Novel metric for evaluating pre-exposure prophylaxis programme effectiveness in real-world settings

Publication date: Available online 31 January 2020Source: The Lancet HIVAuthor(s): Cheryl Hendrickson, Lawrence Long, David van de Vijver, Charles Boucher, Heidi O'Bra, Cassidy W Claassen, Mwansa Njelesani, Crispin Moyo, Daliso B Mumba, Hasina Subedar, Lloyd Mulenga, Sydney Rosen, Brooke E NicholsSummaryAlthough large-scale provision of HIV pre-exposure prophylaxis (PrEP) is gaining momentum, no systematic method to evaluate or compare the effectiveness of different scale-up strategies in real-world settings exists. To date, estimating the effectiveness of PrEP has relied on clinical trials or mathematical models. We propose a novel and pragmatic metric to evaluate and compare programme effectiveness using routine implementation data. Using South African and Zambian PrEP guidelines, we provide two examples of how to consistently measure PrEP-programme effectiveness with routinely collected data. PrEP effectiveness should account for HIV seroconversion, the variable risk of HIV infection (seasons of risk) estimated with routine risk assessment at each clinic visit (when available), and the persistence of PrEP use. Three criteria should be met in order to be considered a successful outcome: first, a person who initiates PrEP must not seroconvert; second, there should be no more than one period at high risk of HIV infection during the follow-up period when not taking PrEP; and finally, an individual must continue to attend health-care visits or discontinue prophylaxis in consult...
Source: The Lancet HIV - Category: Infectious Diseases Source Type: research