1. Delivering PrEP to Young women: Preliminary Findings WHO Satellite Session, IAS Paris 2017
Quarraisha Abdool Karim, PhD* on behalf of the CAPRISA PrEP Demo Project Team
Associate Scientific Director: CAPRISA
Member: UNAIDS Scientific Expert Panel
Professor in Clinical Epidemiology, Columbia University
Adjunct Professor in Public Health, University of KwaZulu-Natal

2. WHO policy on ARVs and Pre-exposure prophylaxis (PrEP):
Daily Truvada
PrEP recommended as global standard for all at high risk
New WHO PrEP guidelines
“..the use of daily oral pre-exposure prophylaxis is recommended as an additional prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches..”

3. Prevention Gap– Key Populations

4. HIV in adolescent girls and young women
1000 young women acquired HIV every day in 2015
90% of all new HIV infections in year-olds are in girls in southern Africa, 74% and in eastern Africa; 60% of population <30 years
Only 6% reduction in HIV among young women aged years from 2010 to 2015.

5. Which of these are prevention tools for young women in Africa?
Existing HIV prevention
strategies- ABCCP:
Abstinence
Behaviour (Be faithful)
Condoms (Male & Female)
Circumcision
PrEP
Which of these are prevention tools for young women in Africa?
HIV in pregnant women in rural
South Africa ( )
Age Group
(Years)
HIV Prevalence
(N=4818)
≤16
11.5%
17-18
21.3%
19-20
30.4%
21-22
39.4%
23-24
49.5%
>25
51.9%
Source: Abdool Karim Q, 2014

6. Project Goal & Potential Outcomes
To assess the feasibility, acceptability, uptake and patterns of use of daily, oral tenofovir diproxyl fumarate + emtricitabine provided as part of SRH services to young women (and men) at risk of acquiring HIV in urban and rural KwaZulu-Natal
Potential Outcomes to inform PrEP scale-up:
How will PrEP be used & what will patterns of PrEP use look like?
Who wants to use PrEP?
Who will be successful
PrEP users?
What factors influences adherence?
What client and provider support is needed for PrEP use?
Change Title to: Goal and outcomes of the CAP084 PrEP Demo Project

7. Approach
Community and PHC level awareness raising of HIV, knowledge of HIV status; prevention and treatment options. Those interested in PrEP are referred to CAPRISA facility
CAPRISA : General Information Session on PrEP and what PrEP use entails
If interested in PrEP use - Screening and eligibility assessment
If eligible – initiated on PrEP and dispensed with 14 days of drug
Follow-up 7 days (telephonic/clinic)
D14, M1, M2, M3, M6, M9, M12
HIV testing, safety, pregnancy, STIs, adherence

8. PrEP Uptake and Patterns of Use March 2016 - February 2017
Average age
23 years
Range: years
# enrolled & offered PrEP
429
# initiated on PrEP
264 (61%)
% still on PrEP after 6 months (n=154+25)
67.8%
 Main reasons for not initiating PrEP
Not interested / willing / ready to take PrEP / Forget pills
Concerned about side effects & drug resistance
No self-perceived HIV risk
Concerned about objection from family
Reasons for stopping PrEP (N = 110*)
Clinician-initiated (n=31): vomiting, rash, PV bleeding
Self-initiated (n=91): nausea, headaches, dizziness, abdominal pain, fatigue, rash 

9. Adherence to PrEP: Pill count
55% (147/264) of women who initiated PrEP reported interrupted PrEP usage
36% (53/147) reported interrupting PrEP more than once
81% (215/264) of women who initiated PrEP missed at least 1 pill
Self-reported reasons for missing pills include:
Forgot, missed clinic appointment, lost pills, travelling, pills stolen (n=1), does not recall, chose to stop PrEP
Mean adherence based on pill count is 92%
Quantitative drug level data expected in September 2017

10. Facilitators to PrEP Uptake: 14 FGDs
Need for innovative interventions to build:
Trust & Awareness of PrEP
Motivation to use ARVs for prevention vs getting infected and going on ARV treatment
Re-packaging: Current containers associated with HIV treatment (Stigmatization of HIV- people as AIDS patients/ confusion in homes with AIDS patients & limited space/privacy)
Reduce product stigma: Segmented introduction (CSW/MSM) labelling and stigmatizing PrEP use
Govender E, Personal Communication

11. Summary
Adolescent girls and young women in eastern and southern Africa - a priority for PrEP
2/3 of young women initiate PrEP, when offered
Adherence based on pill counts is >90%
About 1/3 interrupt PrEP for concomitant ill- effects which are real or perceived effects of PrEP
Substantial clinical management needed in the first few months after PrEP initiation
Too early to inform PrEP roll-out

12. Acknowledgements This project is funded by:
US Agency for International Development (USAID) (Washington DC and Pretoria)
President’s Emergency fund for AIDS Relief (PEPFAR)
FHI 360 (Pretoria)
South African Department of Science and Technology (DST)
MACAIDS Fund (via Tides Foundation)
CAPRISA
CAPRISA is the UNAIDS
Collaborating Centre for
HIV Research and Policy
CAPRISA hosts a DST-NRF Centre of Excellence in HIV Prevention
CAPRISA hosts a MRC
HIV-TB Pathogenesis and
Treatment Research Unit
CAPRISA Partner
Institutions: