PrEP在非洲的拓展- 緩慢進行中

 

PrEP在非洲的拓展- 緩慢進行中

阿姆斯特丹第22屆國際愛滋大會中許多研究表示,今年即2018年在非洲,將是會有相當數量的人開始實施愛滋病毒暴露前預防投藥(PrEP)的一年, PrEP是今年會議上的主要議題 - 與其他任何議題相比,會議中的討論要多得多, 更值得注意的是,他們中的大多數人關注的是非洲的PrEP的狀況以及除了男同性戀者和男男間性行為者(MSM)等以外的人群。

多年來,一些非洲國家試點的PrEP項目已在進行中。但自2017年底以來,一些國家 - 尤其是肯亞和南非,以及史瓦濟蘭已更換新名稱的史瓦帝尼 (eSwatini)--已經開始為更廣泛的人群開展嚴謹且具可用性的PrEP計劃。在南非,大約有25,00030,000人開始服用PrEP ; 肯亞在大約25,000人中發起了PrEP; 辛巴威約5000; 史瓦帝尼已經評估過將執行PrEP2,250人,如果這些人都開始進行,那麼與人口眾多的肯亞相比,實施人數佔人均人口之比率約為三倍。賴索托、桑比亞以及西非的塞內加爾也開始實施計劃,無論是針對性工作者等目標人群,還是針對具危險行為的普通人群。

我們目前只有幾個月有關PrEP的採用和提供之數據,且還沒有關於其有效性的數據。但隨著PrEP知識的傳播以及醫療保健工作者在與社區合作方面變得更有經驗時,則計畫中個案存留情形和目標定位可能會有所改善。

不同國家PrEP的採用和存留在計畫中之情形差異很大,但有幾個突出因素。其中一個原因是許多計畫項目的中輟率很高,特別是在女性性工作者中,而且在年輕女性和一般的男性中也是如此。在許多研究中,大多數開始啟動PrEP的人在第一次就診後沒有回來。

第二個不繼續使用PrEP的最常見因素是,在是第一個月就出現副作用。來自南非和肯亞的兩項研究結果相似,表明噁心、腹痛、頭痛和頭暈等急性副作用,可能比高收入國家男男間性行為者所報告之結果更為常見或更嚴重,需要認真對待。

肯亞和辛巴威

來自華盛頓州立大學的Jillian Pintye介紹了肯亞的PRIYA計劃(PrEP在年輕族群和青少年中的實施)的結果。該計劃於去年11月啟動,正在試行PrEP,成為在肯亞流行率最高省份中的基蘇木縣之16個計劃生育中心提供的服務之一。

在該計劃的初始的七個月,它已經由評估並向1,122名年輕女性提供了PrEP,參與者主要是20多歲,平均年齡為25歲。大多數已經結婚(83%)。其中有三分之一的人不知道他們的伴侶的愛滋病毒狀況,有4%(95名的女性)他們已知道有感染愛滋病毒的伴侶。

只有五分之一(21%)的年輕女性開始接受PrEP投藥。但是不了解自己伴侶感染情形者採用所佔比例則只有三分之一,而知曉伴侶愛滋病病毒陽性的女性則有91%的人採用。具有HIV陽性伴侶的女性開始PrEP的可能性是平均水平的3.5倍,而其他具有愛滋病毒易感性指標的女性更是如此:那些經歷過親密伴侶暴力的人的可能性是4.8倍,經歷過強姦和性侵犯的人是6.6倍更可能的是,那些被診斷患有性感染疾病的人的可能性增加10.6倍。

不接受PrEP的最常見原因是人們認為自我感染愛滋病毒的風險較低,藥丸太大或難以服用,但其中最重要的原因是,女性認為首先需要諮詢他們的伴侶。

一項辛巴威針對所有年齡層的女性和男性的研究,這個由克林頓愛滋倡議組織贊助的項目,在首都哈拉雷的一個計劃生育診所,以及另一個遠在200英里外之Chimanimani,一個靠近莫桑鼻克邊境農村地區的青年中心,在兩個試驗性愛滋病毒檢測中心中提供了PrEP。其研究也發現,前述原因也是女性對PrEP猶豫不決的重要原因。這些中心向在那裡接受愛滋病毒檢測的每個人提供PrEP(哈拉雷中心每月執行300次,Chimanimani每月執行175次),但只有極少數人同意嘗試。今年1月至5月期間,3,158人中有151人開始了PrEP4.8%:Chimanimani9%,哈拉雷為2.7%)。同樣,尋求伴侶許可的必要性是最常見的拒絕PrEP的原因。一位20歲的女士說:「讓我拒絕PrEP的原因是我的丈夫會在他離開時指責我有另一個性伴侶。因此,我認為最好是要求獲得其許可使用PrEP,如果他同意,那麼我會來」。

