Browsing by Author "Selepe, Pearl"

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    High recent PrEP adherence with point-of-care urine tenofovirtesting and adherence counselling among young African women:results from the INSIGHT cohort
    (John Wiley and Sons Inc, 2024-12) Gati Mirembe, Brenda; Donnell, Deborah; Krows, Meighan; Zwane, Zinhle; Bukusi, Elizabeth; Panchia, Ravindre; Louw, Cheryl; Mwelase, Noluthando; Selepe, Pearl; Senne, Melissa; Naidoo, Logashvari; Chihana, Rachel; Kasaro, Margaret; Nuwagaba-Biribonwoha, Harriet; Kotze, Philip; Gill, Katherine; MacDonald, Pippa; vanHeerden, Alastair; Bosman, Shannon; Jaggernath, Manjeetha; du Preez, Phillip; Ward, Amy; Peters, Remco P H; Delany-Moretlwe, Sinead; Et.al
    Adolescent girls and young women (AGYW) account for two-thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre-exposure prophylaxis (PrEP) but low adherence, which might be improved by point-of-care adherence monitoring with tailored counselling. From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16-30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia. Participants were offered oral tenofovir-based PrEP at enrolment and followed up at 1, 3 and 6 months. PrEP adherence was assessed by a point-of-care qualitative lateral flow urine tenofovir (TFV) assay indicating PrEP use in the prior 4 days, which accompanied real-time adherence counselling that incorporated urine TFV results when testing was available (70.8% of month 1, 35.3% of month 3 and 83.9% of month 6 visits). We estimated overall adherence, correcting for missing test results, and analysed the association of having received urine TFV results at month 1 or 3 with subsequent urine TFV test positivity, using modified Poisson regression. Of the 3087 AGYW enrolled, the median age was 24 years (interquartile range 21-27), 75.7% were from South Africa, 2878 (93.2%) initiated PrEP at enrolment and 107 (3.5%) after enrolment. Visit retention was 92.0-96.2% for months 1, 3 and 6, and 2518 (90.1%) exited the study with a PrEP refill. Adherence, based on the point-of-care urine tenofovir test positivity rate, was estimated as 72%, 71% and 65% at months 1, 3 and 6, respectively. Women who received one prior urine TFV test had a 42% higher likelihood of a subsequent positive urine TFV test (adjusted odds ratio, OR = 1.42, 95% confidence interval, CI 1.27-1.60), and those having received two prior tests had a 67% higher likelihood (adjusted OR = 1.67; 95% CI 1.41-1.98). Observed HIV incidence was 1.38/100 person-years (95% CI 0.97-2.08). Oral PrEP uptake, recent adherence and persistence were high in a multisite cohort of young African women over 6 months of follow-up. The use of a novel point-of-care tenofovir assay with tailored real-time adherence counselling was associated with increased adherence to PrEP at subsequent visits, warranting further study. clinicaltrials.gov NCT05746065.
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    HIV disease progression among women following seroconversion during a tenofovirbased HIV prevention trial
    (PLoS ONE, 2017) Riddler, Sharon A.; Husnik, Marla; Gita, Ramjee; Anamika, Premrajh; Onini Tutshana, Bomkazi; Arendevi, Pather; Siva, Samantha; Jeenarain, Nitesha; Nair, Gonasagrie; Selepe, Pearl; Kabwigu, Samuel; Palanee-Phillips, Thesla; Panchia, Ravindre; Mhlanga, Felix; Lisa, Levy; Livant, Edward; Patterson, Karen; Elharrar, Vanessa; Balkus, Jennifer
    Little is known regarding HIV disease outcomes among individuals who become infected with HIV while receiving antiretroviral medications for prevention. We compared HIV disease parameters among women who seroconverted while receiving tenofovir-containing oral or vaginal pre-exposure prophylaxis (PrEP) to placebo. Methods Participants with HIV seroconversion in a randomized placebo-controlled trial of oral tenofovir, oral tenofovir/emtricitabine, and vaginal tenofovir gel (MTN-003) were followed in a longitudinal cohort study (MTN-015). The effect of oral and vaginal tenofovir-containing PrEP on HIV disease progression was compared to placebo using linear mixed effects and Cox proportional hazard models, as appropriate. Additional analyses were performed to compare the outcomes among participants with detectable tenofovir or emtricitabine in plasma at the first quarterly visit in MTN-003. Results A total of 224 participants were included in the analysis; 93% from South Africa and 94% clade C virus. No differences in HIV RNA at steady state or the trajectory over 12 months were observed for each active arm compared to placebo; tenofovir gel recipients had higher CD4+ T cell counts (722 vs 596 cells/mm3; p = 0.02) at 90 days after estimated HIV seroconversion and higher average rates of change over 12 months compared to placebo (-181 vs -92 cells/mm3 per year; p = 0.08). With a median follow-up of 31 months, no significant differences were observed for time to CD4+ T cell count 350 cells/mm3, or the composite endpoint of CD4+ T cells 350 cells/mm3, initiation of antiretroviral therapy or death for each active arm compared to placebo. Additionally, there were no significant differences in the HIV RNA or CD4+ T cell counts at baseline, the change to month 12, or any disease progression outcomes among participants with oral drug detected and no oral drug detected compared to placebo. Conclusions No clinically significant differences in HIV seroconversion outcomes were observed among women randomized to tenofovir-containing oral or vaginal PrEP regimens, however low overall adherence limits the generalizability of these findings.
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    The MTN-016 Pregnancy Registry: Baseline Characteristics of Enrollees from the VOICE Study and Reasons for Non-enrollment of Eligible Women
    (AIDS Research and Human Retroviruses, 2014) Kabwigu, Samuel; Noguchi, Lisa; Moodley, Jothi; Palanee, Thes; Kintu, Kenneth; Nair, Lulu; Panchia, R.; Selepe, Pearl; Balkus, Jennifer E.; Torjesen, Kristine; Piper, Jeanna; Scheckter, Rachel; Hazra, Rohan; Beigi, Richard
    As pregnant women are at risk for HIV and women at risk of HIV may become pregnant, it is important to assess the safety of candidate HIV prevention products in both non-pregnant and pregnant women. The MTN-016 pregnancy registry is a prospective observational cohort in which participants who became pregnant during MTN effectiveness studies or those with planned exposures in pregnancy safety studies are monitored for adverse obstetric outcomes; infants from these pregnancies are followed through the first year of life. Registry enrollment systematically excludes termination of pregnancy and early pregnancy loss, including early non-viable pregnancies with a transient positive test at a monthly visit, as these data are captured in parent protocols. For VOICE participants enrolled into the registry from Uganda, Zimbabwe and South Africa, we describe baseline demographic characteristics and key reasons for non-enrollment as reported by site investigators.