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Background: PrEP is now recommended for high-risk persons in Africa. There are limited data on PrEP uptake in Africa outside of clinical efficacy trials. “Early adopters” can provide insights for program strengthening. We report on early PrEP adopters in SEARCH (NCT01864603), an ongoing population-based combination prevention study of 320,000 persons in rural Uganda and Kenya.
Methods: Following mobilization and community education, 2 groups were offered PrEP: i)HIV-uninfected adults at high risk (R) based an HIV risk score that maximized observed seroconversion coverage under a minimized number of persons needed to treat and ii)those who perceived themselves at risk (S) including being in serodiscordant relationship. “Early adopters” were defined as those who started PrEP within 30 days of being offered. To estimate predictor coefficients for early PrEP uptake, we used generalized linear models with binomial distribution.
Results: Of 24,709 HIV-uninfected individuals in six communities, 4622 were identified for PrEP; 2995 based on risk score(Rs) and 1627 as self-referrals(Ss). 2374(51%) scheduled an appointment with 946(20%) initiating PrEP; 916(97%) of these were “early adopters” with a vast majority 712(78%) starting PrEP on the same day. “Early adopters” tended to be Ss (64%), women (52%) and married (68%). Youth accounted for only 29% of “early adopters.” Predictors of PrEP uptake among Rs were older age (ref: 18-25, age 36-45 OR 1.6, 95% CI 1.0-2.5, age 46-55 OR 2.1,95%CI 1.2-3.9), polygamy (OR 1.9,95%CI 1.3-2.7), serodiscordant spouse (OR 4.3,95%CI 1.6-11.5), no history of recent migration (ref: 0 months, 1-6 months OR 0.6, 95% CI 0.4-1.0 >6months OR 0.3, 95%CI 0.2-0.7), perceived current risk of HIV (OR 2.2, 95%CI 1.8-2.8). Among Ss, predictors were gender (male vs female OR 0.7,95%CI 0.6-0.9), age >=26(ref: 18-25, age 26-35 OR 1.4,95%CI 1.1-1.9, age 36-45 OR 1.8,95%CI 1.4-2.5, age 46-55 OR 2.4,95%CI 1.7-3.4, age>55 OR 2.0 95%CI 1.3-3.2) and a serodiscordant spouse (OR 2.5, 95%CI 1.0-6.1).
Conclusions: Among the 916 PrEP “early adopters”, most started the same day as offered, two-thirds were married and perceived themselves as high-risk. Low participation among certain crucial groups such as youth (18-25 years) emphasizes the need for more effective mobilization.