On-site PrEP access reduces HIV incidence by half in South African women
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On-site access to PrEP during a clinical trial reduced HIV incidence by around 50%, according to a study of South African women published in The Lancet HIV.
“Lowering the barriers to PrEP access by providing PrEP prescriptions during clinical visits and having medication in the study pharmacies may be effective in reducing HIV risk in women in Africa,” Deborah Donnell, PhD, affiliate professor of global health and health services at the University of Washington, told Healio. “This is the first study we know of that has examined the effect of simply providing ready access to PrEP in women in South Africa on HIV incidence. Women in the study were at high risk for HIV, even though we did not use any risk criteria, except that they were seeking contraception.”
Donnell and colleagues conducted a nested, interrupted time-series study of 2,124 women from South Africa from nine sites where access to oral PrEP was initiated between March 13 and June 12, 2018. The women were a part of the ECHO trial, which evaluated the effects of contraceptive methods on HIV acquisition.
The researchers compared HIV incidence before and after PrEP access was introduced at the sites, and they confirmed HIV infection using two rapid HIV tests for each participant.
A total of 543 (26%) of the women reported PrEP use. Results showed that 12 HIV seroconversions occurred in 556 person-years (2.16%) after on-site PrEP access was introduced, compared with 133 seroconversions in 2,860 person-years (4.65%) before it was offered (incidence rate ratio = 0.45; 95% CI, 0.25-0.82; P = .0085).
“We looked for any evidence of a sudden change in HIV incidence for any other time and could not find any,” Donnell said. “Because PrEP is proven to reduce risk of HIV acquisition when taken daily, it would not be ethical to do a randomized trial, so it is likely this could only [be] carried out through studies that use this type of observational design.”
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