Oral pre-exposure prophylaxis (PrEP) is highly effective when used consistently, and recommended for people at substantial risk of HIV infection. Young women in sub-Saharan Africa are an important population who could benefit from PrEP, but may experience barriers to consistent use. Strategies are needed to support PrEP uptake and adherence in this population.
HPTN 082 is an open label PrEP study in Cape Town and Johannesburg, South Africa and Harare, Zimbabwe, enrolled sexually active HIV-negative women ages 16-25 using the VOICE risk score and a PrEP readiness scale. Women interested in PrEP were enrolled regardless of initial decision to initiate PrEP. PrEP ‘acceptors’ were randomized to standard adherence support (cognitive behavioral counseling, 2-way SMS, and adherence clubs) or enhanced adherence support based on drug level feedback at 8 and 13 weeks plus standard adherence support, with follow-up for one year.
Of 434 enrolled, 396 initiated PrEP at and 13 after enrollment (94%) and 25 (6%) declined PrEP. Median age was 21 years. The median VOICE risk score was 7 in both acceptors and decliners (maximum score=10; score ≥5 associated with 6-8% HIV incidence in prior cohorts). 84% of acceptors reported a primary sex partner-60% were thought to be HIV negative, 19% of unknown status, and 1% HIV positive (21% missing data). Most acceptors thought their partners had other partners (24%) or were not sure (60%). Most acceptors reported risk behaviors – 66% inconsistent or infrequent condom use, 22% transactional sex in the past 3 months, and 50% intimate partner violence in the past year. STI prevalence was high: 30% C.trachomatis, 8% N. gonorrhoeae, and 7% T. vaginalis. 41% had depression based on a CES-D-10 score ≥11. Motivation for pregnancy prevention was high; 80% reported it was very important to them to not become pregnant in the next year and 71% were using contraception other than condoms. Only 16% reported a moderate or high chance of acquiring HIV in the next year. Of acceptors, 62% had a friend encourage them to take PrEP, 94% reported they were ready to start PrEP, 81% planned to tell family and friends about PrEP use, 94% thought they could take it daily, and 39% anticipated side effects.
Uptake of PrEP is very high among young African women participating in HPTN 082. A majority felt they could take PrEP daily and planned to disclose PrEP use. Women in HPTN 082 are appropriate for PrEP, given risk behaviors and high STI prevalence.