Integrated Delivery of Antiretroviral Treatment and Pre-exposure Prophylaxis to HIV-1–Serodiscordant Couples: A Prospective Implementation Study in Kenya and Uganda
Publication Date
August 23, 2016
Journal
PLOS Medicine
Authors
Jared M. Baeten, Renee Heffron, Lara Kidoguchi, Nelly R. Mugo, et al
Volume
13
Issue
8
Pages
e1002099
DOI
https://dx.plos.org/10.1371/journal.pmed.1002099
Publisher URL
http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1002099
Web of Science
000383357400017
Scopus
84988980974
Mendeley
http://www.mendeley.com/research/integrated-delivery-antiretroviral-treatment-preexposure-prophylaxis-hiv1serodiscordant-couples-pros
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{"title"=>"Integrated Delivery of Antiretroviral Treatment and Pre-exposure Prophylaxis to HIV-1–Serodiscordant Couples: A Prospective Implementation Study in Kenya and Uganda", "type"=>"journal", "authors"=>[{"first_name"=>"Jared M.", "last_name"=>"Baeten", "scopus_author_id"=>"7003812564"}, {"first_name"=>"Renee", "last_name"=>"Heffron", "scopus_author_id"=>"35320040100"}, {"first_name"=>"Lara", "last_name"=>"Kidoguchi", "scopus_author_id"=>"15044580700"}, {"first_name"=>"Nelly R.", "last_name"=>"Mugo", "scopus_author_id"=>"8660196500"}, {"first_name"=>"Elly", "last_name"=>"Katabira", "scopus_author_id"=>"6701499800"}, {"first_name"=>"Elizabeth A.", "last_name"=>"Bukusi", "scopus_author_id"=>"6507523123"}, {"first_name"=>"Stephen", "last_name"=>"Asiimwe", "scopus_author_id"=>"8413281900"}, {"first_name"=>"Jessica E.", "last_name"=>"Haberer", "scopus_author_id"=>"7101804832"}, {"first_name"=>"Jennifer", "last_name"=>"Morton", "scopus_author_id"=>"56747159400"}, {"first_name"=>"Kenneth", "last_name"=>"Ngure", "scopus_author_id"=>"23493080300"}, {"first_name"=>"Nulu", "last_name"=>"Bulya", "scopus_author_id"=>"56743289600"}, {"first_name"=>"Josephine", "last_name"=>"Odoyo", "scopus_author_id"=>"48662625000"}, {"first_name"=>"Edna", "last_name"=>"Tindimwebwa", "scopus_author_id"=>"57118332600"}, {"first_name"=>"Craig", "last_name"=>"Hendrix", "scopus_author_id"=>"7101661990"}, {"first_name"=>"Mark A.", "last_name"=>"Marzinke", "scopus_author_id"=>"25823249700"}, {"first_name"=>"Norma C.", "last_name"=>"Ware", "scopus_author_id"=>"7004902553"}, {"first_name"=>"Monique A.", "last_name"=>"Wyatt", "scopus_author_id"=>"8614184700"}, {"first_name"=>"Susan", "last_name"=>"Morrison", "scopus_author_id"=>"35748926300"}, {"first_name"=>"Harald", "last_name"=>"Haugen", "scopus_author_id"=>"57196869134"}, {"first_name"=>"Andrew", "last_name"=>"Mujugira", "scopus_author_id"=>"9043425200"}, {"first_name"=>"Deborah", "last_name"=>"Donnell", "scopus_author_id"=>"57201600005"}, {"first_name"=>"Connie", "last_name"=>"Celum", "scopus_author_id"=>"7003477042"}], "year"=>2016, "source"=>"PLoS Medicine", "identifiers"=>{"sgr"=>"84988980974", "doi"=>"10.1371/journal.pmed.1002099", "pui"=>"612441817", "pmid"=>"27552090", "scopus"=>"2-s2.0-84988980974", "issn"=>"15491676", "isbn"=>"1549-1277"}, "id"=>"8c010f28-147e-3256-a765-3c8b80ec7afa", "abstract"=>"BACKGROUND Antiretroviral-based interventions for HIV-1 prevention, including antiretroviral therapy (ART) to reduce the infectiousness of HIV-1 infected persons and pre-exposure prophylaxis (PrEP) to reduce the susceptibility of HIV-1 uninfected persons, showed high efficacy for HIV-1 protection in randomized clinical trials. We conducted a prospective implementation study to understand the feasibility and effectiveness of these interventions in delivery settings. METHODS AND FINDINGS Between November 5, 2012, and January 5, 2015, we enrolled and followed 1,013 heterosexual HIV-1-serodiscordant couples in Kenya and Uganda in a prospective implementation study. ART and PrEP were offered through a pragmatic strategy, with ART promoted for all couples and PrEP offered until 6 mo after ART initiation by the HIV-1 infected partner, permitting time to achieve virologic suppression. One thousand thirteen couples were enrolled, 78% of partnerships initiated ART, and 97% used PrEP, during a median follow-up of 0.9 years. Objective measures of adherence to both prevention strategies demonstrated high use (≥85%). Given the low HIV-1 incidence observed in the study, an additional analysis was added to compare observed incidence to incidence estimated under a simulated counterfactual model constructed using data from a prior prospective study of HIV-1-serodiscordant couples. Counterfactual simulations predicted 39.7 HIV-1 infections would be expected in the population at an incidence of 5.2 per 100 person-years (95% CI 3.7-6.9). However, only two incident HIV-1 infections were observed, at an incidence of 0.2 per 100 person-years (95% CI 0.0-0.9, p < 0.0001 versus predicted). The use of a non-concurrent comparison of HIV-1 incidence is a potential limitation of this approach; however, it would not have been ethical to enroll a contemporaneous population not provided access to ART and PrEP. CONCLUSIONS Integrated delivery of time-limited PrEP until sustained ART use in African HIV-1-serodiscordant couples was feasible, demonstrated high uptake and adherence, and resulted in near elimination of HIV-1 transmission, with an observed HIV incidence of <0.5% per year compared to an expected incidence of >5% per year.", "link"=>"http://www.mendeley.com/research/integrated-delivery-antiretroviral-treatment-preexposure-prophylaxis-hiv1serodiscordant-couples-pros", "reader_count"=>51, "reader_count_by_academic_status"=>{"Unspecified"=>5, "Researcher"=>15, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>3, "Student > Master"=>11, "Other"=>2, "Student > Bachelor"=>5, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>5, "Researcher"=>15, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>3, "Student > Master"=>11, "Other"=>2, "Student > Bachelor"=>5, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>8, "Nursing and Health Professions"=>4, "Mathematics"=>2, "Medicine and Dentistry"=>24, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Psychology"=>1, "Social Sciences"=>5, "Computer Science"=>1, "Immunology and Microbiology"=>2, "Economics, Econometrics and Finance"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>24}, "Social Sciences"=>{"Social Sciences"=>5}, "Psychology"=>{"Psychology"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>4}, "Mathematics"=>{"Mathematics"=>2}, "Unspecified"=>{"Unspecified"=>8}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}}, "reader_count_by_country"=>{"Brazil"=>1}, "group_count"=>13}

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Scopus | Further Information

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