Open AccessEarly antiretroviral therapy and daily pre‐exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: a prospective observational demonstration study
Author(s) -
Mboup Aminata,
Béhanzin Luc,
Guédou Fernand A,
Geraldo Nassirou,
GomaMatsétsé Ella,
Giguère Katia,
AzaGnandji Marlène,
Kessou Léon,
Diallo Mamadou,
Kêkê René K,
Bachabi Moussa,
Dramane Kania,
Geidelberg Lily,
Cianci Fiona,
Lafrance Christian,
Affolabi Dissou,
Diabaté Souleymane,
Gag MariePierre,
Zannou Djimon M,
Gangbo Flore,
Boily MarieClaude,
Vickerman Peter,
Alary Michel
Publication year - 2018
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25208
Subject(s) - medicine , observational study , pre exposure prophylaxis , regimen , emtricitabine , human immunodeficiency virus (hiv) , antiretroviral therapy , prospective cohort study , men who have sex with men , viral load , pediatrics , family medicine , syphilis
In sub‐Saharan Africa, HIV prevalence remains high, especially among key populations. In such situations, combination prevention including clinical, behavioural, structural and biological components, as well as adequate treatment are important. We conducted a demonstration project at the Dispensaire IST , a clinic dedicated to female sex workers ( FSW s) in Cotonou, on early antiretroviral therapy (E‐ ART , or immediate “test‐and‐treat”) and pre‐exposure prophylaxis (Pr EP ). We present key indicators such as uptake, retention and adherence. Methods In this prospective observational study, we recruited FSWs from October 4th 2014 to December 31st 2015 and followed them until December 31st 2016. FSW s were provided with daily tenofovir disoproxil fumarate/emtricitabine (Truvada ® ) for Pr EP or received a first‐line antiretroviral regimen as per Benin guidelines. We used generalized estimating equations to assess trends in adherence and sexual behaviour. Results Among FSW s in the catchment area, HIV testing coverage within the study framework was 95.5% (422/442). At baseline, HIV prevalence was 26.3% (111/422). Among eligible FSW s, 95.5% (105/110) were recruited for E‐ ART and 88.3% (256/290) for Pr EP . Overall retention at the end of the study was 59.0% (62/105) for E‐ ART and 47.3% (121/256) for Pr EP . Mean (±SD) duration of follow‐up was 13.4 (±7.9) months for E‐ ART and 11.8 (±7.9) months for PrEP. Self‐reported adherence was over 90% among most E‐ ART participants. For Pr EP , adherence was lower and the proportion with 100% adherence decreased over time from 78.4% to 56.7% ( p ‐trend < 0.0001). During the 250.1 person‐years of follow‐up among Pr EP initiators, two seroconversions occurred (incidence 0.8/100 person‐years (95% confidence interval: 0.3 to 1.9/100 person‐years)). The two seroconverters had stopped using Pr EP for at least six months before being found HIV ‐infected. In both groups, there was no evidence of reduced condom use. Conclusions This study provides data on key indicators for the integration of E‐ ART and Pr EP into the HIV prevention combination package already offered to FSW s in Benin. Pr EP may be more useful as an individual intervention for adherent FSW s rather than a specific public health intervention. E‐ ART was a more successful intervention in terms of retention and adherence and is now offered to all key populations in Benin. Study registration ClinicalTrials.gov NCT02237