Until now, there have been very little data from African
countries on the uptake of PrEP outside of clinical trials. Moreover, studies
have tended to concentrate on targeted populations, such as serodiscordant
couples or sex workers.
is a large study of a test-and-treat approach in Kenya and Uganda. In rural
communities, health campaigns offer testing for HIV, diabetes and hypertension,
with linkage to care and antiretroviral therapy for anyone who needs it.
Based on data on new HIV infections in the first two years
of SEARCH, the researchers developed a risk score that can identify at least
half of people in these communities who will go on to acquire HIV. It is based on
demographic data that are easy to collect, with no need to ask questions about
sexual behaviour or to test for sexually transmitted infections. The risk score
includes age, sex, marital status, polygamy, education, circumcision,
occupation, and alcohol use.
In 2016, a PrEP intervention was added in five of the
communities taking part in SEARCH. One month of community mobilisation activities
on PrEP – including meetings with health workers, religious leaders, young
people and workers in the fishing and transport sectors – preceded the testing campaign. Counsellors
gave information about PrEP and engaged participants in discussions about their
risk of acquiring HIV, as part of the HIV testing process.
For individuals who were assessed as being at higher risk by
the risk score, counsellors explained, “From what we have learned from your community,
and what you shared at the beginning of the campaign, we think that you would
benefit from taking PrEP.” In addition, any individual who decided for
themselves that they might benefit from PrEP was offered it, in line with World
Health Organization guidance, which recommends offering PrEP to those who
request it in the context of a generalised epidemic.
Most people were tested as part of the health campaign at
community sites. Individuals who did not come forward for testing were then
approached at home, with a further opportunity for testing there. In four of
the five communities, a same-day PrEP start was possible at the community
testing site (but not at home). Transport was also offered to PrEP clinics, usually
on the same day.