Easy-to-access PEP pilot shows promise in rural East Africa

The first pilot post-exposure prophylaxis (PEP) to people in parts of rural Kenya and Uganda where HIV prevalence is high has resulted in good uptake and no new HIV infections.

PEP, a 28-day course of antiretroviral medication that people who have been exposed to HIV can take to prevent infection, is recommended by the World Health Organization. It has been available for a long time, but in many African countries PEP is only available for people who are at high risk of HIV, particularly through their jobs, such as healthcare workers and sex workers.

This is the first pilot in Kenya and Uganda to offer PEP to anyone who may have been exposed to HIV due high HIV prevalence in the area where they live.

Researchers held focus groups with community members and healthcare providers to find out what would help to make PEP easy to access. Based on these findings, PEP was made available seven days a week and a PEP hotline, staffed by health providers, was set up. People were also able to get PEP from community sites as well as from health clinics.

The focus groups participants said few people knew about PEP and where to get it. So researchers worked with community leaders to raise awareness about PEP and encourage people to take part in the pilot if they were exposed to HIV.

Fifteen healthcare providers (seven clinical officers and eight nurses) from six clinics were trained on providing PEP. The need for confidential services was part of the training because focus groups participants said a lack of confidentiality might stop people from using PEP.

A total of 124 people took part in the PEP pilot. Two-thirds (66%) were women, 24% were under 24 years old and 58% were married (7% in polygamous marriages). Just over half (54%) worked in jobs that are associated with being at higher risk of HIV. The most common high-risk group were fishing communities (42%).

Reasons for taking PEP varied: 67% were in new or existing sexual relationships with someone who they thought might have HIV. A further 14% wanted to take PEP after having unplanned sex with someone with an unknown HIV status, 8% after transactional sex, 5% after having sex with someone who has HIV and 2% after being raped.

Most participants (85%) completed their four-week course of PEP and took an HIV test at the end of the course.

No participants got HIV and there were no other serious adverse events.

More than one third (35%) of participants accessed PEP through a community-based site at least once (or 12% of all pilot appointments).

The high number of people who finished their course of PEP may be due to the flexible appointment hours, the choice of PEP locations and having phone access to a healthcare provider whenever needed.

The findings suggest that PEP could be a good option to offer to people in East Africa in places with high HIV prevalence. As it is taken for a short period of time in response to a single event of sexual exposure to HIV it may be more suitable for some people than PrEP, which has to be taken every day for as long as someone may be at risk of acquiring HIV. It may be particularly suitable for people who have had unplanned sex or have been sexually assaulted.

Using PEP might also encourage some people to try PrEP – an area that requires further research.