1
|
Anand P, Wu L, Mugwanya K. Integration of sexually transmitted infection and HIV pre-exposure prophylaxis services in sub-Saharan Africa: a scoping review. Front Reprod Health 2023; 5:944372. [PMID: 37457431 PMCID: PMC10338918 DOI: 10.3389/frph.2023.944372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Background Persons living in sub-Saharan Africa (SSA) face disproportionate risk from overlapping epidemics of HIV and bacterial sexually transmitted infections (STIs). Pre-exposure prophylaxis (PrEP) for prevention is gradually being scaled up globally including in several settings in SSA, which represents a key opportunity to integrate STI services with HIV pre-exposure prophylaxis (PrEP). However, there is limited literature on how to successfully integrate these services, particularly in the SSA context. Prior studies and reviews on STI and PrEP services have largely focused on high income countries. Methods We conducted a scoping review of prior studies of integration of STI and PrEP services in SSA. We searched PubMed, EMBASE, Cochrane, and CINAHL, in addition to grey literature to identify studies that were published between January 2012 and December 2022, and which provided STI and PrEP services in SSA, with or without outcomes reported. Citations and abstracts were reviewed by two reviewers for inclusion. Full texts were then retrieved and reviewed in full by two reviewers. Results Our search strategy yielded 1951 records, of which 250 were retrieved in full. Our final review included 61 reports of 45 studies. Most studies were conducted in Southern (49.2%) and Eastern (24.6%) Africa. Service settings included public health clinics (26.2%), study clinics (23.0%), sexual and reproductive care settings (23.0%), maternal and child health settings (8.2%), community based services (11.5%), and mobile clinics (3.3%). A minority (11.4%) of the studies described only syndromic STI management while most (88.6%) included some form of etiological laboratory STI diagnosis. STI testing frequency ranged from baseline testing only to monthly screening. Types of STI tested for was also variable. Few studies reported outcomes related to implementation of STI services. There were high rates of curable STIs detected by laboratory testing (baseline genitourinary STI rates ranged from 5.6-30.8% for CT, 0.0-11.2% for GC, and 0.4-8.0% for TV). Discussion Existing studies have implemented a varied range of STI services along with PrEP. This range reflects the lack of specific guidance regarding STI services within PrEP programs. However, there was limited evidence regarding implementation strategies for integration of STI and PrEP services in real world settings.
Collapse
Affiliation(s)
- Priyanka Anand
- Department of Medicine, University of Washington School of Medicine, Seattle, WAUnited States
| | - Linxuan Wu
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| |
Collapse
|
2
|
Irungu EM, Musau M, Nyerere B, Dollah A, Kwach B, Owidi E, Wamoni E, Odoyo J, Mugo N, Bukusi E, Mugwanya K, Baeten JM. Using an on-site modular training approach to amplify prep service delivery in public health facilities in Kenya. PLOS Glob Public Health 2022; 2:e0000092. [PMID: 36962311 PMCID: PMC10021257 DOI: 10.1371/journal.pgph.0000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022]
Abstract
Delivery of oral PrEP, a potent HIV prevention intervention, has begun within public health systems in many countries in Africa. Training as many health providers as possible expeditiously is necessary to efficiently and rapidly scale up PrEP delivery among at risk populations and thereby realize the greatest impact of PrEP. We designed and implemented an innovative on-site modular training approach delivered in five two-hour modules. The modules could be covered in two consecutive days or be broken across several days enabling flexibility to accommodate health provider work schedules. We assessed knowledge gain comparing pre-and post-training test scores and determined monthly PrEP uptake for six months following the training intervention. We also evaluated the cost of this training approach and conducted key informant interviews to explore acceptability among health providers. Between January 2019 and December 2020, 2111 health providers from 104 health facilities were trained on PrEP. Of 1821 (83%) providers who completed both pre- and post-tests, 505 (28%) were nurses, 333 (18%) were HIV counsellors, 276 (15%) were clinical officers and 255 (14%) were lay providers. The mean score prior to and after training was 58% and 82% respectively (p <0.001). On average, health facilities initiated an average of 2.7 (SD 4.7) people on PrEP each month after the training, a number that did not decline over six months post-training (p = 0.62). Assuming Ministry of Health costs, the costs per provider trained was $16.27. Health providers expressed satisfaction with this training approach because it enabled many providers within a facility receive training. On-site modular training is an effective approach for improving PrEP education for health workers in public health facilities, It is also acceptable and low-cost. This method of training can be scaled up to rapidly amplify the number of health workers able to offer PrEP services.
