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Early antiretroviral therapy and daily pre‐exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: a prospective observational demonstration study

2018; International AIDS Society; Volume: 21; Issue: 11 Linguagem: Inglês

10.1002/jia2.25208

1758-2652

Aminata Mboup, Luc Béhanzin, Fernand Guédou, Nassirou Geraldo, Ella Goma‐Matsétsé, Katia Giguère, Marlène Aza‐Gnandji, Léon Kessou, Mamadou Diallo, René K. Kèkè, Moussa Bachabi, Dramane Kania, Lily Geidelberg, Fiona Cianci, Christian Lafrance, Dissou Affolabi, Souleymane Diabaté, Marie‐Pierre Gagnon, Djimon Marcel Zannou, Flore Gangbo, Marie‐Claude Boily, Peter Vickerman, Michel Alary,

HIV, Drug Use, Sexual Risk

Abstract Introduction 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