High Rates of Pre-exposure Prophylaxis Eligibility and Associated HIV Incidence in a Population With a Generalized HIV Epidemic in Rakai, Uganda. (1st July 2022)

• Record Type: Journal Article
• Authors: Ssempijja, Victor; Nakigozi, Gertrude; Ssekubugu, Robert; Kagaayi, Joseph; Kigozi, Godfrey; Nalugoda, Fred; Nantume, Betty; Batte, James; Kigozi, Grace; Yeh, Ping Teresa; Nakawooya, Hadijja; Serwadda, David; Quinn, Thomas C.; Gray, Ronald H.; Wawer, Maria J.; Grabowski, Kate M.; Chang, Larry W.; van't Hoog, Anja; Cobelens, Frank; Reynolds, Steven J.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 90:Number 3(2022)
• Page Start: 291
• Page End: 299
• Publication Date: 2022-07-01
• Subjects: HIV -- cohort -- HIV prevention -- pre-exposure prophylaxis -- PrEP -- antiretroviral therapy -- Africa; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002946
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Background: The utility of using pre-exposure prophylaxis (PrEP) eligibility assessments to identify eligibility in general populations has not been well studied in sub-Saharan Africa. We used the Rakai Community Cohort Study to conduct a cross-sectional analysis to estimate PrEP eligibility and a cohort analysis to estimate HIV incidence associated with PrEP eligibility. Methods: Based on Uganda's national PrEP eligibility tool, we defined eligibility as reporting at least one of the following HIV risks in the past 12 months: sexual intercourse with more than one partner of unknown HIV status; nonmarital sex act without a condom; sex engagement in exchange for money, goods, or services; or experiencing genital ulcers. We used log-binomial and modified Poisson models to estimate prevalence ratios for PrEP eligibility and HIV incidence, respectively. Findings: We identified 12, 764 participants among whom to estimate PrEP eligibility prevalence and 11, 363 participants with 17, 381 follow-up visits and 30, 721 person-years (pys) of observation to estimate HIV incidence. Overall, 29% met at least one of the eligibility criteria. HIV incidence was significantly higher in PrEP-eligible versus non–PrEP-eligible participants (0.91/100 pys versus 0.41/100 pys; P < 0.001) and independently higher in PrEP-eligible versus non–PrEP-eligible female participants (1.18/100 pys versus 0.50/100 pys; P < 0.001). Among uncircumcised male participants, HIV incidence was significantly higher in PrEP-eligible versus non–PrEP-eligible participants (1.07/100 pys versus 0.27/100 pys; P = 0.001), but there was no significant difference for circumcised male participants. Interpretation: Implementing PrEP as a standard HIV prevention tool in generalized HIV epidemics beyond currently recognized high-risk key populations could further reduce HIV acquisition and aid epidemic control efforts.