Community-Based Pre-Exposure Prophylaxis Implementation in Rural KwaZulu-Natal: A Feasibility Study

Abstract

Young women in sub-saharan Africa bear a disproportionate burden of disease when it relates to HIV transmission. Strategies to combat HIV transmission are needed to combat disease transmission. Pre-exposure prophylaxis has been found to be an effective medication for the prevention of HIV acquisition amongst cohorts at substantial risk for HIV transmission. However, it has failed to achieve substantial reductions in HIV incidence in young women in sub-Saharan Africa. Nonetheless, there is great interest in learning how it might play an integral part as a key component of a multi-dimensional sexual health promotion package. The STAR study recruited individuals from the community in rural KwaZulu-Natal South Africa through mobile or free-standing sexual health clinics. PrEP was available to men and women between the ages of 18 and 30. We found a high proportion, 83% (217/260), of individuals presenting to clinic adopting PrEP. Ever having condomless sex and ever having received an HIV result were positively associated with PrEP uptake while female gender and any symptoms of a sexually transmitted infection were negatively correlated with uptake of PrEP. These findings demonstrate that some of those at most risk for HIV acquisition appear to be more inclined to uptake PrEP. Nonetheless, we also found that a key population in South Africa (i.e. women) might require additional opportunities to optimize HIV prevention efforts in this setting. Indeed, the gender differences in adoption of PrEP we identified indicate the need for further study regarding barriers to PrEP adoption amongst young women, perhaps the most vulnerable population as it relates to HIV transmission in Sub-Saharan Africa.