This is a very vulnerable population notably due to
- Poor access to education
- Transactional sex (often older partners that can provide money and goods)
- Gender based violence
- Intergenerational sex
- Limited access to HIV prevention
The HPTN (HIV prevention trial network) has undertaken and planned numerous trials on prevention strategies in this population, namely:
- Oral PreP in this population
- Initial studies (FemPrep and Voice) showed poor adherence of <30%, primarily due to low risk perception, daily pill burden but also a desire for positive feedback
- HPTN 082/HERS study tried to address this with added adherence support with PreP via counselling, SMS reminders and intermittent drug levels to review adherence – outcome data still pending
- Cash transfers conditional for school attendance to prevent HIV
- No direct impact on HIV transmission and school attendance vs control
- Schooling was however still found to be protective of HIV – mainly due to reduce number of older partners and partner numbers
- Long-acting injectables (LAIs) for PreP
- Women do require higher adherence of oral PreP for reliable efficacy compared to men – leading to an increased acceptability for LAIs
- Injectable cabotegravir- Oral CAB/CAB LA (oral run in and injections) 600mg 8 weekly versus daily oral TDF/FTC
- Aiming for 3200 women recruited, with adherence support.
- Will be monitoring pregnancy and effects of such in use
- Unlikely to interact with oral contraception
A very thought provoking and eye-opening session for me…excited for further sessions to come.