Collapse
Affiliation(s)
- Elizabeth M Irungu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Moses Musau
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Bernard Nyerere
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anabelle Dollah
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Benn Kwach
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmah Owidi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Wamoni
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Josephine Odoyo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nelly Mugo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Epidemiology, University of Washington, Seattle, WA, United States of America
- Medicine, University of Washington, Seattle, WA, United States of America
| | | |
Collapse
|
3
|
Ongolly FK, Dolla A, Ngure K, Irungu EM, Odoyo J, Wamoni E, Peebles K, Mugwanya K, Mugo NR, Bukusi EA, Morton J, Baeten JM, O’Malley G. "I Just Decided to Stop:" Understanding PrEP Discontinuation Among Individuals Initiating PrEP in HIV Care Centers in Kenya. J Acquir Immune Defic Syndr 2021; 87:e150-e158. [PMID: 33492024 PMCID: PMC8026512 DOI: 10.1097/qai.0000000000002625] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) discontinuation rates in clinical trials and demonstration projects have been well characterized; however, little is known about discontinuation in routine public health settings in sub-Saharan Africa. Understanding discontinuation in nonstudy settings is important for establishing expectations for PrEP continuation in national programs and for facilitating effective PrEP scale-up. METHODS We conducted in-depth interviews with 46 individuals who had initiated PrEP at 25 HIV comprehensive care clinics (CCCs) in central and western Kenya and whose clinic records indicated they had discontinued. RESULTS Many of our study participants discontinued PrEP when their perceived risk decreased (eg, hiatus or end of a sexual relationship or partner known to be living with HIV became virally suppressed). Others reported discontinuation due to side effects, daily pill burden, preference for condoms, or their partner's insistence. Participant narratives frequently described facility level factors such as stigma-related discomforts with accessing PrEP at CCCs, inconvenient clinic location or operating hours, long wait times, and short refill dates as discouraging factors, suggesting actionable areas for improving PrEP access and continuation. CONCLUSION Clients frequently make intentional decisions to discontinue PrEP as they weigh different prevention options within the context of complex lives. Many clients will decide to discontinue PrEP when perceiving themselves to be at reduced risk and PrEP counseling must include provisions for addressing seasons of risk. PrEP will not be the right prevention method for everyone, or forever. Expanding PrEP access points and increasing sex-positive messaging may facilitate PrEP being a better option for many.
Collapse
Affiliation(s)
| | - Annabel Dolla
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, Seattle, Washington, USA
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Elizabeth M. Irungu
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Elizabeth Wamoni
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kathryn Peebles
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Kenneth Mugwanya
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Nelly R. Mugo
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
- Department of Global Health, Seattle, Washington, USA
| | - Elizabeth A. Bukusi
- Department of Global Health, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Jennifer Morton
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Jared M. Baeten
- Department of Global Health, Seattle, Washington, USA
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Gabrielle O’Malley
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| |
Collapse
|
4
|
Pintye J, Kinuthia J, Abuna F, Mugwanya K, Lagat H, Dettinger JC, Odinga D, Sila J, Anderson PL, John-Stewart G, Baeten JM. Frequency and Predictors of Tenofovir-diphosphate Detection Among Young Kenyan Women in a Real-world Pre-exposure Prophylaxis Implementation Program. Clin Infect Dis 2021; 71:e509-e512. [PMID: 32109293 DOI: 10.1093/cid/ciaa181] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/24/2020] [Indexed: 11/12/2022] Open
Abstract
In a pre-exposure prophylaxis program for Kenyan women, we detected tenofovir-diphosphate in 61% (125/201) of randomly selected dried blood spots collected at the first follow-up visit. Tenofovir-diphosphate was detected more frequently among women who had partners living with human immunodeficiency virus, who were not pregnant, and who were ≥24 years.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Harison Lagat
