Assessment of PrEP eligibility and uptake among at-risk MSM participating in a HIV-1 vaccine feasibility cohort in coastal Kenya
Year: 2019
Type: article
Abstract: Introduction Pre-exposure prophylaxis (PrEP) is provided free of costs to a broad range of at-risk populations in Kenya, including men who have sex with men (MSM), but anal intercourse is not an eligibility criterion. We set out to determine PrEP eligibility, uptake and predictors of PrEP uptake among MSM enrolled in an HIV-1 vaccine feasibility cohort in coastal Kenya. Methods We compared the number of MSM identified as eligible for PrEP from June - December 2017 by Kenyan Ministry of Health (MoH) criteria, which do not include reported anal intercourse, to those identified as eligible by a published MSM cohort-derived HIV-1 risk score (CDHRS). We determined PrEP uptake and assessed factors associated with PrEP uptake at first offer among eligible MSM followed up monthly for HIV-1 testing, risk assessment, and risk reduction counselling. Results Out of 167 MSM assessed for PrEP eligibility, 118 (70.7%) were identified by both MoH and CDHRS eligibility criteria. However, the CDHRS identified 33 (19.8%) more cohort MSM for PrEP eligibility than the MoH criteria, of whom the majority (24 or 72.7%) reported receptive anal intercourse (RAI). Of the 162 MSM eligible for PrEP, 113 (69.7%) accepted PrEP at first offer. Acceptance of PrEP was higher for men reporting RAI (adjusted prevalence ratio [aPR], 1.4; 95% confidence interval [CI], 1.0–1.9), having paid for sex (aPR, 1.3; 95% CI, 1.1–1.6) and group sex (aPR, 1.4; 95% CI, 1.1–1.8), after adjustment for sociodemographic factors. Conclusions Assessing PrEP eligibility using a CDHRS identified 20% more at-risk MSM for PrEP initiation than when Kenyan MoH criteria were used. Approximately 70% of eligible men accepted PrEP at first offer, suggesting that PrEP is acceptable among at-risk MSM. MSM reporting RAI, group sex, or paying for sex were more likely to accept PrEP, reinforcing the importance of an informed discussion of HIV-1 risk during PrEP counselling.
Source: Wellcome Open Research
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,128
Funders: United States Agency for International Development, International AIDS Vaccine Initiative, Fred Hutchinson Cancer Research Center, University of Washington, Starr Foundation, Wellcome Trust, Government of the United Kingdom, Department for International Development, UK Government, Department for International Development, New Partnership for Africa's Development, African Academy of Sciences, National Institutes of Health, Center for AIDS Research, University of Washington, University of California, San Francisco, Alliance for Accelerating Excellence in Science in Africa, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Complementary and Alternative Medicine
Awards: G1323885547, G1382257660, G2003180161, G2219438539, G2415674080, G3000957577, Impact of a novel screening program to detect acute and prevalent HIV infection and reduce HIV transmission, G3407947818, G3985073149, G4083274430, G4156438909, G4160532866, International Traineeships in AIDS Prevention Studies (ITAPS), G4847806209, Kenya KWTRP Major Overseas Programme, G5353592002, Sub-Saharan African Network for TB/HIV research Excellence (SANTHE), G5901762629, G6277005470, G6590892262, G6617178558, G6802846633, G6868616705, G6886766237, G704771751, G7238354678, G726642961, G7791962275, G7889379128, Core Support for the East African Major Overseas Programme, G8119020889, G8183321107, G8445079486, G8488937646, G9000186388, University of Washington/Fred Hutch Center for AIDS Research, Sub-Saharan African Network for TB/HIV research Excellence (SANTHE)
OpenAlex ID: W2973313131