PrEP下降的其他原因是人們對保險套感到滿意並且害怕副作用。 然而,正如在肯亞的研究中一樣,PrEP被那些風險指標最高的人抓住,例如這個虐待關係的女人:「我將終身接受PrEP,因為我不再感染愛滋病病毒。 加上我的丈夫是殘忍的,因為他有時可以撕掉保險套,他可以假裝它已經爆裂了。 我很高興我現在有了備份」。或另一個丈夫的不忠導致她感染性病的人:「我在丈夫的電話裡看到了很多來自不同女孩的信息,我和他談到了這件事,而且我很驚訝我被診斷出感染性病兩次,所以我意識到,我因此對自己說我決定接受PrEP」。

簡而言之,包括年輕女性在內的人如果處於即將面臨風險的情況下會接受PrEP,特別是如果他們認為自己無法控制這種風險。

南非的計劃

除了試點項目之外,其中一些項目在去年在巴黎舉行的IAS會議上已提出,南非的PrEP目前已在34個試點實施地點分四個階段推出。截至20185月,共有5,857人在該計劃中啟動了PrEP--約佔南非估計總數的四分之一。 PrEP20166月首次被引入女性性工作者(FSWs)場域,然後於20174月進入MSM場域,201710月進入青年學生大學場域,最近於20185月進入年輕人的一般場域。這四個群體提供和接受PrEP的比率在每種情況下都有趣地不同。

在女性性工作者(FSWs)中,過去兩年有近50,000名人員在PrEP實施的FSW站點接受了HIV檢測,其中13%的人患有HIV並被轉診治療 ; 其中一半開始抗反轉錄病毒治療(ART)。其餘32,500人中有三分之二獲得了PrEP之提供。儘管只有13%(4,109)實際採用了PrEP,但這明顯已經遠遠高於南非2016 - 2022年國家愛滋病、性病和結核病策略計劃中的前兩年中將於女性性工作者中推廣採用PrEP的目標1,880人。

MSM中,自20174月開始實施於MSM族群後,已有10,800人在PrEP實施的MSM場域上進行了測試,其中5%的人感染愛滋病毒,所有人都開始接受抗病毒治療。在HIV陰性的剩餘部分中,PrEP提供的比例低於FSWs - 28%或2,937個人 - 因為更多的男同性戀者屬於低風險類別。但是,在提供給PrEP的人數中實際採用者則增加了54%或1,537人。同樣地,這也超過了國家策略計劃中2016 - 2018年其目標應達818人。

在第三階段,大學生在大學實施地點接受受滋病毒檢測。自201710月開始這一階段以來,僅有超過14,700人接受了艾滋病毒檢測,其中1.5%(219人)檢測出愛滋病毒陽性,其中209人(92%)已開始抗病毒治療。在那些檢測HIV陰性的人中,有15%被提供PrEP,但其中只有6%(138人)已經開始PrEP

最後,第四階段是在社區測試場地和街頭拓展中向年輕人提供PrEP。這僅在20185月開始,在那個月期間,185人已接受艾滋病病毒檢測,沒有陽性結果,73人(39%)已提供PrEP - 而其接受率為100%(即所有被提供PrEP者均開始服用)。

這種高接受率是否反映出透過外展能更好地針對有風險的人群、抑或隨著時間的推移有更多地了解和接受PrEP,或僅僅是屬於一些可能已經想要PrEP一段時間的「早期採用者」獲得它的方法,判定其原因現在還為時過早。

負責在南非衛生部實施PrEP計劃的主持人Yogan Pillay評論說,最初將其提供給已被污名化的人群,「事後看來,我們推出PrEP的方式可能無意中將其污名化」。

副作用和標籤歧視 - 停止使用的兩個最重要的原因

南非的Wits生殖健康和愛滋病研究所的Diantha Pillay,介紹了在當時於開放的16PrEP實施地點中的9個地點,針對FSWMSM所實施直到20176月為止深入且定性的調查結果。

