Effect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trial. (1st April 2022)
- Record Type:
- Journal Article
- Title:
- Effect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trial. (1st April 2022)
- Main Title:
- Effect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trial
- Authors:
- Mujugira, Andrew
Nakyanzi, Agnes
Nabaggala, Maria S.
Muwonge, Timothy R.
Ssebuliba, Timothy
Bagaya, Monica
Nampewo, Olivia
Sapiri, Oliver
Nyanzi, Kikulwe R.
Bambia, Felix
Nsubuga, Rogers
Serwadda, David M.
Ware, Norma C
Baeten, Jared M.
Haberer, Jessica E. - Abstract:
- Abstract : Supplemental Digital Content is Available in the Text. Abstract : Background: HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP) are complementary tools that could empower sex workers to control their HIV protection, but few studies have jointly evaluated PrEP and HIVST in any setting. Methods: The Empower Study was an open-label randomized trial in Uganda. Sex workers were offered F/tenofovir disoproxil fumarate and randomized 1:1 to monthly HIVST and quarterly in-clinic testing (intervention) or quarterly in-clinic HIV testing alone (standard of care) and followed up for 12 months. PrEP adherence was measured using electronic adherence monitoring and tenofovir diphosphate (TFV-DP) levels in dried blood spots. Adherence outcomes and sexual behaviors were compared by arm using generalized estimating equation models. Results: We enrolled 110 sex workers: 84 cisgender women, 14 transgender women, 10 men who have sex with men, and 2 transgender men. The median age was 23 years. The 12-month retention was 75%. Nearly all (99.4%) used ≥1 HIVST kit. The proportion with TFV-DP levels ≥700 fmol/punch in the HIVST and standard of care arms at the 3-, 6-, 9-, and 12-month visits was 2.4%, 2.3%, 0%, and 0% and 7.9%, 0%, 0%, and 0%, respectively, with no differences by randomization arm ( P > 0.2). Self-reported condomless sex acts with paying partners was similar by arm [adjusted incidence rate ratio 0.70; 95% confidence interval (CI): 0.42 to 1.17; P = 0.18]. OneAbstract : Supplemental Digital Content is Available in the Text. Abstract : Background: HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP) are complementary tools that could empower sex workers to control their HIV protection, but few studies have jointly evaluated PrEP and HIVST in any setting. Methods: The Empower Study was an open-label randomized trial in Uganda. Sex workers were offered F/tenofovir disoproxil fumarate and randomized 1:1 to monthly HIVST and quarterly in-clinic testing (intervention) or quarterly in-clinic HIV testing alone (standard of care) and followed up for 12 months. PrEP adherence was measured using electronic adherence monitoring and tenofovir diphosphate (TFV-DP) levels in dried blood spots. Adherence outcomes and sexual behaviors were compared by arm using generalized estimating equation models. Results: We enrolled 110 sex workers: 84 cisgender women, 14 transgender women, 10 men who have sex with men, and 2 transgender men. The median age was 23 years. The 12-month retention was 75%. Nearly all (99.4%) used ≥1 HIVST kit. The proportion with TFV-DP levels ≥700 fmol/punch in the HIVST and standard of care arms at the 3-, 6-, 9-, and 12-month visits was 2.4%, 2.3%, 0%, and 0% and 7.9%, 0%, 0%, and 0%, respectively, with no differences by randomization arm ( P > 0.2). Self-reported condomless sex acts with paying partners was similar by arm [adjusted incidence rate ratio 0.70; 95% confidence interval (CI): 0.42 to 1.17; P = 0.18]. One seroconversion occurred (HIV incidence, 0.9/100 person-years); TFV-DP was not detected at any visit. Conclusions: A gender-diverse sample of sex workers in Uganda used HIVST but not daily oral PrEP for HIV protection. Alternate approaches to promote PrEP use, including long-acting formulations, should be considered in this population. … (more)
- Is Part Of:
- Journal of acquired immune deficiency syndromes. Volume 89:Number 4(2022)
- Journal:
- Journal of acquired immune deficiency syndromes
- Issue:
- Volume 89:Number 4(2022)
- Issue Display:
- Volume 89, Issue 4 (2022)
- Year:
- 2022
- Volume:
- 89
- Issue:
- 4
- Issue Sort Value:
- 2022-0089-0004-0000
- Page Start:
- 381
- Page End:
- 389
- Publication Date:
- 2022-04-01
- Subjects:
- HIVST -- PrEP -- adherence -- sex worker -- Africa
AIDS (Disease) -- Periodicals
Acquired Immunodeficiency Syndrome -- Periodicals
AIDS (Disease)
Periodicals
616.9792005 - Journal URLs:
- http://journals.lww.com/jaids/pages/default.aspx ↗
http://www.jaids.com ↗
http://journals.lww.com ↗ - DOI:
- 10.1097/QAI.0000000000002895 ↗
- Languages:
- English
- ISSNs:
- 1525-4135
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 4644.422000
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