HIV Pre-exposure Prophylaxis Uptake and Continuation Among Key Populations in Cameroon: Lessons Learned From the CHAMP Program

Abstract

Introduction: Pre-exposure prophylaxis (PrEP) is proven to be a highly effective HIV prevention method for key populations. However, its scale-up in resource-limited settings remains suboptimal. This paper seeks to describe PrEP initiation and continuation among key populations in Cameroon.Methodology: From June 2019 through October 2020, we collected routine program data on PrEP uptake and continuation among female sex workers (FSWs) and men who have sex with men (MSM) in the Continuum of prevention, care and treatment of HIV/AIDS with Most-at-risk Populations (CHAMP) program in Cameroon. PrEP was offered to clients who tested negative for HIV and were assessed to potentially benefit from PrEP. Using survival analysis, we identified factors associated with PrEP discontinuation over time with significance set at 5%.Results: Overall, 27,750 clients were sensitized for PrEP of whom 3,138 persons were eligible to start PrEP and 1,409 (45%; FSW: 691 and MSM: 718) initiated PrEP. The PrEP continuation rate was 37% at 3 months, 28% at 6 months and 19% at 12 months. PrEP discontinuation was significantly higher among FSW than MSM [adjusted hazard ratio (aHR) 1.5 (95% CI: 1.2 to 1.9)] in Yaounde [aHR 1.5 (95% CI: 1.2 to 1.9)] and Bafoussam/Bertoua [aHR 3.1 (2.2-4.5)] relative to Douala. Discontinuation was lower among those with moderate [aHR 0.3 (0.3-0.4)] or good adherence [aHR 0.4 (0.3-0.6)] compared with poor adherence (all P , 0.001). Conclusion:Differentiated approaches to deliver PrEP, create demand, and provide more intensive support for adherence and continuation may support scale-up of PrEP in Cameroon for equitable and prolonged impact on HIV prevention.

Determinants of intention to use pre-exposure prophylaxis and condom use among cisgender female sex workers in Madrid, Spain

“…For each determinant, we adapted the shortest available scale with the goal of including a diverse and informative set of variables at the expense of losing some precision which might also explain, in part, the relatively low percentage of variance explained for intention to use PrEP. Finally, intention to use PrEP does not always correlate with PrEP initiation and adherence (i.e., the so-called "intention-behavior gap"); meaning that determinants identified in our study might differ from the ones associated with effective PrEP usage (Ndenkeh et al 2022;Witte et al 2022;;Sheeran and Webb 2016).…”

“…It is known that FSWs in Spain do suffer from stigma that can impact their access to PrEP services (Asociación Pro Derechos Humanos de Andalucía n.d.) with more than half of the study participants not reporting their occupation to health care providers when it would be appropriate to do so. Some additional things to consider in future studies are the impact of side-effects (not significant in the analysis, but found to be a primary reason to decline initiation or continuation of oral PrEP among FSWs in previous studies) (Amogne et al 2022;Ndenkeh et al 2022;Reza-Paul et al 2020;Sarr et al 2020), and the need for integration of family planning services within PrEP programs given the low pre-existing use of contraceptive methods other than condoms in the study cohort.…”

“…An alternative successful program took place at Ministry of Health run clinics in Senegal (82.4% uptake, 73.4% and retention at 12 months), using already stablished clinic programs for registered FSWs that include mandatory monthly check-ups and on-site education on STIs (Sarr et al 2020). On the other hand, programs with a lower impact, such as the CHAMP Program in Cameroon (45% uptake, and 5% retention at 12 months), are looking to work closely with community groups to improve awareness and knowledge of the benefits of PrEP to normalize its use as an effective means of HIV prevention (Ndenkeh et al 2022). Build-upon these past studies, our results suggest that increasing awareness about PrEP and its efficacy might be the most effective way to reinforce intention to use PrEP in FSWs from Spain at risk of HIV infection.…”

Modeling the potential impact of pre-exposure prophylaxis for HIV among men who have sex with men in Cameroon

“…Therefore, additional strategies for prevention are needed to achieve progress in addressing the HIV epidemic among MSM in Cameroon. PrEP coverage in Cameroon is currently low, since programs only began to be implemented in 2019 alongside the inclusion of PrEP in the national strategic plan for HIV[ 26 ]. Given the high risk of HIV among MSM, PrEP represents an additional intervention to be included among a suite of biological, behavioural, and structural interventions.…”

“…Scale up of PrEP initiated in early 2021 in six cities with high concentrated key populations including Bafoussam, Ngaoundéré, Kribi, Bertoua, Bamenda and Buea. Although PrEP has not yet been widely available in Cameroon, the new national HIV strategic plan has included PrEP as an intervention for HIV prevention for MSM and female sex workers [ 26 ]. Therefore, modeling the potential impact of PrEP on HIV prevalence in the two largest cities in Cameroon can help inform the level of implementation needed to achieve prevention outcomes.…”