At the International AIDS Society’s annual conference in Paris last month, a lot of new information was announced from various organizations regarding treatment and prevention of HIV. One such organization, SEARCH (Sustainable East Africa Research in Community Health), released findings from their study about PrEP use when it was offered to those assessed as “high risk” in various communities throughout Kenya and Uganda.
SEARCH began offering PrEP to this high-risk group after the World Health Organization recommended it for all populations at risk of HIV in November 2015, according to NAM AIDSMap. The “risk score” is determined by an algorithm that includes factors such as age, gender, marital status, education, occupation, circumcision in men, alcohol use and whether people are polygamous.
“[The risk score assessment] was developed primarily as a research tool to assess HIV infection risk,” presenter James Ayieko explained, “rather than to set criteria for PrEP. It’s therefore quite conservative and almost designed to minimize the number of people we offer PrEP to — those we do offer it to are genuinely at very high risk.” It was also then decided to allow people to self-refer and discuss whether they needed PrEP, even if their risk seemed lower than that suggested by the algorithm.
The study found that the people who self-referred were much more likely to adhere to taking PrEP than those in the high-risk group. Among the high-risk people, only 11 percent started PrEP within 30 days of being offered it. However, people who fell outside the risk score criteria but had the chance to request PrEP themselves, nearly 40 percent started PrEP within 30 days (although there were much fewer people in this group).
Factors identified as barriers to PrEP were identified through interviews with 42 people who decided not to start PrEP and 63 other community members. Out of a large number of barriers, one factor that stood out for the researchers was that interviewees said would prefer to be able to take PrEP on-demand rather than daily. Several different women in the study spontaneously brought up the idea of preferring periodic injections, which is what they are more used to in the context of contraception. Another barrier mentioned by young people was the assumption that parental consent would be needed for them to start.
Ayieko said the findings were somewhat “disappointing,” however the study does show that population-based PrEP delivery and uptake is feasible and acceptable in “real-life” rural African settings.