High demand for PrEP among key populations in the DRC
First project to provide PrEP through key population-friendly clinics finds many people take up the offer but 39% struggle to take the medication every day
The first study to provide people most affected by HIV in the Democratic Republic of the Congo (DRC) with PrEP as part of routine care found many people took up the offer but their adherence and use of follow-up appointments was uneven.
The demonstration project happened between February and May 2018 in seven key-population friendly clinics in the cities of Kinshasa and Lubumbashi.
A total of 469 HIV-negative people attending the clinics were offered daily oral PrEP, and 75% accepted the offer. Around half of those who said no to PrEP were not interested in taking daily medication, while around one third (30%) did not think they needed PrEP.
The majority of people who said yes to PrEP were female sex workers (79%). The remaining people identified as men who has sex with men (20%) or transgender women (1%). There was clear crossover between populations as 98% said sex work was their main income source. Six of the female sex workers and one man also injected drugs (2% of all participants), and 17% of men said they had sex with men and women. The median age of all participants was 30.
Each participant started PrEP immediately. They were also given condoms and lubricants, screened and treated for STIs, and received counselling on how to take PrEP every day and how to reduce their risk of getting HIV. They were asked to return for one-month, three-month and six-month follow-up appointments.
Clinic staff provided the PrEP services, with support from a PrEP coordinator in each city. Outreach – in the form of calls, texts and home visits to remind people of upcoming appointments and to reschedule missed visits – was also offered.
Around two-thirds (64%) of people came to their 1-month follow-up appointment.
The proportion of people who came for their 3-month appointment was higher, at 82%. Around one-third (31%) of people who came to their 3-month appointment had missed their 1-month appointment but had been re-engaged through outreach.
When data analysis began, 168 people (48%) had been using PrEP for at least 6 months, of whom 86% came for their 6-month appointment. Among them, nine people (6%) had missed their three-month appointment and five had missed both one-month and three-month appointments.
Two-thirds (66%) of participants were asked about their PrEP adherence. Of these, 39% said they had missed at least 2 PrEP doses in the past week.
No one who was taking PrEP and received an HIV test was diagnosed with HIV.
The study’s use of routine clinic data means it is impossible to know whether those people who stopped taking PrEP did so because they felt they were no longer at risk of HIV or for other reasons.
But the study’s real-world setting shows that PrEP can be effectively delivered as part of routine HIV care in the DRC.
The DRC’s Ministry of Health ran the study with ICAP at Columbia University and the U.S. Centers for Disease Control and Prevention, and its results will be used to inform the inclusion of PrEP into DRC’s national HIV guidelines.