HIV prevalence and incidence in a cohort of South African men and transgender women who have sex with men: the Sibanye Methods for Prevention Packages Programme (MP3) project

Abstract

Introduction: Men who have sex with men (MSM) and transgender women (TGW) are at increased risk for acquiring HIV, but there are limited HIV incidence data for these key populations in Africa. Understanding HIV prevalence and incidence provides important context for designing HIV prevention strategies, including pre-exposure prophylaxis (PrEP) programmes. We describe HIV prevalence, awareness of HIV infection, HIV incidence and associated factors for a cohort of MSM and TGW in Cape Town and Port Elizabeth, South Africa. Methods: From 2015 to 2016, MSM and TGW in Cape Town and Port Elizabeth were enrolled and prospectively followed for 12 months, receiving a comprehensive package of HIV prevention services. HIV testing was conducted at baseline and at follow-up visits (targeted for three, six and twelve months). All HIV-negative PrEP-eligible participants were offered PrEP enrolment during the first four months of study participation. We determined HIV prevalence among participants at baseline, and incidence by repeat screening of initially HIV-negative participants with HIV tests at three, six and twelve months. Results: Among 292 participants enrolled, HIV prevalence was high (43%; 95% CI: 38 to 49) and awareness of HIV status was low (50%). The 167 HIV-negative participants who were followed prospectively for 144.7 person-years; nine incident HIV infections were documented. Overall annual incidence was 6.2% (CI: 2.8 to 11.8) and did not differ by city. Annual HIV incidence was significantly higher for younger (18 to 19 years) MSM and TGW (MSM: 21.8% (CI: 1.2 to 100); TGW: 31.0 (CI: 3.7, 111.2)). About half of participants started PrEP during the study; the annual incidence of HIV among 82 (49%) PrEP starters was 3.6% (CI: 0.4, 13.1) and among those who did not start PrEP was 7.8% (CI: 3.1, 16.1). Conclusions: HIV incidence was high among MSM and TGW in the context of receiving a comprehensive package of prevention interventions and offering of PrEP. PrEP uptake was high; the observed incidence of HIV in those who started PrEP was about half the incidence of HIV in those who did not. Future implementation-oriented studies should focus on decisions to start and continue PrEP for those at highest risk, including young MSM.

“I wish to remain HIV negative”: Pre-exposure prophylaxis adherence and persistence in transgender women and men who have sex with men in coastal Kenya

“…HIV-1 incidence among TGW in sub-Saharan Africa is probably several fold higher than among MSM. Our initial estimate of 20.6 per 100 person years in a small cohort study of TGW in coastal Kenya [ 11 ] is now supported by incidence estimates among TGW in Nigeria (23.8 per 100 person years) [ 24 ] and in South Africa (31.0 per 100 person years) [ 6 ]. As protective drug concentrations among TGW taking PrEP were significantly higher than among MSM taking PrEP participants, our findings hold promise for PrEP programmes targeting TGW in the region.…”

“…While PrEP efficacy has been proven also in sub Saharan Africa (SSA) [ 5 ], it is unknown what motivates the uptake and adherence to PrEP among MSM and transgender women (TGW) in Kenya. In a study in South Africa in 2015, among 167 MSM and TGW, approximately half of the participants started PrEP, but this study did not collect adherence data or laboratory markers of protection [ 6 ]. In a recent study in coastal Kenya among 170 MSM eligible for PrEP, 140 (82%) started it and 64 (58%) reported PrEP use at the end of study [ 7 ].…”

Healthcare worker training to improve quality of care for sexual and gender minority people in sub‐Saharan Africa: learning from efforts in Uganda

“…SGM health training is critical for providers who deliver sexual health and HIV medical services, including in sub‐Saharan Africa. HIV incidence and prevalence remain exceptionally high among SGM populations in sub‐Saharan African countries [7‐9]. SGM communities in the region encounter significant psychosocial and structural barriers to engagement in sexual health services, and HIV prevention and treatment [10‐12].…”

Involvement of African men and transgender women who have sex with men in HIV research: progress, but much more must be done

“…Sullivan et al . [29] describe a high prevalence of HIV in the study population with only half of those living with HIV aware of their status. HIV incidence during longitudinal follow‐up was 6.3 cases per 100 person‐years, and even higher among TGW (31.0 cases per 100 person‐years) and MSM aged 18 to 19 years (21.8 cases per 100 person‐years).…”