S3  year: 2017  
doi: 10.1186/s12978-017-0425-z

65. Viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa: a cross sectional study to assess progress towards UNAIDS indicators and Implications for HIV Epidemic Control
Nonzwakazi P. Ntombela, Ayesha B. M. Kharsany, Adenike Soogun, Nonhlanhla Yende-Zuma, Cheryl Baxter, Hans-Peter Kohler, Lyle R. McKinnon
Reproductive Health  vol: 19  issue: 1  year: 2022  
doi: 10.1186/s12978-022-01419-5

66. PrEP use and HIV seroconversion rates in adolescent girls and young women from Kenya and South Africa: the POWER demonstration project
Connie L. Celum, Elizabeth A. Bukusi, Linda Gail Bekker, Sinead Delany‐Moretlwe, Lara Kidoguchi, Victor Omollo, Elzette Rousseau, Danielle Travill, Jennifer F. Morton, Felix Mogaka, Gabrielle O'Malley, Gena Barnabee, Ariane van der Straten, Deborah Donnell, Urvi M. Parikh, Lauren Kudrick, Peter L. Anderson, Jessica E. Haberer, Linxuan Wu, Renee Heffron, Rachel Johnson, Susan Morrison, Jared M. Baeten
Journal of the International AIDS Society  vol: 25  issue: 7  year: 2022  
doi: 10.1002/jia2.25962

67. “Killing two birds with one stone” – a qualitative study on women’s perspectives on the dual prevention pill in Johannesburg, South Africa
Siyanda Tenza, Lydia Mampuru, Mpho Moji, Sihle Zulu, Lorna Begg, Irene V. Bruce, Krishnaveni Reddy, Barbara A. Friedland, Thesla Palanee-Phillips, Sanyukta Mathur
BMC Women's Health  vol: 24  issue: 1  year: 2024  
doi: 10.1186/s12905-024-03269-8

68. Towards achieving the 90–90–90 HIV targets: results from the south African 2017 national HIV survey
Edmore Marinda, Leickness Simbayi, Khangelani Zuma, Nompumelelo Zungu, Sizulu Moyo, Lwando Kondlo, Sean Jooste, Patrick Nadol, Ehimario Igumbor, Cheryl Dietrich, Melissa Briggs-Hagen
BMC Public Health  vol: 20  issue: 1  year: 2020  
doi: 10.1186/s12889-020-09457-z

69. Human Immunodeficiency Virus Prophylaxis Use among High-risk Populations in Sub-Saharan Africa: Application of the Theory of Planned Behaviour
Mabel W. Dzenu, Sedinam T. Baku, Benjamine S. Dzameshie, Hubert Amu
Preventive Medicine: Research & Reviews  vol: 2  issue: 2  first page: 87  year: 2025  
doi: 10.4103/PMRR.PMRR_160_24

70. The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia
Cheryl Hendrickson, Lawrence C. Long, Craig van Rensburg, Cassidy W. Claassen, Mwansa Njelesani, Crispin Moyo, Lloyd Mulenga, Heidi O’Bra, Colin A. Russell, Brooke E. Nichols, Abdur Razzaque Sarker
PLOS Global Public Health  vol: 2  issue: 11  first page: e0001246  year: 2022  
doi: 10.1371/journal.pgph.0001246

71. 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  issue: 1  year: 2022  
doi: 10.4102/sajhivmed.v23i1.1405

72. Use of tenofovir-based preexposure prophylaxis among pregnant women in South Africa
Lynn T. Matthews, Katia J. Bruxvoort, Manjeetha Jaggernath, Yolandie Kriel, Patricia M. Smith, Jessica E. Haberer, John Bassler, Kara Bennett, Christina Psaros, David R. Bangsberg, Kathleen Wirth Hurwitz, Jennifer A. Smit
AIDS  vol: 39  issue: 5  first page: 508  year: 2025  
doi: 10.1097/QAD.0000000000004090

73. The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study
Jennifer Velloza, Nomhle Khoza, Fiona Scorgie, Miria Chitukuta, Prisca Mutero, Kudzai Mutiti, Nomvuyo Mangxilana, Lumka Nobula, Michelle A Bulterys, Millicent Atujuna, Sybil Hosek, Renee Heffron, Linda‐Gail Bekker, Nyaradzo Mgodi, Mike Chirenje, Connie Celum, Sinead Delany‐Moretlwe
Journal of the International AIDS Society  vol: 23  issue: 3  year: 2020  
doi: 10.1002/jia2.25463

74. Qualitative Insights Into Adherence to HIV Pre-Exposure Prophylaxis (PrEP) Among Australian Gay and Bisexual Men
Stefanie J. Vaccher, John M. Kaldor, Denton Callander, Iryna B. Zablotska, Bridget G. Haire
AIDS Patient Care and STDs  vol: 32  issue: 12  first page: 519  year: 2018  
doi: 10.1089/apc.2018.0106

75. The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis
Sarah E. Stutterheim, Mart van Dijk, Haoyi Wang, Kai J. Jonas, Viviane D. Lima
PLOS ONE  vol: 16  issue: 12  first page: e0260063  year: 2021  
doi: 10.1371/journal.pone.0260063