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. 2023 Sep 1;50(9):559-566.
doi: 10.1097/OLQ.0000000000001841. Epub 2023 Jun 6.

Determinants of Preexposure Prophylaxis Cascade Among Sexual and Gender Minorities in Nigeria

Habib Omari Ramadhani, Trevor A Crowell, Rebecca G Nowak  1 , Sylvia Adebajo  2 , Blessing O Kayode  3 , Uchenna Ononaku  3 , Stefan D Baral  4 , Nicaise Ndembi, Man E Charurat; TRUST/RV368 Study Group
Collaborators, Affiliations

Determinants of Preexposure Prophylaxis Cascade Among Sexual and Gender Minorities in Nigeria

Habib Omari Ramadhani et al. Sex Transm Dis. .

Abstract

Background: Preexposure prophylaxis (PrEP) is effective in preventing human immunodeficiency virus (HIV) infection among sexual and gender minorities (SGMs). We evaluated the characteristics associated with engagement in 7 steps of the PrEP cascade among SGMs in Nigeria.

Methods: Sexual and gender minorities without HIV from the Abuja site of TRUST/RV368 cohort who were surveyed on awareness of and willingness to use PrEP were approached for PrEP initiation upon availability of oral daily PrEP. To understand gaps in the uptake of oral daily PrEP, we categorized the HIV PrEP cascade as (i) education about PrEP, (ii) interest in PrEP, (iii) successful contact, (iv) appointment scheduled, (v) appointment attendance, (vi) PrEP initiation, and (vii) plasma protective levels of tenofovir disoproxil fumarate. Multivariable logistic regression models were used to determine factors associated with each of the 7 steps in the HIV PrEP cascade.

Results: Of 788 participants, 718 (91.1%) showed interest in taking oral daily PrEP every day and/or after a sexual act, 542 (68.8%) were successfully contacted, 433 (54.9%) scheduled an appointment, 409 (51.9%) attended a scheduled appointment, 400 (50.8%) initiated oral daily PrEP, and 59 (7.4%) had protective levels of tenofovir disoproxil fumarate. Of initiators of PrEP, 23 (5.8%) seroconverted at a rate of 13.9 cases/100 person-years. Better social support, larger network density, and higher education were associated with engagement in 4 to 5 components of the cascade.

Conclusions: Our data highlight a gap between willingness and actual PrEP use. Despite PrEP's effectiveness in preventing HIV, the optimal impact of PrEP for SGMs in sub-Saharan Africa will require multifaceted approaches that combine social support, education, and destigmatization.

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Conflict of interest statement

Conflict of Interest and Sources of Funding: The authors declare no conflict of interest. This work was supported by cooperative agreements between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, and the US Department of Defense (W81XWH-11-2-0174, W81XWH-18-2-0040); the National Institutes of Health (R01 MH099001, R01 AI120913, R01 MH110358); the Fogarty Epidemiology Research Training for Public Health Impact in Nigeria program (D43TW010051); and the President's Emergency Plan for AIDS Relief through a cooperative agreement between the Department of Health and Human Services/Centers for Disease Control and Prevention, Global AIDS Program, and the Institute for Human Virology—Nigeria (NU2GGH002099), and Gilead Sciences, Inc (ISR IN-EU-276-4468).

Figures

Figure 1:
Figure 1:
PrEP Cascade among Nigerian MSM and TGW
See this image and copyright information in PMC

References

    1. Nowak RG, Mitchell A, Crowell TA, et al. Individual and Sexual Network Predictors of HIV Incidence Among Men Who Have Sex With Men in Nigeria. J Acquir Immune Defic Syndr. Apr 1 2019;80(4):444–453. - PMC - PubMed
    1. https://www.hrw.org/report/2016/10/20/tell-me-where-i-can-be-safe/impact... .
    1. Ramadhani HO, Ndembi N, Nowak RG, et al. Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services. J Acquir Immune Defic Syndr. Sep 1 2018;79(1):e7–e16. - PMC - PubMed
    1. Keshinro B, Crowell TA, Nowak RG, et al. High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria. J Int AIDS Soc. 2016;19(1):21270. - PMC - PubMed
    1. Ramadhani HO, Liu H, Nowak RG, et al. Sexual partner characteristics and incident rectal Neisseria gonorrhoeae and Chlamydia trachomatis infections among gay men and other men who have sex with men (MSM): a prospective cohort in Abuja and Lagos, Nigeria. Sex Transm Infect. Aug 2017;93(5):348–355. - PMC - PubMed

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