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Daniel Odinga
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
5
|
Bulterys MA, Sharma M, Mugwanya K, Stein G, Mujugira A, Nakyanzi A, Twohey-Jacobs L, Ware NC, Heffron R, Celum C. Correlates of HIV Status Nondisclosure by Pregnant Women Living With HIV to Their Male Partners in Uganda: A Cross-Sectional Study. J Acquir Immune Defic Syndr 2021; 86:389-395. [PMID: 33148995 PMCID: PMC8249052 DOI: 10.1097/qai.0000000000002566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV status disclosure by pregnant women living with HIV (PWLHIV) to their male partners is associated with improved maternal and infant outcomes. Understanding relationship factors associated with nondisclosure of HIV status by PWLHIV to their partners can inform the design of interventions to facilitate disclosure. METHODS We conducted a cross-sectional study using enrollment data from 500 PWLHIV unaware of their male partners' HIV status and participating in a randomized clinical trial assessing secondary distribution of HIV self-testing kits in Kampala, Uganda. The primary outcome was women's HIV status nondisclosure to their partners. We conducted univariate and multivariate binomial regressions to assess the association between baseline sociodemographic, HIV history, and relationship characteristics with HIV status nondisclosure. RESULTS 68.2% of the 500 PWLHIV had not disclosed their HIV status to their partner(s). Factors associated with higher likelihood of nondisclosure included relationship duration <1 year [adjusted prevalence ratio (aPR = 1.25); 95% confidence interval (CI): 1.02 to 1.54], being in a polygamous relationship (aPR = 1.21; 95% CI: 1.07 to 1.36), unmarried (aPR = 1.20; 95% CI: 1.07 to 1.35), uncertainty about whether their partner had ever tested for HIV (aPR = 1.55; 95% CI: 1.28 to 1.88), and a lack of social support from people aware of their status (aPR = 1.32; 95% CI: 1.18 to 1.49). CONCLUSION Relationship factors, including shorter-term, unmarried, and polygamous relationships and uncertainty about partner's HIV testing history, were associated with higher likelihood of pregnant women's nondisclosure of HIV status to their partner. Interventions that facilitate couples' HIV testing and disclosure, provide counseling to reduce relationship dissolution in serodiscordant couples, and offer peer support for women may increase disclosure. CLINICALTRIALSREGISTRATION Clinicaltrials.gov ID number: NCT03484533.
Collapse
Affiliation(s)
- Michelle A Bulterys
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
| | | | - Kenneth Mugwanya
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
| | | | - Andrew Mujugira
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
| | - Agnes Nakyanzi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda ; and
| | | | - Norma C Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - Renee Heffron
- Departments of Epidemiology, and
- Global Health, University of Washington, Seattle, WA
| | - Connie Celum
- Global Health, University of Washington, Seattle, WA
| |
Collapse
|
6
|
Begnel ER, Escudero J, Mugambi M, Mugwanya K, Kinuthia J, Beima-Sofie K, Dettinger JC, Baeten JM, John-Stewart G, Pintye J. High pre-exposure prophylaxis awareness and willingness to pay for pre-exposure prophylaxis among young adults in Western Kenya: results from a population-based survey. Int J STD AIDS 2020; 31:454-459. [PMID: 32208816 DOI: 10.1177/0956462420912141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We conducted a population-level short message service (SMS)-based survey among individuals aged 18–34 years in six HIV high-burden counties in Western Kenya to assess pre-exposure prophylaxis (PrEP) awareness, acceptability of non-facility PrEP delivery, and willingness to pay for PrEP. In January 2019, anonymous data were collected using mSurvey Inc., Nairobi, Kenya, which sends SMS messages via mobile provider networks to a ‘general audience’ pool of subscribers ≥18 years. Subscribers’ demographic information was matched to Kenyan census data by age, gender, and county. Of the 3825 individuals who received the survey, 2617 (68%) opened the survey and 2498/2617 (95%) completed all questions. Overall, 84% had ever heard of PrEP, of whom 59% demonstrated understanding of PrEP; understanding was greater among men than women (64% versus 55%, p < 0.001). Among participants who understood PrEP (n = 1249), 38% reported pharmacies (informal or formal) as the preferred venue to obtain PrEP. Over half (61%) were willing to pay for PrEP and 78% reported that the maximum amount they were willing to pay for a one-month supply was <5 USD. High awareness of PrEP in high HIV prevalence settings in Kenya suggests effective public health messaging. Willingness to pay and preference for pharmacy access suggest that non-facility PrEP delivery may be useful.
