PrEP uptake and adherence in relation to HIV-1 incidence among Kenyan men who have sex with men.

Autor:	Wahome EW; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya., Graham SM; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya.; Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Wash, USA., Thiong'o AN; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya., Mohamed K; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya., Oduor T; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya., Gichuru E; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya., Mwambi J; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya., Prins PM; Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.; Department of Infectious Diseases, Amsterdam Infection & Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., van der Elst E; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya.; Department of Global Health, University of Amsterdam, Amsterdam, the Netherlands., Sanders PEJ; KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, P.O. Box 230-80108, Kilifi, Kenya.; Department of Global Health, University of Amsterdam, Amsterdam, the Netherlands.; Nuffield Department of Medicine, University of Oxford, Headington, UK.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2020 Sep 09; Vol. 26, pp. 100541. Date of Electronic Publication: 2020 Sep 09 (Print Publication: 2020).
DOI:	10.1016/j.eclinm.2020.100541
Abstrakt:	Background: Data on HIV-1 incidence following programmatic pre-exposure prophylaxis (PrEP) uptake by men who have sex with men (MSM) are limited in sub-Saharan Africa. Methods: Since June 2017, MSM participating in an ongoing cohort study in Kenya were offered daily PrEP, assessed for PrEP uptake and adherence, and evaluated for HIV-1 acquisition monthly. We determined tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots 6-12 months after PrEP initiation, and tenofovir (TFV) concentrations and genotypic drug resistance in plasma samples when HIV-1 infection occurred. We assessed HIV-1 incidence by reported PrEP use. Findings: Of 172 MSM, 170 (98·8%) were eligible for PrEP, 140 (82·4%) started it, and 64 (57·7%) reported PrEP use at end of study. Of nine MSM who acquired HIV-1 [incidence rate: 3·9 (95% confidence interval (CI), 2·0-7·4) per 100 person-years (PY)], five reported PrEP use at the time of HIV-1 acquisition [incidence rate: 3·6 (95% CI, 1·5-8·6) per 100 PY)] and four had stopped or had never started PrEP [incidence rate: 4·3 (95% CI, 1·6-11·3) per 100 PY]. Among 76 MSM who reported PrEP use, 11 (14·5%) had protective TFV-DP concentrations of ≥700 fmol/punch (≥4 tablets a week). Among the five MSM who acquired HIV-1 while reporting PrEP use, only one had detectable but low TFV concentrations in plasma and none had genotypic HIV-1 resistance. Interpretation: HIV-1 incidence among MSM with access to programmatic PrEP was high and did not differ by reported PrEP use. Only one in seven MSM taking PrEP had protective tenofovir concentrations and four out of five MSM who acquired HIV-1 while reporting PrEP use had not taken it. Strengthened PrEP adherence support is required among MSM in Kenya. Funding: This work was supported by the International AIDS Vaccine Initiative (IAVI). Competing Interests: Dr Prins reports grants from Gilead sciences, Roche, AbbVie, and MSD during the conduct of the study. All other authors have nothing to report. (© 2020 The Authors.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu