HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda

by Catherine A. Koss, Diane V. Havlir, James Ayieko, Dalsone Kwarisiima, Jane Kabami, Gabriel Chamie, Mucunguzi Atukunda, Yusuf Mwinike, Florence Mwangwa, Asiphas Owaraganise, James Peng, Winter Olilo, Katherine Snyman, Benard Awuonda, Tamara D. Clark, Douglas Black, Joshua Nugent, Lillian B. Brown, Carina Marquez, Hideaki Okochi, Kevin Zhang, Carol S. Camlin, Vivek Jain, Monica Gandhi, Craig R. Cohen, Elizabeth A. Bukusi, Edwin D. Charlebois, Maya L. Petersen, Moses R. Kamya, Laura B. Balzer BackgroundOral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but data are limited on HIV incidence among PrEP users in generalized epidemic settings, particularly outside of selected risk groups. We performed a population-based PrEP study in rural Kenya and Uganda and sought to evaluate both changes in HIV incidence and clinical and virologic outcomes following seroconversion on PrEP. Methods and findingsDuring population-level HIV testing of individuals ≥15 years in 16 communities in the Sustainable East Africa Research in Community Health (SEARCH) study (NCT01864603), we offered universal access to PrEP with enhanced counseling for persons at elevated HIV risk (based on serodifferent partnership, machine learning–based risk score, or self-iden tified HIV risk). We offered rapid or same-day PrEP initiation and flexible service delivery with follow-up visits at facilities or community-based sites at 4, 12, and every 12 weeks up to week 144. Among participant...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research