Recent Alcohol Use Is Associated With Increased Pre-exposure Prophylaxis (PrEP) Continuation and Adherence Among Pregnant and Postpartum Women in South Africa

Miller, Amanda P.; Shoptaw, Steven; Moucheraud, Corrina; Mvududu, Rufaro; Essack, Zaynab; Gorbach, Pamina M.; Myer, Landon; Davey, D. A.

doi:10.1097/qai.0000000000003133

Cited by 5 publications

(4 citation statements)

References 49 publications

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“…An illustrative example comes from a South African study involving pregnant and post-partum women where 1 in 3 women reported hazardous alcohol use. At 3 months, 58% of women were reportedly still using PrEP and alcohol use correlated with higher odds of PrEP continuation (aOR 1.54, 95% CI 1.16-2.06) [40]. In our study, while there was a higher inclination towards initiating PrEP among the high-risk alcohol group, continuation rates remained largely uniform irrespective of alcohol use.…”

Section: Discussionmentioning

confidence: 52%

“…Two prospective studies, including one in Uganda and Kenya among serodiscordant couples, observed a decrease in PrEP adherence and continuation with hazardous alcohol use [37, 38]. In contrast, recent studies indicate that those reporting alcohol consumption often show better adherence, supported by biomarkers confirming medication compliance [39, 40]. An illustrative example comes from a South African study involving pregnant and post-partum women where 1 in 3 women reported hazardous alcohol use.…”

Section: Discussionmentioning

confidence: 99%

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Alcohol use and the pre-exposure prophylaxis continuum of care among men in rural South Africa

Castle,

Busang,

Dreyer

et al. 2024

Preprint

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Introduction Despite freely available HIV pre-exposure prophylaxis (PrEP), HIV incidence among young men in South Africa is high. There is conflicting evidence around the association between alcohol use behaviors and PrEP utilization. We explore the impact of alcohol use on PrEP initiation and continuation among South African men. Methods We performed a secondary analysis of data from a trial that included men aged 16-29 randomly selected from a demographic surveillance site in KwaZulu-Natal. All participants were referred to HIV and sexual health services, where those who were HIV negative and sexually active were offered oral PrEP. Alcohol consumption was assessed at monthly visits and categorized as: non-drinking (0), low/moderate risk drinking (1-5), and high/very high-risk drinking (6-12) based on AUDIT-C criteria. Primary outcomes were PrEP initiation and PrEP continuation defined as refilling prescriptions for >3 months. We fitted logistic regression models, adjusted for potential clinical and demographic confounders, to estimate relationships between PrEP initiation/continuation and reported alcohol use. Results Of the 325 men in the analytic cohort, the average age was 22.9 years (SD 3.6) and 131 (40%) had high/very high-risk alcohol consumption (AUDIT-C score ≥6). Men with the highest risk alcohol use also reported more frequent condomless sex (89%, vs 68% in no alcohol group). We found the greatest uptake of PrEP among the high/very high-risk alcohol group (46/131, 35%), followed by the low/moderate-risk group (17/53, 32%) and the no alcohol group (25/141, 18%). Those with high-risk alcohol use remained more likely to initiate PrEP compared to the no alcohol group in multivariable models adjusted for confounders (aOR 2.44 95% CI 1.29-4.60; p-value 0.006). Overall, only 30% (26/88) of men remained on PrEP at 3 months. Men with high/very high-risk drinking had similar PrEP continuation at 3 months compared to men who reported no alcohol use (aOR 1.02 95% CI: 0.28-3.86, p=0.98). Conclusions High-risk alcohol use is common among men in rural South Africa and associated with increased PrEP initiation. However, PrEP continuation was low overall, and similar across all levels of alcohol use. Hazardous alcohol use should not discourage PrEP implementation efforts to engage and retain young men.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Alcohol use and the pre-exposure prophylaxis continuum of care among men in rural South Africa

Castle,

Busang,

Dreyer

et al. 2024

Preprint

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“…We also observed higher adherence with alcohol use and lower income; generally, in the literature, women with competing demands (e.g., lower income, alcohol use [50,51]) struggle with adherence. Perhaps in this context, women faced other challenges that encouraged them to engage in their HIV prevention strategy; this positive association with alcohol use was also observed among pregnant women accessing PrEP in Cape Town [52] and men accessing PrEP in rural KwaZulu-Natal [53], suggesting that alcohol use should not be a contra-indication to PrEP care. In a nested qualitative substudy, women in our cohort described challenges getting to study visits (including for refills), succeeded when they were able to disclose PrEP use to a supporter, and made decisions about PrEP use based on sexual activity [24].…”

