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Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda

INTRODUCTION: Antiretroviral‐based HIV prevention, including pre‐exposure prophylaxis (PrEP), is expanding in generalized epidemic settings, but additional prevention options are needed for individuals with periodic, high‐risk sexual exposures. Non‐occupational post‐exposure prophylaxis (PEP) is rec...

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Autores principales: Ayieko, James, Petersen, Maya L, Kabami, Jane, Mwangwa, Florence, Opel, Fred, Nyabuti, Marilyn, Charlebois, Edwin D, Peng, James, Koss, Catherine A, Balzer, Laura B, Chamie, Gabriel, Bukusi, Elizabeth A, Kamya, Moses R, Havlir, Diane V
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215805/
https://www.ncbi.nlm.nih.gov/pubmed/34152067
http://dx.doi.org/10.1002/jia2.25670
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author Ayieko, James
Petersen, Maya L
Kabami, Jane
Mwangwa, Florence
Opel, Fred
Nyabuti, Marilyn
Charlebois, Edwin D
Peng, James
Koss, Catherine A
Balzer, Laura B
Chamie, Gabriel
Bukusi, Elizabeth A
Kamya, Moses R
Havlir, Diane V
author_facet Ayieko, James
Petersen, Maya L
Kabami, Jane
Mwangwa, Florence
Opel, Fred
Nyabuti, Marilyn
Charlebois, Edwin D
Peng, James
Koss, Catherine A
Balzer, Laura B
Chamie, Gabriel
Bukusi, Elizabeth A
Kamya, Moses R
Havlir, Diane V
author_sort Ayieko, James
collection PubMed
description INTRODUCTION: Antiretroviral‐based HIV prevention, including pre‐exposure prophylaxis (PrEP), is expanding in generalized epidemic settings, but additional prevention options are needed for individuals with periodic, high‐risk sexual exposures. Non‐occupational post‐exposure prophylaxis (PEP) is recommended in global guidelines. However, in Africa, awareness of and access to PEP for sexual exposures are limited. We assessed feasibility, acceptability, uptake and adherence in a pilot study of a patient‐centred PEP programme with options for facility‐ or community‐based service delivery. METHODS: After population‐level HIV testing with universal access to PrEP for persons at elevated HIV risk (SEARCH Trial:NCT01864603), we conducted a pilot PEP study in five rural communities in Kenya and Uganda between December 2018 and May 2019. We assessed barriers to PEP in the population and implemented an intervention to address these barriers, building on existing in‐country PEP protocols. We used community leaders for sensitization. Test kits and medications were acquired through the Ministry of Health supply chain and healthcare providers based at the Ministry of Health clinics were trained on PEP delivery. Additional intervention components were (a)PEP availability seven days/week, (b)PEP hotline staffed by providers and (c)option for out‐of‐facility medication delivery. We assessed implementation using the Proctor framework and measured seroconversions via repeat HIV testing. Successful “PEP completion” was defined as self‐reported adherence over four weeks of therapy with post‐PEP HIV testing. RESULTS: Community leaders were able to sensitize and mobilize for PEP. The Ministry of Health supplied test kits and PEP medications; after training, healthcare providers delivered the 28‐day regimen with high completion rates. Among 124 persons who sought PEP, 66% were female, 24% were ≤25 years and 42% were fisherfolk. Of these, 20% reported exposure with a serodifferent partner, 72% with a new or existing relationship and 7% from transactional sex. 12% of all visits were conducted at out‐of‐facility community‐based sites; 35% of participants had ≥1 out‐of‐facility visit. No serious adverse events were reported. Overall, 85% met the definition of PEP completion. There were no HIV seroconversions. CONCLUSIONS: Among individuals with elevated‐risk exposures in rural East African communities, patient‐centred PEP was feasible, acceptable and provides a promising addition to the current prevention toolkit.
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spelling pubmed-82158052021-06-28 Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda Ayieko, James Petersen, Maya L Kabami, Jane Mwangwa, Florence Opel, Fred Nyabuti, Marilyn Charlebois, Edwin D Peng, James Koss, Catherine A Balzer, Laura B Chamie, Gabriel Bukusi, Elizabeth A Kamya, Moses R Havlir, Diane V J Int AIDS Soc Short Reports INTRODUCTION: Antiretroviral‐based HIV prevention, including pre‐exposure prophylaxis (PrEP), is expanding in generalized epidemic settings, but additional prevention options are needed for individuals with periodic, high‐risk sexual exposures. Non‐occupational post‐exposure prophylaxis (PEP) is recommended in global guidelines. However, in Africa, awareness of and access to PEP for sexual exposures are limited. We assessed feasibility, acceptability, uptake and adherence in a pilot study of a patient‐centred PEP programme with options for facility‐ or community‐based service delivery. METHODS: After population‐level HIV testing with universal access to PrEP for persons at elevated HIV risk (SEARCH Trial:NCT01864603), we conducted a pilot PEP study in five rural communities in Kenya and Uganda between December 2018 and May 2019. We assessed barriers to PEP in the population and implemented an intervention to address these barriers, building on existing in‐country PEP protocols. We used community leaders for sensitization. Test kits and medications were acquired through the Ministry of Health supply chain and healthcare providers based at the Ministry of Health clinics were trained on PEP delivery. Additional intervention components were (a)PEP availability seven days/week, (b)PEP hotline staffed by providers and (c)option for out‐of‐facility medication delivery. We assessed implementation using the Proctor framework and measured seroconversions via repeat HIV testing. Successful “PEP completion” was defined as self‐reported adherence over four weeks of therapy with post‐PEP HIV testing. RESULTS: Community leaders were able to sensitize and mobilize for PEP. The Ministry of Health supplied test kits and PEP medications; after training, healthcare providers delivered the 28‐day regimen with high completion rates. Among 124 persons who sought PEP, 66% were female, 24% were ≤25 years and 42% were fisherfolk. Of these, 20% reported exposure with a serodifferent partner, 72% with a new or existing relationship and 7% from transactional sex. 12% of all visits were conducted at out‐of‐facility community‐based sites; 35% of participants had ≥1 out‐of‐facility visit. No serious adverse events were reported. Overall, 85% met the definition of PEP completion. There were no HIV seroconversions. CONCLUSIONS: Among individuals with elevated‐risk exposures in rural East African communities, patient‐centred PEP was feasible, acceptable and provides a promising addition to the current prevention toolkit. John Wiley and Sons Inc. 2021-06-21 /pmc/articles/PMC8215805/ /pubmed/34152067 http://dx.doi.org/10.1002/jia2.25670 Text en © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Short Reports
Ayieko, James
Petersen, Maya L
Kabami, Jane
Mwangwa, Florence
Opel, Fred
Nyabuti, Marilyn
Charlebois, Edwin D
Peng, James
Koss, Catherine A
Balzer, Laura B
Chamie, Gabriel
Bukusi, Elizabeth A
Kamya, Moses R
Havlir, Diane V
Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda
title Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda
title_full Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda
title_fullStr Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda
title_full_unstemmed Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda
title_short Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda
title_sort uptake and outcomes of a novel community‐based hiv post‐exposure prophylaxis (pep) programme in rural kenya and uganda
topic Short Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215805/
https://www.ncbi.nlm.nih.gov/pubmed/34152067
http://dx.doi.org/10.1002/jia2.25670
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