SEARCH Study Evaluates Population-Level PrEP Uptake

The Sustainable East Africa Research in Community Health (SEARCH) study is an ongoing trial assessing evidence-based interventions that lead to the elimination of HIV in rural communities in select areas of East Africa. The second phase of the study, which will be completed in July 2020, is evaluating the impact of targeted pre-exposure prophylaxis (PrEP), targeted HIV testing, and targeted care interventions for universal treatment and streamlined care.

The study is being led by investigators from the University of California, San Francisco, who report that optimal PrEP delivery approaches are needed in the African region. In a presentation at the 10^th IAS Conference on HIV Science (IAS 2019), study investigators presented a poster on population-level PrEP uptake and engagement following near-universal HIV testing in rural Kenya and Uganda.

As part of the investigation, the research team initiated community-level PrEP outreach and education. Following the implementation, the team conducted home-based testing and offered PrEP to individuals who were at a higher risk (as determined by a self-assessment, seroconversion risk score, or serodiscordance). To determine effectiveness, the study team evaluated PrEP uptake within 90 days of HIV testing. More specifically, the team assessed program engagement, medication refills, and self-reported 3-day adherence over 72 weeks among the individuals who initiated PrEP.

According to the study abstract, among 71,825 HIV-uninfected residents in 16 communities, 3488 (4.9%) began a PrEP regimen. Uptake among higher-risk young women between 15-24 years was 17%, 21% among young women using contraception, 21% among men between 15-24 years, 38% among discordant partners, 23% among fishing/bar/transport workers, 16% among mobile persons, and 36% among men over 45 years of age.

The team found that among the 3488 individuals who started taking PrEP, 82% started the regimen the same day—50% were women, and 28% were between the ages of 15-24 years. At weeks 4, 24, and 72 following initiation, program engagement was 64%, 56%, 55%, respectively.

More specifically, the investigators report that “at week 24 engagement, refill, and adherence were higher among discordant partners (70%/56%/48%) and fishing/bar/transport workers (73%/43%/35%) than young women (54%/22%/17%), young men (42%/19%/13%), and mobile persons (31%/20%/18%).”

The abstract also notes that HIV testing was performed at 3962 of the 5099 (78%) visits where participants had discontinued PrEP. Among patients who discontinued the regimen, self-reported barriers to use included daily adherence, the presence of side effects, and non-supportive partners and travel.

The results of the study indicate that through a population-based approach, the investigators were able to initiate PrEP in more than 3000 individuals; however, engagement and adherence were suboptimal overall, with only half of the participants remaining on the regimen at week 4.

“Strategies to increase engagement and adherence are needed, particularly for youth and mobile populations, to maximize the benefits of PrEP,” the investigators concluded.

The study, “PrEP uptake, engagement, and adherence following population-wide HIV testing in rural Kenya and Uganda in the SEARCH study,” was presented on Monday, July 22, 2019, at IAS 2019 in Mexico City, Mexico.