Collapse
Affiliation(s)
- Emily R Begnel
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jaclyn Escudero
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Melissa Mugambi
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
7
|
Dettinger JC, Kinuthia J, Pintye J, Abuna F, Begnel E, Mugwanya K, Sila J, Lagat H, Baeten JM, John‐Stewart G. Perinatal outcomes following maternal pre-exposure prophylaxis (PrEP) use during pregnancy: results from a large PrEP implementation program in Kenya. J Int AIDS Soc 2019; 22:e25378. [PMID: 31498563 PMCID: PMC6733245 DOI: 10.1002/jia2.25378] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/31/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The World Health Organization, while recommending pre-exposure prophylaxis (PrEP) for HIV-negative pregnant and postpartum women in HIV high-burden settings, advocates for continued safety evaluation of PrEP in this population. METHODS The PrEP Implementation in Young Women and Adolescents (PrIYA) program delivered PrEP to pregnant and postpartum women integrated within routine maternal and child health clinics (MCH) at 16 sites in Western Kenya. PrEP exposure and perinatal outcome data were collected among women obtaining postnatal services during programme evaluation. PrEP use was self-reported and confirmed with clinical records. Perinatal outcomes including gestational age at birth, birthweight, congenital malformations and infant growth outcomes were abstracted from clinical records for mother-infant pairs attending the six week visit. Associations between infant outcomes and maternal prenatal PrEP use were assessed using univariate and multivariate logistic and linear regression. RESULTS The PrIYA evaluation identified 1530 postpartum mother-infant pairs with data on prenatal PrEP exposure: 206 with prenatal PrEP use, 1324 without. Median maternal age was 24 years in both groups. PrEP users (any reported PrEP use) were significantly more likely to report HIV risk factors such as: intimate partner violence, sexually transmitted infections and having a partner with positive or unknown HIV status. Most mothers initiated PrEP during the second trimester (n = 116, 57%) and used PrEP for more than one month (n = 110, 58%). The mean birthweight was 3.3 kg and gestational age at birth was 38.5 weeks in both groups. There were no major differences between PrEP exposed and unexposed infants in rates of preterm birth and low birthweight. There were no congenital malformations identified in the PrEP-exposed group and five reported in the PrEP unexposed group. At six weeks postpartum, infants in both groups had similar growth. No differences in infant outcomes were found by duration PrEP exposure, trimester of PrEP initiation, a subset analysis of women 15 to 24 years old or in multivariate analyses. This analysis demonstrates that monitoring of infant outcomes is feasible within large-scale programmatic implementation of PrEP among pregnant and postpartum populations. CONCLUSIONS Pregnancy outcomes and early infant growth did not differ by PrEP exposure.
Collapse
Affiliation(s)
| | - John Kinuthia
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Obstetrics/GynecologyKenyatta National HospitalNairobiKenya
| | - Jillian Pintye
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Felix Abuna
- University of Washington – KenyaNairobiKenya
| | - Emily Begnel
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | | | - Joseph Sila
- University of Washington – KenyaNairobiKenya
| | | | - Jared M Baeten
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
- Department of PediatricsUniversity of WashingtonSeattleWAUSA
| |
Collapse
|
8
|
Ortblad KF, Kearney JE, Mugwanya K, Irungu EM, Haberer JE, Barnabas RV, Donnell D, Mugo NR, Baeten JM, Ngure K. HIV-1 self-testing to improve the efficiency of pre-exposure prophylaxis delivery: a randomized trial in Kenya. Trials 2019; 20:396. [PMID: 31272495 PMCID: PMC6610957 DOI: 10.1186/s13063-019-3521-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background The introduction of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus-1 (HIV-1) prevention in Africa presents new challenges for health systems that are already overburdened because PrEP delivery requires frequent clinic visits (generally every 3 months) for HIV-1 testing and PrEP refills. HIV-1 self-testing (HIVST) has the potential to improve the efficiency of PrEP delivery by decreasing the number of clinic visits. Here, we describe the rationale and design of a randomized, noninferiority trial designed to test the effectiveness and safety of using HIVST to support PrEP delivery in Kenya. Methods The JiPime-JiPrEP (Kiswahili for ‘Test Yourself, PrEP Yourself’) study is a three-arm randomized trial taking place in Thika, Kenya. Participants (n = 495) are eligible for enrollment if they are at least 18 years old, HIV-1 seronegative, and have been taking PrEP for 1 month. Three distinct participant types will be enrolled: men (n = 165) and women (n = 165) who are in mutually disclosed HIV-1 serodiscordant relationships, and women (n = 165) who are at HIV-1 risk and not in a known serodiscordant relationship. Participants in each of these subpopulations will be 1:1:1 randomized to: 1) the standard of care, with quarterly clinic visits; 2) oral HIVST, with biannual clinic visits plus oral HIVSTs to use at the quarters between those visits; or 3) blood-based HIVST, with biannual clinic visits plus blood-based HIVSTs. All participants will complete quantitative surveys and provide blood samples for the objective measurement of PrEP adherence at baseline, 6 months, and 12 months. The primary outcomes are PrEP adherence, PrEP continuation, and HIV-1 testing, measured at 6 months and secondarily at 12 months. Discussion The findings from this trial can help to understand how HIVST—a new HIV-1 testing technology—can support health systems in sub-Saharan Africa. Additionally, the findings can inform policy aimed at improving the efficiency of PrEP implementation and scale-up in Kenya. Trial registration ClinicalTrials.gov, NCT03593629. Retrospectively registered on 20 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3521-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Katrina F Ortblad
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.
| | - John E Kearney
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA
| | - Elizabeth M Irungu
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA
| | - Jessica E Haberer
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Deborah Donnell
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.,Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Nelly Rwamba Mugo
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.,Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jared M Baeten
- Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, USA.,Department of Medicine, University of Washington, Seattle, USA.,Department of Epidemiology, University of Washington, Seattle, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| |
Collapse
|
9
|
Shacklett BL, Blanco J, Hightow-Weidman L, Mgodi N, Alcamí J, Buchbinder S, Chirenje M, Dabee S, Diallo M, Dumchev K, Herrera C, Levy ME, Martin Gayo E, Makoah NA, Mitchell KM, Mugwanya K, Reddy K, Rodríguez ML, Rodriguez-Garcia M, Shover CL, Shrivastava T, Tomaras G, Van Diepen M, Walia M, Warren M, Manrique A, Thyagarajan B, Torri T. HIV Research for Prevention 2018: From Research to Impact Conference Summary and Highlights. AIDS Res Hum Retroviruses 2019; 35:598-607. [PMID: 31007035 PMCID: PMC6602109 DOI: 10.1089/aid.2019.0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The HIV Research for Prevention (HIVR4P) conference is dedicated to advancing HIV prevention research, responding to a growing consensus that effective and durable prevention will require a combination of approaches as well as unprecedented collaboration among scientists, practitioners, and community workers from different fields and geographic areas. The conference theme in 2018, "From Research to Impact," acknowledged an increasing focus on translation of promising research findings into practical, accessible, and affordable HIV prevention options for those who need them worldwide. HIVR4P 2018 was held in Madrid, Spain, on 21-25 October, with >1,400 participants from 52 countries around the globe, representing all aspects of HIV prevention research and implementation. The program included 137 oral and 610 poster presentations. This article presents a brief summary of highlights from the conference. More detailed information, complete abstracts as well as webcasts and daily Rapporteur summaries may be found on the conference website.
Collapse
Affiliation(s)
- Barbara L. Shacklett
- Medical Microbiology and Immunology, University of California, Davis, Davis, California
| | - Julià Blanco
- IrsiCaixa, IGTP, Barcelona, Spain
- Chair in AIDS and Related Illnesses, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-UCC, Barcelona, Spain
| | - Lisa Hightow-Weidman
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Nyaradzo Mgodi
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - José Alcamí
- AIDS Immunopathology Unit, Instituto de Salud Carlos III, Madrid, Spain
| | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, California
| | - Mike Chirenje
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Smritee Dabee
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Mamadou Diallo
- Department of Social and Preventive Medicine, University Laval, Quebec, Canada
| | | | - Carolina Herrera
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Matthew E. Levy
- Department of Epidemiology and Biostatistics, The George Washington University, Washington, District of Columbia
| | - Enrique Martin Gayo
- Immunology Department, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nigel Aminake Makoah
- Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kate M. Mitchell
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
- HPTN Modelling Centre, Imperial College London, London, United Kingdom
| | - Kenneth Mugwanya
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa
| | | | - Marta Rodriguez-Garcia
- Department of Physiology and Neurobiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Chelsea L. Shover
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Tripti Shrivastava
- Department of Infection and Immunology, Translational Health Science and Technology Institute, Faridabad, India
| | - Georgia Tomaras
- Departments of Surgery, Immunology, and Molecular Genetics and Microbiology, Duke University, Durham, North Carolina
| | - Michiel Van Diepen
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | |
Collapse
|
10
|
Pintye J, Drake AL, Begnel E, Kinuthia J, Abuna F, Lagat H, Dettinger J, Wagner AD, Thirumurthy H, Mugwanya K, Baeten JM, John-Stewart G. Acceptability and outcomes of distributing HIV self-tests for male partner testing in Kenyan maternal and child health and family planning clinics. AIDS 2019; 33:1369-1378. [PMID: 30932954 PMCID: PMC6546533 DOI: 10.1097/qad.0000000000002211] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Providing HIV self-tests to women for distribution to male partners may provide a unique opportunity to increase male partner and couples testing among women in HIV high-burden settings. METHODS Between November 2017 and June 2018, we offered self-tests for at-home couples or partner HIV testing to HIV-uninfected women seeking routine maternal and child health and family planning services at eight facilities in Kisumu, Kenya. Women accepting self-tests were offered at least two self-tests (OraQuick) to take to their partner(s) with instructions on use. HIV self-testing (HIVST) outcomes were evaluated using available programmatic data. RESULTS Overall, 3620 women were offered self-tests for at-home male partner HIV testing. The median age was 24 years (interquartile range 21-28) and 81% were in monogamous marriages. Overall, 1422 (39%) women reported having a partner of unknown HIV status, of whom 755 (53%) accepted self-tests. Among women with partners of unknown HIV status who declined self-tests (n = 667), 49% reported needing to consult their partner. Pregnant women were more likely to accept HIVST than nonpregnant women (prevalence ratio = 1.2, 95% confidence interval 1.0-1.4, P = 0.013). Self-testing outcomes were ascertained for 389 (44%) women who accepted self-tests. Among these women, 93% offered HIVSTs to their male partner; of these, 95% reported their male partners used the self-test and 99% used a self-test with their partner. CONCLUSION Among women attending routine maternal and child health and family planning services who had male partners of unknown HIV status, over half accepted self-tests for partner testing. Most women with outcomes ascertained reported that male partners accepted and used self-tests and that couples testing occurred.
Collapse
Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, Washington
| | - Emily Begnel
- Department of Global Health, University of Washington, Seattle, Washington
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- University of Washington—Kenya, Nairobi, Kenya
| | | | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, Washington
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Pediatric, University of Washington, Seattle, Washington
| |
Collapse
|
11
|
Irungu EM, Ngure K, Mugwanya K, Mugo N, Bukusi E, Wamoni E, Odoyo J, Morton JF, Bernabee G, Mambo B, Masyuko S, Mukui I, O'Malley G, Baeten JM. Training health care providers to provide PrEP for HIV serodiscordant couples attending public health facilities in Kenya. Glob Public Health 2019; 14:1524-1534. [PMID: 30871413 DOI: 10.1080/17441692.2019.1588908] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To catalyse national scale up of PrEP for HIV serodiscordant couples in public health facilities in Kenya, the Partners Scale-Up Project, using a two-day case-based interactive curriculum, trained health care providers working in 24 high volume facilities in central and western Kenya on PrEP service delivery. Using a standardised test with questions about PrEP and antiretroviral-based HIV prevention we assessed gain in knowledge and confidence gain by comparing pre-and post-training test scores. We explored experiences of the training through key informant interviews after clinics started delivering PrEP. Of 716 health care providers trained, 235 (32.9%) were nurses, 144 (20.2%) were clinical officers and 155 (21.7%) were HIV counsellors. There was a significant improvement between the means of pre-test and post-test scores (61.7% (SD 17.4) vs 86.4% (SD 12.7) p < 0.001). The proportion of those who reported being 'very comfortable' providing care to HIV serodiscordant couples increased from 22.8% to 67.3% (p < 0.001). Key themes that training increasing both knowledge of PrEP and confidence to deliver PrEP to HIV serodiscordant couples emerged from interviews. This short, standardised training resulted in a substantial increase in knowledge of PrEP and in the confidence of the health providers to provide PrEP to HIV serodiscordant couples. Trial registration ClinicalTrials.gov NCT03052010.
