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PrEP implementation research in Africa: what is new?

Cowan, Frances ORCID:, Delany-Moretlwe, Sinead, Sanders, Eduard J, Mugo, Nelly R, Guedou, Fernand A, Alary, Michel, Behanzin, Luc, Mugurungi, Owen and Bekker, Linda-Gail (2016) 'PrEP implementation research in Africa: what is new?'. Journal of the International AIDS Society, Vol 19, Issue Suppl 6, p. 21101.

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Of the two million new HIV infections in adults in 2014, 70% occurred in sub-Saharan Africa. Several African countries have already approved guidelines for pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV as part of combination HIV prevention but key questions remain about how to identify and deliver PrEP to those at greatest need. Throughout the continent, individuals in sero-discordant relationships, and members of key populations (sex workers, men who 15 have sex with men (MSM), transgender women and injection drug users) are likely to benefit from the availability of PrEP. In addition, adolescent girls and young women (AGYW) are at substantial risk in some parts of the continent. It has been estimated that at least three million individuals in Africa are likely to be eligible for PrEP according to WHO’s criteria. Tens of demonstration projects are planned or underway across the continent among a range of countries, populations and delivery settings.
In each of the target populations, there are overarching issues related to (i) creating demand for PrEP, (ii) addressing 20 supply-side issues and (iii) providing appropriate and tailored adherence support. Critical for creating demand for PrEP is the normalization of HIV prevention. Community-level interventions which engage opinion leaders as well as empowerment interventions for those at highest risk will be key. Critical to supply of PrEP is that services are accessible for all, including for stigmatized populations. Establishing accessible integrated services provides the opportunity to address other public health priorities including the unmet need for HIV testing, contraception and sexually transmitted infections treatment. National 25 policies need to include minimum standards for training and quality assurance for PrEP implementation and to address supply chain issues. Adherence support needs to recognize that social and structural factors are likely to have an important influence. Combining interventions that build self-efficacy, empowerment and social cohesion, with evidence-based individualized adherence support for PrEP, are most likely to be effective.
Efficacy of tenfovir-based PrEP is proven but many issues related to implementation remain unclear. Here, we have
30 summarized some of the important implementation questions that need to be assessed as PrEP is rolled out across Africa.

Item Type: Article
Uncontrolled Keywords: empowerment; key populations; HIV/AIDS; pre-exposure prophylaxis; prevention; Africa; adherence; implementation.
Subjects: WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Tina Bowers
Date Deposited: 13 Sep 2016 13:36
Last Modified: 06 Feb 2018 13:13


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