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1. Dose finding study for on-demand HIV pre-exposure prophylaxis for insertive sex in sub-Saharan Africa: results from the CHAPS open label randomised controlled trialResearch in context

Author

Carolina Herrera, Jennifer Serwanga, Laura Else, Lebina Limakatso, Daniel Opoka, Andrew S. Ssemata, Azure-Dee Pillay, Patricia Namubiru, Thabiso B. Seiphetlo, Geoffrey Odoch, Susan Mugaba, Portia Seatlholo, Amara Alieu, Sujan Dilly Penchala, Richard Muhumuza, Berenice Alinde, Stefan Petkov, Kyle O'Hagan, Christian Callebaut, Janet Seeley, Helen Weiss, Saye Khoo, Francesca Chiodi, Clive M. Gray, Pontiano Kaleebu, Emily L. Webb, Neil Martinson, Julie Fox, Nadia Ahmed, Millicent Atujuna, Esther Awino, Linda-Gail Bekker, Mike Chirenje, Janan Dietrich, Jeffrey Dorfman, Clive Gray, Christian Holm Hansen, Stefanie Hornschuh, Ayoub Kakande, Charles Kelly, Mamkiri Khunwane, Limaktso Lebina, Joseph Makhura, Nomvuyo Mangxilana, Freddie Mukasa Kibengo, Gertrude Mutonyi, Lucia Mungate, Winnie Nabukeera, Rehema Nagawa, Phiona Nalubega, Stephen Nash, Denis Ndekezi, Teacler Nematadzira, Lumka Nobula, Jim Rooney, Elzette Rousseau, Eugene Ruzagira, Alison Sango, Ntombexolo Seatlholo, Thabiso Seiphetlo, Robin Shattock, Lynda Stranix-Chibanda, Gugulethu Tshabalala, and Emily Webb

Subjects
HIV-1, Foreskin, Oral PrEP, Adolescents, PK/PD, Tissue explants, Medicine, Medicine (General), R5-920
Abstract

Summary: Background: The efficacy of on-demand HIV pre-exposure prophylaxis (PrEP) for men in sub-Saharan Africa has not been evaluated, and the on-demand PrEP dosing requirement for insertive sex remains unknown. Methods: HIV-negative males 13–24 years, requesting voluntary medical male circumcision (VMMC), were enrolled into an open-label randomised controlled trial (NCT03986970), and randomised 1:1:1:1:1:1:1:1:1 to control arm or one of eight arms receiving emtricitabine-tenofovir disoproxil fumarate (F/TDF) or emtricitabine-tenofovir alafenamide (F/TAF) over one or two days, and circumcised 5 or 21 h thereafter. The primary outcome was foreskin p24 concentrations following ex vivo HIV-1BaL challenge. Secondary outcomes included peripheral blood mononuclear cell (PBMC) p24 concentration, and drug concentrations in foreskin tissue, PBMCs, plasma and foreskin CD4+/CD4-cells. In the control arm, post-exposure prophylaxis (PEP) activity of non-formulated tenofovir-emtricitabine (TFV-FTC) or TAF-FTC was assessed with ex vivo dosing 1, 24, 48 or 72 h post-HIV-1 challenge. Findings: 144 participants were analysed. PrEP with F/TDF or F/TAF prevented ex vivo infection of foreskins and PBMCs both 5 and 21 h after PrEP dosing. There was no difference between F/TDF and F/TAF (p24day15 geometric mean ratio 1.06, 95% confidence interval: 0.65–1.74). Additional ex vivo dosing did not further increase inhibition. In the control arm, PEP ex vivo dosing was effective up to 48 post-exposure diminishing thereafter, with TAF-FTC showing prolonged protection compared to TFV-FTC. Participants receiving F/TAF had higher TFV-DP concentrations in foreskin tissue and PBMCs compared with F/TDF, irrespective of dose and sampling interval; but F/TAF did not confer preferential TFV-DP distribution into foreskin HIV target cells. FTC-TP concentrations with both drug regimens were equivalent and ∼1 log higher than TFV-DP in foreskin. Interpretation: A double dose of either F/TDF or F/TAF given once either 5 or 21 h before ex vivo HIV-challenge provided protection across foreskin tissue. Further clinical evaluation of pre-coital PrEP for insertive sex is warranted. Funding: EDCTP2, Gilead Sciences, Vetenskapsrådet.

Published
2023
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2. The potential effect of pre-exposure prophylaxis (PrEP) roll-out on sexual-risk behaviour among adolescents and young people in East and southern Africa

Author

Andrew Sentoogo Ssemata, Richard Muhumuza, Lynda Stranix-Chibanda, Teacler Nematadzira, Nadia Ahmed, Stefanie Hornschuh, Janan Janine Dietrich, Gugulethu Tshabalala, Millicent Atujuna, Denis Ndekezi, Phiona Nalubega, Esther Awino, Helen A Weiss, Julie Fox, and Janet Seeley

Subjects
Adult, Adolescent, Sexual Behavior, Public Health, Environmental and Occupational Health, HIV Infections, behaviour change, HIV prevention, pre-exposure prophylaxis, qualitative research methods, sexual behaviour, sub-Saharan Africa, General Medicine, Africa, Southern, Young Adult, Infectious Diseases, Risk-Taking, Virology, Humans, Pre-Exposure Prophylaxis
Abstract

Pre-exposure prophylaxis (PrEP) is an HIV-prevention strategy recommended for those at high-risk of infection, including adolescents and young people (AYP). We explored how PrEP roll-out could influence sexual risk behaviour among AYP in East and southern Africa. Twenty-four group discussions and 60 in-depth interviews were conducted with AYP between 13 and 24 years old, recruited from community settings in Uganda, Zimbabwe and South Africa, from September 2018 to January 2019. Participants perceived that PrEP availability could change sexual behaviour among AYP, influencing: (1) condom use (increased preference for condomless sex, reduced need and decrease in use of condoms, relief from condom use discomfort, consistent condom use to curb sexually transmitted infections and pregnancies); (2) sexual activities (increase in sexual partners and sexual encounters, early sexual debut, sexual experimentation and peace of mind during risky sex, sexual violence and perversion); (3) HIV risk perception (neglect of other HIV prevention strategies, unknown sexual partner HIV status, adoption of PrEP). PrEP initiation may be associated with increased interest in sexual activities and risky sexual behaviour among AYP. PrEP should be included as part of a combination package of HIV prevention strategies for AYP with methods to prevent other sexually transmitted infections and unwanted pregnancies.

Published
2022

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