HIV prevalence and incidence in a cohort of South African men and transgender women who have sex with men: the Sibanye Methods for Prevention Packages Programme (MP3) project

• Authors: Patrick Sullivan, Emory University; Nancy Phaswana-Mafuya, North West University; Stefan D. Baral, Johns Hopkins University; Rachel Valencia, Emory University; Ryan Zahn, Emory University; Karen Dominguez, Emory University; Clarence S. Yah, University of Witwatersrand; Jeb Jones, Emory University; Lesego B. Kgatitswe, Human Sciences Research Council of South Africa; A.D. McNaghten, Emory University; Aaron Siegler, Emory University; Travis Sanchez, Emory University; Linda-Gail Bekker, University of Cape Town
• Journal Title: Journal of the international AIDS Society
• Volume: Volume 23, Number S6
• Publisher: John Wiley & Sons Ltd. | 2020-10-01, Pages e25591-e25591
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1002/jia2.25591
• Subjects: Health Sciences, Immunology; Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; HIV; men who have sex with men; sexually transmitted infections; pre-exposure prophylaxis; HIV prevention; cohort studies; Risk; Epidemiology; MSM

Abstract

Introduction Men who have sex with men (MSM) and transgender women (TGW) are at increased risk for acquiring HIV, but there are limited HIV incidence data for these key populations in Africa. Understanding HIV prevalence and incidence provides important context for designing HIV prevention strategies, including pre‐exposure prophylaxis (PrEP) programmes. We describe HIV prevalence, awareness of HIV infection, HIV incidence and associated factors for a cohort of MSM and TGW in Cape Town and Port Elizabeth, South Africa. Methods From 2015 to 2016, MSM and TGW in Cape Town and Port Elizabeth were enrolled and prospectively followed for 12 months, receiving a comprehensive package of HIV prevention services. HIV testing was conducted at baseline and at follow‐up visits (targeted for three, six and twelve months). All HIV‐negative PrEP‐eligible participants were offered PrEP enrolment during the first four months of study participation. We determined HIV prevalence among participants at baseline, and incidence by repeat screening of initially HIV‐negative participants with HIV tests at three, six and twelve months. Results Among 292 participants enrolled, HIV prevalence was high (43%; 95% CI: 38 to 49) and awareness of HIV status was low (50%). The 167 HIV‐negative participants who were followed prospectively for 144.7 person‐years; nine incident HIV infections were documented. Overall annual incidence was 6.2% (CI: 2.8 to 11.8) and did not differ by city. Annual HIV incidence was significantly higher for younger (18 to 19 years) MSM and TGW (MSM: 21.8% (CI: 1.2 to 100); TGW: 31.0 (CI: 3.7, 111.2)). About half of participants started PrEP during the study; the annual incidence of HIV among 82 (49%) PrEP starters was 3.6% (CI: 0.4, 13.1) and among those who did not start PrEP was 7.8% (CI: 3.1, 16.1). Conclusions HIV incidence was high among MSM and TGW in the context of receiving a comprehensive package of prevention interventions and offering of PrEP. PrEP uptake was high; the observed incidence of HIV in those who started PrEP was about half the incidence of HIV in those who did not. Future implementation‐oriented studies should focus on decisions to start and continue PrEP for those at highest risk, including young MSM.