Collapse
Affiliation(s)
- Elizabeth M Irungu
- Centre for Clinical Research, Kenya Medical Research Institute , Nairobi , Kenya.,Department of Global Health, University of Washington , Seattle , WA , USA
| | - Kenneth Ngure
- Department of Global Health, University of Washington , Seattle , WA , USA.,College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology , Nairobi , Kenya
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington , Seattle , WA , USA
| | - Nelly Mugo
- Centre for Clinical Research, Kenya Medical Research Institute , Nairobi , Kenya.,Department of Global Health, University of Washington , Seattle , WA , USA
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington , Seattle , WA , USA.,Centre for Microbiology Research, Kenya Medical Research Institute , Nairobi , Kenya
| | - Elizabeth Wamoni
- Centre for Clinical Research, Kenya Medical Research Institute , Nairobi , Kenya
| | - Josephine Odoyo
- Centre for Microbiology Research, Kenya Medical Research Institute , Nairobi , Kenya
| | - Jennifer F Morton
- Department of Global Health, University of Washington , Seattle , WA , USA
| | - Gena Bernabee
- Department of Global Health, University of Washington , Seattle , WA , USA
| | - Barbara Mambo
- National AIDS and STI Control Program , Nairobi , Kenya
| | - Sarah Masyuko
- Department of Global Health, University of Washington , Seattle , WA , USA.,National AIDS and STI Control Program , Nairobi , Kenya
| | - Irene Mukui
- National AIDS and STI Control Program , Nairobi , Kenya
| | - Gabrielle O'Malley
- Department of Global Health, University of Washington , Seattle , WA , USA
| | - Jared M Baeten
- Department of Global Health, University of Washington , Seattle , WA , USA.,Department of Epidemiology, University of Washington , Seattle , WA , USA.,Department of Medicine, University of Washington , Seattle , WA , USA
| |
Collapse
|
12
|
Mugwanya K, Baeten J, Celum C, Donnell D, Nickolas T, Mugo N, Branch A, Tappero J, Kiarie J, Ronald A, Yin M, Wyatt C. Low Risk of Proximal Tubular Dysfunction Associated With Emtricitabine-Tenofovir Disoproxil Fumarate Preexposure Prophylaxis in Men and Women. J Infect Dis 2016; 214:1050-7. [PMID: 27029778 DOI: 10.1093/infdis/jiw125] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/24/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Tenofovir disoproxil fumarate (TDF) is associated with proximal tubular dysfunction (tubulopathy) when used in the treatment of human immunodeficiency virus (HIV) infection. We evaluated whether TDF causes tubulopathy when used as HIV preexposure prophylaxis (PrEP) and whether tubulopathy predicts clinically relevant decline (≥25%) in the estimated glomerular filtration rate (eGFR). METHODS A subgroup analysis of the Partners PrEP Study, a randomized, placebo-controlled trial of daily oral TDF, alone or with emtricitabine (FTC), in HIV-uninfected African men and women (Clinicaltrials.gov NCT00557245). Tubulopathy was assessed in concurrently obtained urine and serum samples at the 24-month or last on-treatment visit, predefined as ≥2 of the following: tubular proteinuria, euglycemic glycosuria, increased urinary phosphate, and uric acid excretion. RESULTS Of 1549 persons studied (776 receiving FTC-TDF, 773 receiving placebo), 64% were male, and the median age was 37 years. Over a median 24 months of study-drug exposure, the frequency of tubulopathy was 1.7% for FTC-TDF versus 1.3% for placebo (odds ratio, 1.30; 95% confidence interval, .52-3.33; P = .68); Tubulopathy occurred in 2 of 52 persons (3.8%) with versus 3 of 208 (1.4%) without ≥25% eGFR decline (adjusted odds ratio, 1.39; .10-14.0; P > .99). CONCLUSIONS Daily oral FTC-TDF PrEP was not significantly associated with tubulopathy over the course of 24 months, nor did tubulopathy predict clinically relevant eGFR decline.