研究人員從臨床就診者中選擇了299FSWMSM和一般人群。首先,他們排除了從未聽說過PrEP的人。PrEP的知識在FSWMSM族群中普遍存在:只有七名性工作者(4.5%)和三名男男性接觸者(3.75%)從未聽說過。在選定的一般人口中,則有46%從未聽說過。

在聽說過PrEP260人中,有94人正在使用PrEP80人曾使用它但目前停止了,86人從未使用過它。調查顯示,即使在這些PrEP實施場域中,也不是每個可能採用者都可以獲得PrEP的提供。在那些從未聽說過PrEP的人中,近一半(45%)的FSW從未被提供過,MSM則佔三分之二,「其他」組則佔四分之三。

想要開始或繼續PrEP的最常見原因是這個人是性活躍的; 「愛滋病毒風險」較少被引用作為將PrEP納入男男間性行為者和其他族群中的理由,儘管它在女性性工作社中經常被引用。

在那些停止使用PrEP者中,副作用是迄今為止在FSWMSM族群中停止使用之最常見原因:四分之三的FSW87%的MSM表示副作用包括:胃腸不適、噁心、頭暈和頭痛是他們停止的主要原因。相比之下,在「其他」類別中,停止PrEP的最常見原因是人們感到被它污名化。

在這些過去的用戶中,83%表示副作用影響了他們的日常生活,甚至在當前用戶中,59%表示他們經歷過這些,31%表示副作用的確影響了他們的日常生活。

Diantha Pillay評論說,雖然大部分PrEP用戶回憶起在PrEP使用前諮詢會議中被告知其副作用,但只有少數人接受過如何管理這些副作用的建議。

回到肯亞,奈洛比愛滋組織LVCT HealthJordan Kyongo亦同意認為,副作用是停止PrEP的最常見原因之一。

2015-2017 PrEP示範項目位於維多利亞湖的基蘇木和霍馬灣以及首都奈洛比。它招募了796FSW597名男男性接觸者和723名普通人口中的年輕女性。儘管在2013年的可行性研究中,85%的潛在參與者表示他們會使用PrEP,但25%的因PrEP而接受篩檢者從未在他們最初的PrEP處方預約中出現過(34%的FSW)。但真正引人注目的是第一個月的中輟率。 40%已接受PrEP處方的FSW從未在他們第二個處方時出現過,男男性接觸者為55%和普通人口中的年輕女性則為70%。

中輟率持續下去,在六個月的預約中,最初接受篩查的人中,只有14%的FSW15%的男男性接觸者和10%的普通人群年輕女性返回接受下一個PrEP處方。

副作用是退出的最常見原因。 PrEP接受者抱怨「噁心」、「頭痛」、「持續頭暈」、「拉肚子」、「皮膚變黑」、「體重增加」和「食慾不振」。 「由於副作用,我只用了半瓶」一名年輕女士說。

社區中對PrEP的看法,例如它導致陽痿或不孕或它是一種人口控制的措施,可能會引發真正的副作用,並且可能會誘發虛構的副作用。

PrEP中輟的第二個最常見的原因是標籤歧視,其表現形式從社會上的不贊成到暴力。一位女士說:「當我告訴我的丈夫時,他拒絕並告訴我他不應該讓我使用它,所以我開始秘密服用這種藥物。當他知道這件事的時候,當他看到那個瓶子時,他痛打我一頓直到打斷鼻樑」。實際原因還經常包括運送的困難等。

繼續的原因包括希望與醫療保健工作者保持積極的關係,以及認知到人們不能依賴他人宣布這其愛滋病毒感染狀:一名女性性工作者說 「由於有多個伴侶和進行無保護性行為,你不知道他們是否感染HIV的狀態;就像那四個人一樣,我只知道其中一個人的狀態,而他們並不想來診所進行測試」。

Kyongo稱自己為「PrEP研究員和倡導者」,他說重要的是要考慮PrEP使用的背景,並記住PrEP只是一個選擇:「終局是HIV預防,而不是PrEP使用」,他說。他繼續說道:「合適採用PrEP的人是想要參與其中的人。如果我想參加PrEP,請允許我。如果我想拿它一個月然後停下來,也請同意我 ; 從使用者的角度來看,它不像吃藥,更像是使用保險套。如果我不想接受PrEP,請不要告訴我,我應該使用它因為我是具有高風險者」。

 

PrEP spreads across Africa – slowly

Numerous PrEP initiation projects started in the last year – but retention is a problem

 

Gus Cairns

Published: 06 August 2018

This year, 2018, will be the year that a really significant number of people in Africa started HIV pre-exposure prophylaxis (PrEP), the 22nd International AIDS Conference (AIDS 2018) in Amsterdam heard last week.

