Study raises alarm over low uptake of HIV drugs

One of the largest campaigns to recruit Kenyans for the HIV prevention pill has reported low uptake, poor adherence and serious drug related side effects.

The exercise, which had mobilised 70,000 people in Western Kenya and Uganda, identified 12,000 as high HIV risk individuals but only 3,489 took up the drug called PrEP.

The study findings published last week in The Lancet says even while most of the recruits claimed high adherence, test of their hair showed up to a third were not being truthful.

“Although at least 70 per cent of individuals … self-reported adherence to PrEP, concentrations of the drug in hair samples showed poor adherence (fewer than four doses per week) in one third of those individuals,” says the report.

Of concern, the study by the Kenya Medical Research Institute, University of California, US, Makerere University, Uganda, and University of Massachusetts Amherst, US, says is poor uptake and adherence among young women.

“Of particular concern is that women and participants younger than 25 years had lower odds of having drug concentrations consistent with daily dosing, which might be required for protection from vaginal exposure to HIV,” says the study.

PrEP or Pre-exposure Prophylaxis, the use of anti-retroviral for HIV prevention was launched in Kenya in 2017, with current use estimated at 56,000 people.

This is the highest use of the drug in Africa and second of all reporting countries in the world after US, which has 135,000 users.

There are 10,000 users in Uganda, 3,700 in Tanzania, 100 in Rwanda, 35,000 in South Africa and 600 in Nigeria. There is none in Israel, 600 in China and 17,000 in the UK.

The drug is associated with serious side effects including kidney impairment, bone loss and liver problems. The current study reports 29 participants who initiated PrEP had serious side effects, including seven deaths. “Five adverse events were assessed as being possibly related to the study drug,” wrote the authors.

“A 71-year-old man was treated in hospital for urinary retention and creatinine elevation (kidney impairment) which normalised after PrEP was withdrawn,” says the report.

Kidney test

While it is a requirement that recruits take a kidney test to inform on PrEP initiation, this was not observed in the current study.

“Baseline kidney testing was done but PrEP was provided at enrolment before the receipt of laboratory results,” says the study also funded by the US Government and Bill and Melinda Gates Foundation.

The authors say this study carried out from June 2016 to June 2017, was different from other PrEP recruitment campaigns that have been based in health clinics mainly targeting high risk groups such as sex workers, gays, and drug injectors.

People at high risk included sex partners where one person is HIV positive, otherwise known as sero-different; persons aged 15 to 24, highly mobile individuals and workers in bars, transport and fishing sectors.

“Adolescent girls and young women have among the highest HIV risk, yet they were less likely than women aged 25 years or older to initiate PrEP.”

The Kenya Population-based HIV Impact Assessment 2018 released last week by the Ministry of Health showed young women at very high risk of HIV infection.

“Among adolescents and young people aged 20 to 34 years, prevalence of HIV was three times as high among women compared to men,” said Dr Catherine Ngugi, head National AIDS and STI Control Programme.

To improve adherence and especially among young women the study suggests need for a long-acting formulation of PrEP.