Collapse
Affiliation(s)
- Kenneth Mugwanya
- Department of Epidemiology Department of Global Health Division of Disease Control, School of Public Health, Makerere University, Kampala, Uganda
| | - Jared Baeten
- Department of Epidemiology Department of Global Health Department of Medicine, University of Washington
| | - Connie Celum
- Department of Epidemiology Department of Global Health Department of Medicine, University of Washington
| | - Deborah Donnell
- Department of Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Nelly Mugo
- Department of Global Health Kenya Medical Research Institute
| | | | - Jordan Tappero
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Kiarie
- Department of Obstetrics and Gynecology, University of Nairobi, Kenya
| | - Allan Ronald
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Michael Yin
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | |
Collapse
|
13
|
Fife KH, Mugwanya K, Thomas KK, Baeten JM, Celum C, Bukusi E, de Bruyn G, Mujugira A, Vwalika B, Wald A, Lingappa JR. Transient Increase in Herpes Simplex Virus Type 2 (HSV-2)-Associated Genital Ulcers Following Initiation of Antiretroviral Therapy in HIV/HSV-2-Coinfected Individuals. J Infect Dis 2015; 213:1573-8. [PMID: 26704611 DOI: 10.1093/infdis/jiv765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected persons beginning antiretroviral therapy (ART) has been incompletely characterized for herpes simplex virus type 2 (HSV-2). METHODS We evaluated genital ulcer disease (GUD) and HSV-2-associated GUD at quarterly visits or when spontaneously reported at monthly visits in 3381 HIV/HSV-2-coinfected individuals in a placebo-controlled trial of suppressive acyclovir therapy to prevent HIV transmission, 349 of whom initiated ART during the study. Incidence was calculated for months before and after ART initiation, and incidence rate ratios (IRRs) were calculated. RESULTS GUD incidence increased from 15.0 episodes per 100 person-years before ART to 26.9 episodes per 100 person-years in the first full quarter after ART initiation (IRR, 1.83;P= .03), and the incidence of HSV-2-associated GUD increased from 8.1 to 19.0 episodes per 100 person-years (IRR, 2.20;P= .02). Subsequently, the incidence of GUD was similar to that before ART, although the numbers were small. Persons receiving suppressive acyclovir had fewer GUD episodes, but the IRR after beginning ART was similar in the acyclovir and placebo groups. CONCLUSIONS Initiation of ART in HIV/HSV-2-coinfected persons is associated with a transient increase in GUD and HSV-2 GUD. Acyclovir reduces the incidence of GUD but does not prevent an increase in GUD incidence during the first quarter following initiation of ART.
Collapse
Affiliation(s)
- Kenneth H Fife
- Department of Medicine Deparment of Microbiology and Immunology Department of Pathology, Indiana University, Indianapolis
| | | | | | - Jared M Baeten
- Department of Epidemiology Department of Global Health Department of Medicine
| | - Connie Celum
- Department of Epidemiology Department of Global Health Department of Medicine
| | - Elizabeth Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi
| | | | | | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia, and Zambia-Emory HIV Research Project, Lusaka
| | - Anna Wald
- Department of Epidemiology Department of Medicine Department of Laboratory Medicine, University of Washington, and Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jairam R Lingappa
- Department of Global Health Department of Medicine Department of Pediatrics
| | | |
Collapse
|
14
|
Mugwanya K, Baeten JM, Mugo NR, Irungu E, Ngure K, Celum C. High-dose valacyclovir HSV-2 suppression results in greater reduction in plasma HIV-1 levels compared with standard dose acyclovir among HIV-1/HSV-2 coinfected persons: a randomized, crossover trial. J Infect Dis 2011; 204:1912-7. [PMID: 21998479 DOI: 10.1093/infdis/jir649] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Standard-dose HSV-2 suppressive therapy (acyclovir 400 mg twice daily) reduces plasma HIV-1 levels by 0.25-0.50 log(10) copies/mL. It is not known if higher doses might further suppress HIV-1 levels. METHODS We enrolled 32 HIV-1/HSV-2 dually infected Kenyan individuals who were not on antiretroviral therapy (ART) into a randomized, crossover trial of 2 dosing regimens of HSV-2 suppression: valacyclovir 1.5 g vs acyclovir 400 mg, both twice daily for 12 weeks, then a 2-week washout, and then the alternative for 12 weeks. Weekly plasma HIV-1 RNA quantity was measured (ClinicalTrials.gov number NCT01026454). RESULTS Mean plasma HIV-1 levels were significantly lower on valacyclovir compared with acyclovir: 2.94 vs 3.56 log(10) copies/mL, an average difference of 0.62 log(10) copies/mL (95% confidence interval [CI]: -0.68, -0.55; P < .001), a 76% decrease. Valacyclovir resulted in a 1.23 log(10) copies/mL decrease compared with baseline HIV-1 levels without HSV-2 suppression. Adherence was similar (99.4% of dispensed study tablets taken), and high-dose valacyclovir was well tolerated. CONCLUSIONS High-dose valacyclovir reduced plasma HIV-1 viral levels by 0.62 log(10) copies/mL compared with standard-dose acyclovir. The potential for higher-dose HSV-2 suppressive therapy to slow HIV-1 disease progression and reduce HIV-1 infectiousness among HIV-1/HSV-2 coinfected persons not yet eligible for ART warrants further evaluation.
Collapse
Affiliation(s)
- Kenneth Mugwanya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | | | | |
Collapse
|