PrEP was probably the dominant subject at this year’s conference – there were far more sessions devoted to it than any other topic – and even more notable was the fact that the majority of them concerned PrEP in Africa and in populations other than gay men and men who have sex with men (MSM).

Pilot PrEP projects have been underway in some African countries for several years. But it has only been since late 2017 that some countries – notably Kenya and South Africa, and also eSwatini, which is the new name for Swaziland – have started serious PrEP availability programmes for wider populations. In South Africa roughly 25,000 to 30,000 people have started taking PrEP; Kenya has initiated PrEP in about 25,000 people; Zimbabwe in about 5000; and the 2250 in eSwatini who have been assessed for PrEP will, if all of them start it, be about three times the number per head of population compared with the much larger Kenya.

Lesotho, Zambia and, over in west Africa, Senegal have also started programmes, either among targeted populations such as sex workers, or among the general at-risk population.

Right now we only have a few months’ data on PrEP uptake and delivery, and none at all yet on effectiveness. As knowledge of PrEP spreads and as healthcare workers become more experienced in working with their communities, retention and targeting may improve.

PrEP uptake and retention varied considerably from country to country, but a couple of factors stood out.

One was that there was a high drop-out rate in many programmes, especially among female sex workers but also among young women and men in general. In many studies a majority of those who had initiated PrEP did not return after their first visit.

A second factor was that the most frequent reason given for not continuing with PrEP was the experience of side-effects during the first month. Two studies from South Africa and Kenya had similar-enough results to suggest that acute side-effects such as nausea, abdominal pain, headache and dizziness might be more common or more severe than has been reported from MSM in high-income countries, and need to be taken seriously.

Kenya and Zimbabwe

From Kenya, Jillian Pintye of the University of Washington State presented results from the PRIYA programme (PrEP Implementation in Young People and Adolescents). This programme started last November and is piloting PrEP as one of the services offered at 16 Family Planning Centres in Kisumu County, the highest-prevalence province in Kenya.

In the programme’s first seven months, it assessed and offered PrEP to 1122 young women, mainly in their 20s, with an average age of 25. Most were already married (83%). A third of them did not know their partner’s HIV status and 4% (95 women) had a partner they knew had HIV.

Only one in five (21%) of the young women started PrEP. But one in three of those who did not know their partner’s status started it, as did 91% of the women who had a known HIV-positive partner.

Women with positive partners were 3.5 times more likely than average to start PrEP and women with other indicators of vulnerability to HIV even more so: those who had experienced intimate partner violence were 4.8 times more likely, those who had experienced rape and sexual assault 6.6 times more likely, and those who had been diagnosed with a sexually transmitted infection 10.6 times more likely.

The most common reasons given for not taking PrEP were the perception that one was at low risk of HIV, that the pills would be too big or difficult to take, but most importantly of all that women felt that they needed to consult with their partner first.

A study among women and men of all ages in Zimbabwe also found that this was an important reason women hesitated about PrEP. This project, sponsored by the Clinton HIV and AIDS Initiative, offered PrEP at two pilot HIV testing centres, in a family planning clinic in the capital, Harare, and the other 200 miles away in a youth centre in Chimanimani, a rural district near the Mozambican border.

These centres offered PrEP to every person taking an HIV test there (the Harare centre performs 300 a month and there are 175 a month at Chimanimani), but only got a very small proportion agreeing to try it. Between January and May this year, 151 out of 3158 people started PrEP (4.8%: it was 9% at Chimanimani and 2.7% in Harare).

Again, the need to seek a partner’s permission was the reason given most often for declining PrEP. One woman aged 20 said: “What made me decline PrEP is that my husband would accuse me of having another sexual partner while he is away. So I think it is best for me to ask for the permission to take PrEP and if he agrees then I will come.”

Other reasons for declining PrEP were that people were happy with condoms and were afraid of side-effects. However, as in the Kenyan study, PrEP was seized on by those with the highest risk indicators, such as this woman in an abusive relationship: “I will take PrEP for life because I can no longer be infected by HIV. To add on my husband was cruel as he could tear the condoms sometimes and he could pretend as if it had burst. I was really happy that I now have a backup.”

Or another whose husband’s unfaithfulness had resulted in her being infected with STIs: “I saw a lot of messages from different girls on my husband’s phone and I spoke to him about it but I was surprised to be diagnosed of an STI twice, so I realised that I was talking to myself. I therefore decided to take PrEP.”

In short, people including young women will take PrEP if they are in situations of imminent risk, especially if they feel they have no control over that risk.

South Africa’s programme

Alongside and following pilot projects, some presented at the IAS conference in Paris last year,  PrEP in South Africa has been introduced so far in four stages at 34 pilot implementing sites. As of May 2018, 5857 people have started PrEP in this scheme – about one in four of South Africa’s estimated total. PrEP was first introduced into sites for female sex workers (FSWs) in June 2016, then into sites for MSM in April 2017, into university sites for young students in October 2017, and most recently in May 2018 into general sites for young people.

The rate at which PrEP was both offered and accepted by these four groups was interestingly different in each case.

Among FSWs, nearly 50,000 have been tested for HIV in the last two years at the PrEP-implementing FSW sites, of which 13% had HIV and were referred to treatment; half of them started antiretroviral therapy (ART). Two-thirds of the remaining 32,500 were offered PrEP. Although only 13% (4109) started PrEP, this is already considerably higher than the 1880 that is the target for PrEP uptake in FSWs in the first two years of South Africa’s 2016-2022 National Strategic Plan for HIV, STIs and TB.

We will look at the South African FSW PrEP programme more closely in another article.

In MSM 10,800 have been tested at the PrEP-implementing MSM sites since their phase started in April 2017. Five per cent had HIV, and all of them started ART. Of the HIV-negative remainder, the proportion offered PrEP was lower than in FSWs – 28% or 2937 individuals – because more gay men are in lower-risk categories. But the uptake among those offered PrEP has been higher, at 54% or 1537 individuals. Again, this exceeded the 818 that is the 2016-2018 target in the national Strategic Plan.

In the third phase, university students were tested for HIV at college implementing sites. Since this phase started in October 2017, just over 14,700 have been tested for HIV and of those 1.5% (219 people) tested HIV positive, of whom 209 (92%) have started ART. Of those testing HIV negative, 15% were offered PrEP of whom only 6% (138 people) have started PrEP.

Finally, the fourth phase is piloting the offer of PrEP to young people at community testing sites and via street outreach. This only started in May 2018 and during that month 185 have been tested for HIV with no positive results, and 73 (39%) have been offered PrEP – with an 100% acceptance rate (i.e. all who were offered PrEP started it).

It’s too early to say whether this high acceptance rate reflects better targeting of at-risk people via outreach, greater knowledge of and acceptance of PrEP with time, or simply that a few ‘early adopters’ who may have wanted PrEP for some time now have a way to get it.

Presenter Yogan Pillay, who is in charge of implementing the PrEP programme at South Africa’s Department of Health, did comment that “With hindsight, the way we rolled out PrEP may have inadvertently stigmatised it” by offering it initially to already stigmatised populations.

Side-effects and stigma – the two most important reasons for discontinuation

Diantha Pillay of South Africa’s Wits Reproductive Health and HIV Institute presented in-depth qualitative findings from FSWs and MSM who took PrEP up till June 2017 at nine of the 16 PrEP implementation sites that were open at the time.

The researchers selected 299 FSWs, MSM and general-population members from clinic attendees. Firstly, they excluded people who had never heard of PrEP. PrEP knowledge was widespread among FSWs and MSM: only seven sex workers (4.5%) and three MSM (3.75%) had never heard of it. Among the general population members selected, 46% had never heard of it.

Among the 260 people who had heard of PrEP, 94 were currently using it, 80 had used it but stopped, and 86 had never used it.

The survey showed that even in these PrEP implementation sites, not everyone was being offered PrEP who might take it. Among those who had never heard of PrEP, nearly half (45%) of FSWs had never been offered it, two-thirds of MSM, and three-quarters of the ‘other’ group.

The most common reason for wanting to start, or to continue, PrEP was that the person was sexually active; “HIV risk” was less often cited as a reason to take PrEP among the MSM and other categories, though it was cited just as often among the FSW.

