At the 2021 Virtual Conference on Retroviruses and Opportunistic Infections (CROI), UW researchers shared groundbreaking research aimed at preventing and treating HIV and other sexually transmitted infections (STIs).
CROI is a leading forum for scientists and clinical investigators to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and associated diseases. To be accepted as a presenter, abstracts are evaluated for the relevance of their topics, the rigor of their research, and the distinct contributions they make to the broad spectrum of study.
Ruanne Barnabas, professor of global health at University of Washington School of Medicine, revealed the findings of an innovative study conducted in partnership with Amazon.com which showed that home delivery of HIV medicines in South Africa significantly increased viral suppression compared to those who received clinical care. After 47 weeks, the study found that compared to standard clinic care, fee for home delivery of ART significantly increased viral suppression from 74% in the clinic group to 88% in the home delivery group.
The study provides evidence that home delivery and monitoring of ART is convenient, overcomes logistic barriers, and could increase ART adherence and viral suppression particularly among men who engage less in clinic-based HIV care than women. If clients pay for this service and the benefits are sufficient, it could be a scalable strategy.
Dr John Kinuthia, UW Affiliate Associate Professor of Global Health, presented the results of the PrEP Implementation for Mothers in Antenatal Care (PrIMA) cluster randomized trial. Conducted in Kenya, the trial compared two models of PrEP delivery in maternal child health clinics: Targeted PrEP offered to women deemed high-risk following an assessment or if requested and Universal PrEP offered to all along with standardized counseling.
Contrary to expectations, the study determined that targeting based on risk did not improve PrEP decision-making or decrease HIV incidence amongst enrolled participants. PrEP was accepted by 20% of the women in the Universal arm (compared to 18% in the Targeted arm), and appropriate PrEP use was 69% in the Universal arm (compared to 59% in the Targeted arm.) Offering Universal PrEP counselling to all women at risk could be an effective and efficient approach to achieve appropriate PrEP use.
UW Global Health Implementation Science PhD candidate Elizabeth Irungu discussed the positive outcomes of the Partners Scale-Up Project in Kenya during a debate-style session with former US Global AID Coordinator Ambassador Mark Dybul. To support Kenya’s nationwide PrEP roll-out, the Partners Scale-Up Project partnered with the Ministry of Health to conduct a trial aimed at scaling delivery in 25 high-volume public HIV care clinics. The project team trained local clinic staff, provided ongoing technical support, and abstracted data from client records.
The results of the trial were encouraging. Nearly 5,000 men and women started PrEP during a two-year period, accounting for approximately ten percent of total countrywide PrEP initiations. Of that group, 65% continued to use PrEP at three months. These findings will have far-reaching implications for how countries address the prevention of HIV, even after the project concludes.
“We have demonstrated that it is feasible to scale up PrEP delivery in HIV care clinics,” says Irungu, whose work was supported by teams at the UW International Clinical Research Centre (ICRC) at the Kenya Medical Research Institute based in Thika and Kisumu, Kenya. “Not only will our work inform the national scale up of PrEP in Kenya, it will also inform other countries in the African region that are considering implementation of national PrEP programs.”
UW Global Health PhD student Melody Wang led a session on the “Risk for Repeat STI Episodes Among Kenyan Adolescent Girls and Young Women,” sharing the results of a five-year longitudinal study of 400 women aged 16-20 in Thika, Kenya. The study, which was led by Wang under the mentorship of UW associate professor of global health Dr. Alison Roxby, determined that adolescent girls and young women (AGYM) are disproportionately affected by HIV and STIs, with at least one STI detected in 56% of the participants. Especially vulnerable were AGYM with new sexual partners during the observed time period and those who did not disclose sexual activity, suggesting that interventions to prevent STIs are needed for this demographic.
To read more about sessions led by University of Washington faculty and students, check out the Virtual CROI Conference Abstract eBook.