Section: Discussionmentioning

confidence: 99%

Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa

Matthews,

Jaggernath,

Kriel

et al. 2024

Aids

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Objective: We developed the Healthy Families-PrEP intervention to support HIV-prevention during periconception and pregnancy. We evaluated preexposure prophylaxis (PrEP) use with three objective measures. Design: This single-arm intervention study enrolled women in KwaZulu-Natal, South Africa, who were HIV-uninfected, not pregnant, in a relationship with a partner with HIV or unknown-serostatus, and with pregnancy plans. PrEP was offered as part of a comprehensive HIV prevention intervention. Participants were followed for 12#$##x0200A;months. Methods: We evaluated periconception PrEP uptake and adherence using quarterly plasma tenofovir concentrations. We modeled factors associated with PrEP uptake and high plasma tenofovir (past day dosing). Patterns of use were analyzed using electronic pillcap data. Dried blood spots to measure intracellular tenofovir product (past 2#$##x0200A;months dosing) were analyzed for a subset of women. Results: Three hundred thirty women with median age 24 (IQR: 22#$#ndash;27) years enrolled. Partner HIV-serostatus was unknown by 96% (N#$##x0200A;#$#equals;#$##x0200A;316); 60% (195) initiated PrEP. High plasma tenofovir concentrations were seen in 35, 25, 22, and 20% of samples at 3, 6, 9, and 12#$##x0200A;months, respectively. Similar adherence was measured by pillcap and dried blood spots. In adjusted models, lower income, alcohol use, and higher HIV stigma were associated with high plasma tenofovir. Eleven HIV-seroconversions were observed (incidence rate: 4.04/100 person-years [95% confidence interval: 2.24#$#ndash;7.30]). None had detectable plasma tenofovir. Conclusion: The Healthy Families-PrEP intervention supported women in PrEP use. We observed high interest in periconception PrEP and over one-third adhered to PrEP in the first quarter; one-fifth were adherent over a year. High HIV incidence highlights the importance of strategies to reduce HIV incidence among periconception women. Clinical Trial Number: NCT03194308

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“…At baseline, the participants were asked with regard to the number of sexual activity, condom use during the last sex, number of sexual partners in the past 12 months, HIV status of the partner in the past 12 months, intimate partner violence (IPV) in the past 12 months (WHO IPV scale) ( 25 ), and alcohol use in the past 12 months and before finding out about their pregnancy using the AUDIT-C ( 26 ). Alcohol use was defined as reporting any alcohol use or by a cutoff of AUDIT-C score of ≥3, which was used in our previous study to identify hazardous alcohol use among pregnant women in South Africa ( 20 ). We also reported pregnancy status at 1, 3, and 6 months and HIV risk perception and number of sex acts at 3 and 6 months.…”

Section: Methodsmentioning

confidence: 99%

Evaluating the use of oral pre-exposure prophylaxis among pregnant and postpartum adolescent girls and young women in Cape Town, South Africa

Khadka,

Gorbach,

Nyemba

et al. 2023

Front. Reprod. Health

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BackgroundAdolescent girls and young women (AGYW) in South Africa are at a higher risk of acquiring HIV. Despite the increasing availability of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention, knowledge on PrEP use during pregnancy and postpartum periods at antenatal care (ANC) facilities remains inadequate.MethodsData from HIV-uninfected pregnant women in Cape Town, South Africa, were used in this study. These women aged 16–24 years were enrolled in the PrEP in pregnancy and postpartum (PrEP-PP) cohort study during their first ANC visit. Using the PrEP cascade framework, the outcomes of the study were PrEP initiation (prescribed tenofovir disoproxil fumarate and emtricitabine at baseline), continuation (returned for prescription), and persistence [quantifiable tenofovir diphosphate (TFV-DP) in dried blood samples]. The two primary exposures of this study were risk perception for HIV and baseline HIV risk score (0–5), which comprised condomless sex, more than one sexual partner, partner living with HIV or with unknown serostatus, laboratory-confirmed sexually transmitted infections (STIs), and hazardous alcohol use before pregnancy (Alcohol Use Disorders Identification Test for Consumption score ≥ 3). Logistic regression was used to examine the association between HIV risk and PrEP, adjusting for a priori confounders.ResultsA total of 486 pregnant women were included in the study, of which 16% were “adolescents” (aged 16–18 years) and 84% were “young women” (aged 19–24 years). The adolescents initiated ANC later than the young women [median = 28 weeks (20–34) vs. 23 weeks (16–34), p = 0.04]. Approximately 41% of the AGYW were diagnosed with sexually transmitted infection at baseline. Overall, 83% of the AGYW initiated PrEP use during their first ANC. The percentage of PrEP continuation was 63% at 1 month, 54% at 3 months, and 39% at 6 months. Approximately 27% consistently continued PrEP use through 6 months, while 6% stopped and restarted on PrEP use at 6 months. With a higher risk score of HIV (≥2 vs. ≤1), the AGYW showed higher odds of PrEP continuation [adjusted odds ratio: 1.85 (95% CI: 1.12–3.03)] through 6 months, adjusting for potential confounders. Undergoing the postpartum period (vs. pregnant) and having lower sexual risk factors were found to be the barriers to PrEP continuation. TFV-DP concentration levels were detected among 49% of the AGYW, and 6% of these women had daily adherence to PrEP at 3 months.ConclusionsAGYW were found to have high oral PrEP initiation, but just over one-third of these women continued PrEP use through 6 months. Pregnant AGYW who had a higher risk of acquiring HIV (due to condomless sex, frequent sex, and STIs) were more likely to continue on PrEP use through the postpartum period. Pregnant and postpartum AGYW require counseling and other types of support, such as community delivery and peer support to improve their effective PrEP use through the postpartum period.Clinical Trial NumberClinicalTrials.gov, NCT03826199.

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Recent Alcohol Use Is Associated With Increased Pre-exposure Prophylaxis (PrEP) Continuation and Adherence Among Pregnant and Postpartum Women in South Africa

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 5 publications

References 49 publications

Alcohol use and the pre-exposure prophylaxis continuum of care among men in rural South Africa

Alcohol use and the pre-exposure prophylaxis continuum of care among men in rural South Africa

Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa

Evaluating the use of oral pre-exposure prophylaxis among pregnant and postpartum adolescent girls and young women in Cape Town, South Africa

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