P13.04
Background: Recent trials demonstrated the efficacy of ART in reducing the risk of transmission in HIV-positive patients and of pre-exposure prophylaxis (PrEP) in reducing the risk of HIV acquisition. Adherence and implementation challenges relating to service delivery may hinder the ability of these interventions to make a significant impact. Sex workers have been identified as a critical community to access HIV prevention technologies.
Methods: This demonstration project seeks to test the ‘real-world' viability of offering oral PrEP (for those testing HIV negative) and immediate HIV treatment (for those testing HIV positive) to female sex workers (FSWs) to prevent acquisition and transmission as part of a routine package of clinical care in two urban sites in South Africa. The main outcome studied will be retention at 12 months. The study will have two arms:
1) PrEP arm for those testing negative; and
2) immediate treatment arm where women will be started on treatment for CD4 counts of>350 cells/mm3.
We will investigate process and other health indicators (i.e. uptake, safety, rates of pregnancy, sexual behaviour, rates of co-infections, and use of SMS reminders). A qualitative research component will aim to better understand the motivations and barriers to uptake of PrEP and immediate treatment from perspectives of participants and providers. Finally, an economic evaluation will inform a cost-effectiveness analysis combined with estimates of impact through epidemiological modelling.
Results: In early 2017, after following FSWs for up to 24 months, we will have finalised the analyses of all outcomes, as well as clinical data, qualitative research, cost data, and impact.
Conclusions: This is one of two demonstration projects integrating immediate treatment and PrEP service delivery in a real world setting. Our results will aim to inform national and global policy making of the viability of PrEP and immediate treatment as interventions prioritised for high risk populations.
