Research Project by Jane Musimbi Evelia
W62/88856/2016
University of Nairobi
ABSTRACT
Background: The current
overall HIV prevalence in Kenya is 4.8%, yet research on effectiveness of non-occupational
Post-Exposure Prophylaxis (PEP) for HIV prevention is still patchy and
consequent risks poorly understood.
Objective: To
characterize the PEP real-world effectiveness and prospective sexual health
risks among.
Methods: Data from
sex workers aged ≥18 years prescribed PEP as from 2016 to 15th October 2018
were analyzed. A comparison group of non-PEP/non-Pre-Exposure Prophylaxis
(PrEP) enrolled as from 2016 was used and random sample of 503 taken for
comparative analysis in a ratio of 1:1. Socio - demographic comparison of
profiles was done at baseline using a Chi-squared test. Kaplan-Meier cumulative
event and hazard functions and Cox proportional hazards models were fitted, in
analyses that included PrEP, for time-to-ARV initiation. Results: There were
42.9% of 196 PEP users and 57.1% (comparison group) whose data were linked with
baseline data. Chi-square test for differences resulted in statistical
significance in age categories (p=0.0027) and in sex work duration (p<0.001)
between the PEP and the Comparison group. There were 8 (0.64%) total HIV
infections (ARV initiations), 6 (1.3%) from the Control group and 2 (0.64%)
from Pre-Exposure Prophylaxis (PrEP) group. Five (3.1%) incident
HIV-infection/ARV initiation among MSMW and 3 (0.28%) among FSW found. Men who
have sex with men (MSMW) were at higher risk of HIV compared to female sex
workers (FSW) with hazard ratio of 17.2 (p<0.00001). In total 52 (9.35%) sex
workers had repeat PEP prescriptions with 90.3%, 8.4%, 1.1% and 0.2% having had
1,2,3 and 4 PEP episodes respectively. PEP recurrence rate was 8.6 per 100
person-months of follow up. There was HIV event-free survival in the PEP group.
Univariable and multivariable Cox models yielded same results. Multiple
pairwise log-rank test indicated presence of significant survival difference
between PEP and Controls (p-value=0.046), insignificant differences between PEP
and PrEP (p=0.025) and PrEP and Control group (p=0.631) and evidence of
clinically significant results. Survival among PEP users was comparative better
hence effective but not statistically significant at alpha 0.05.
Conclusions: There is
evidence that PEP is effective when adherently taken and associated with
event-free survival but this is not statistically significant. The underpin the
potential need to scale up condom counseling and in formulating personalized
risk scores for treatment as HIV prevention among the sex workers for
behavioural risk change and more focus on MSM.
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