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Review
. 2019 Jul;22 Suppl 4(Suppl Suppl 4):e25298.
doi: 10.1002/jia2.25298.

HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

Connie L Celum  1   2   3 , Sinead Delany-Moretlwe  4 , Jared M Baeten  1   2   3 , Ariane van der Straten  5 , Sybil Hosek  6 , Elizabeth A Bukusi  1   7   8 , Margaret McConnell  9 , Ruanne V Barnabas  1   2   3 , Linda-Gail Bekker  10
Affiliations
Review

HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

Connie L Celum et al. J Int AIDS Soc. 2019 Jul.

Abstract

Introduction: Adolescent girls and young women (AGYW) in Africa have high HIV incidence despite scale-up of HIV testing and HIV treatment. Placebo-controlled trials of tenofovir-based pre-exposure prophylaxi (PrEP) in diverse populations demonstrated that PrEP works with close to 100% effectiveness if taken with high, but not perfect, adherence. Divergent efficacy estimates among African AGYW led to demonstration and implementation projects to better understand motivations for HIV prevention, uptake, adherence and persistence to PrEP. To inform PrEP programmes, the design and initial findings from PrEP demonstration projects for AGYW are reviewed.

Discussion: Early lessons from PrEP implementation projects among young African women include: (1) awareness and demand creation with positive messaging about the benefits of PrEP are critical to motivate AGYW to consider this novel prevention technology and to foster awareness among peers, partners, parents and guardians to support AGYW's effective PrEP use; (2) PrEP initiation is high in projects that are integrating PrEP into youth-friendly clinics, family planning clinics and mobile clinics; (3) young African women at risk are initiating PrEP, based on behavioural characteristics, history of intimate partner violence, depression and 30% prevalence of chlamydia and/or gonorrhoea; (4) provision of youth-friendly PrEP delivery programmes that integrate reproductive health services, including contraception and the diagnosis and treatment of sexually transmitted infections, increase health impact; (5) messages that emphasize the necessity for high adherence while at potential risk of HIV exposure and support strategies that addresses AGYW's adherence challenges are essential; and, (6) a substantial proportion of AGYW do not persist with PrEP, and strategies are needed to help AGYW assess their ongoing need, motivation and challenges with persisting with PrEP.

Conclusions: PrEP is feasible to implement in integrated reproductive health service delivery models to reach African AGYW. While PrEP demonstration projects indicate that women with behavioural risks and high rates of sexually transmitted diseases are initiating PrEP; effective strategies to support AGYW's adherence and persistence with PrEP are needed. Lessons learned from oral PrEP delivery, a novel first generation HIV prevention product, are relevant to longer-acting and less adherence-dependent strategies which are currently in clinical trials.

Keywords: Africa; HIV prevention; adolescents; pre-exposure prophylaxis; young women.

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References

    1. UNAIDS . Global AIDS update. Miles to go: closing gaps, breaking barriers, righting injustices. Geneva: UNAIDS; 2018.
    1. Baeten JM, Palanee‐Phillips T, Brown ER, Schwartz K, Soto‐Torres LE, Govender V, et al. Use of a vaginal ring containing dapivirine for HIV‐1 prevention in women. N Engl J Med. 2016;375:2121–32. - PMC - PubMed
    1. Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O'Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973–83. - PMC - PubMed
    1. Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir‐based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–18. - PMC - PubMed
    1. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22. - PMC - PubMed

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