Incorporating oral PrEP into standard prevention services for South African women: a nested interrupted time-series study

作者：Deborah Donnell, Ivana Beesham, Julia D Welch, Renee Heffron, Melanie Pleaner, Lara Kidoguchi, Thesla Palanee‐Phillips, Khatija Ahmed, Deborah Baron, Elizabeth A. Bukusi, Cheryl Louw, Timothy D. Mastro, Jennifer Smit, Joanne Batting, Mookho Malahleha, Veronique Bailey, Mags Beksinska, Helen Rees, Jared M. Baeten, Peter Gichangi, Kate B. Heller, Nomthandazo Mbandazayo, Charles Morrison, Kavita Nanda, Caitlin W. Scoville, Kathleen Shears, Petrus S. Steyn, Douglas Taylor, Katherine K. Thomas, James Kiarie, Jessica Justman, Zelda Nhlabatsi, Linda‐Gail Bekker, Gonasagrie Nair, G Justus Hofmeyr, Mandisa Singata‐Madliki, Raesibe Agnes Pearl Selepe, Sydney Sibiya, Margaret P. Kasaro, Jeffrey S. A. Stringer, Nelly Mugo · 发表于：The Lancet HIV · 年份：2021 · DOI：10.1016/s2352-3018(21)00048-5 · 被引用次数：32 · 研究领域：HIV/AIDS Research and Interventions、Reproductive tract infections research、Adolescent Sexual and Reproductive Health

BACKGROUND: As oral pre-exposure prophylaxis (PrEP) becomes the standard of prevention globally, its potential effect on HIV incidence in clinical trials of new prevention interventions is unknown, particularly for trials among women. In a trial measuring HIV incidence in African women, oral PrEP was incorporated into the standard of prevention in the trial's last year. We assessed the effect of on-site access to PrEP on HIV incidence in this natural experiment. METHODS: We did a nested interrupted time-series study using data from the ECHO trial. At 12 sites in four countries (Eswatini, Kenya, South Africa, and Zambia), women (aged 16-35 years) were randomly assigned to receive one of three contraceptives between Dec 14, 2015, and Sept 12, 2017, and followed up quarterly for up to 18 months to determine the effect of contraceptive method on HIV acquisition. Women were eligible if they wanted long-acting contraception, were medically qualified to receive study contraceptives, and had not used any of the study contraceptives in the past 6 months. The present analyses are limited to nine South African sites where on-site access to oral PrEP was implemented between March 13 and June 12, 2018. Using an interrupted time-series design, we compared HIV incidence before versus after PrEP access, limited to quarterly study visits at which on-site PrEP access was available to at least some participants and, in a sensitivity analysis, to the 180 days before and after access. The outcome...