Among those who had stopped PrEP, side-effects were by far the most common reason to stop among FSWs and MSM: three-quarters of FSWs and 87% of MSM said that side-effects including gastro-intestinal upset, nausea, dizziness and headaches were their main reason for stopping. In contrast, among the ‘other’ category, the most common reason for stopping PrEP was that people felt stigmatised by it.

Among these past users, 83% said side-effects had affected their daily lives and even among current users, 59% said they had experienced them and 31% said they affected their daily lives.

Diantha Pillay commented that although a majority of PrEP users recalled being told about side-effects in pre-PrEP counselling sessions, only a minority received advice on how to manage those side-effects.

Back in Kenya, Jordan Kyongo of the Nairobi-based HIV organisation LVCT Health concurred that side-effects were one of the most common reasons for discontinuing PrEP.

A 2015-2017 PrEP demonstration project was based in the cities of Kisumu and Homa Bay on Lake Victoria and in the capital Nairobi. It enrolled 796 FSWs, 597 MSM and 723 general-population young women.

Although, in a 2013 feasibility study, 85% of potential participants had said they would use PrEP, 25% of those screened for PrEP never turned up for their initial PrEP prescription appointment (34% of FSWs). But what was really striking was the drop-out rate in the first month. Forty per cent of FSWs prescribed PrEP never turned up for their second prescription, 55% of MSM and fully 70% of general-population young women.

The drop-out rate continued and by the six-month appointment, out of those initially screened, only 14% of FSWs, 15% of MSM and 10% of general-population young women returned for their next PrEP prescription.

Side-effects were the most commonly cited reason for dropping out. PrEP takers complained of “‘nausea’, ‘headaches’, ‘constant dizziness’, ‘running stomach’, ‘darkening of the skin’, ‘weight gain’and ‘loss of appetite’”. “I took the bottle halfway due to the side effects,” said one young woman.

Real side-effects reinforced, and imaginary ones might be induced, by community beliefs about PrEP, such as it causing impotence or sterility or being a population-control measure.

The second most common reason for PrEP drop-out was stigma ranging in its manifestations from social disapproval to violence. One woman said: “When I informed my husband, he refused and told me that he should not find me using it. So I started taking the drug in secrecy. When he came to know about it, when he saw that bottle he beat me to an extent of breaking my nose”. Practical reasons such as transport difficulties were also often given.

Reasons for continuing included wanting to maintain a positive relationship with the healthcare worker and a perception that one could not rely on people’s declaration of this HIV status: one FSW said: “Because of having multiple partners and having unprotected sex you do not know their status; like even those four, I only knew status of one person and they do not want to come to the clinic to test”.

Kyongo, who described himself as “a PrEP researcher and advocate,” said that it was important to take account of the context of PrEP use and to keep in mind that PrEP was a choice: “The end game is HIV prevention, not PrEP use,” he said.

He continued: “The right people on PrEP are the people who want to be on it. If I want to be on PrEP, let me. If I want to take it for a month then stop, let me; from the point of the user, it is not like taking medicine, it is much more like using a condom. And if I don't want to take PrEP, don't tell me I should because I'm 'at risk'."

References

This report is drawn from the following presentations at the 22nd International AIDS Conference (AIDS 2018), Amsterdam, July 2018.

Cowan FM. Prioritizing populations and positioning PrEP – How has it been working? Key populations.Symposium presentation WESA1303.

 

Mugwanya K et al (presenter Pintye J). Uptake of PrEP within clinics providing integrated family planning and PrEP services: Results from a large implementation program in Kenya. Oral abstract presentation TUAC0304.

 

Gombe M et al. Integrating oral HIV pre-exposure prophylaxis (PrEP) in a public family planning facility and youth center to inform national roll out in Zimbabwe. Oral abstract presentation TUAC0307LB.

 

Pillay Y. Challenges of South Africa’s sex worker PrEP programme: Lessons learned, moving towards other key populations. Non-commercial satellite presentation TUSA1703.

 

Pillay D. Factors influencing initiation, continuation & discontinuation of oral PrEP at selected facilities in South Africa. Oral abstract presentation WEAE0401.

 

Kyongo JK et al. How long will they take it? Oral pre-exposure prophylaxis (PrEP) retention for female sex workers, men who have sex with men and young women in a demonstration project in Kenya. Oral abstract presentation WEAE0403.