icon-    folder.gif   Conference Reports for NATAP  
  Conference on Retroviruses
and Opportunistic Infections
Denver, Colorado
March 3-6 2024
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Randomized Trial Shows Huge Uptake Success
of HIV Prevention Choices in Kenya, Uganda
  CROI 2024 (Conference on Retroviruses and Opportunistic Infections), March 3-6, 2024, Denver
Mark Mascolini
A large trial in Kenya and Uganda that randomized people to choose and switch among three HIV prevention strategies or to standard-of-care prevention (SOC) showed 56% greater coverage in the 3-choice arm than in the SOC group through 48 weeks [1]. There were no new HIV infections in the 487-person 3-choice SEARCH Dynamic Choice arm versus 7 in the 497-person SOC group.
Moses Kamya (Makerere University, Kampala) and colleagues at other centers noted that many sub-Saharan countries have oral HIV PrEP programs, but uptake remains spotty. SEARCH Dynamic Choice randomized participants to a structured choice of three prevention strategies based on product preference and risk—long-acting cabotegravir (CAB-LA) PrEP, oral TDF/FTC PrEP, or PEP (Dynamic Choice group), while the SOC group got oral PrEP or PEP at local Ministry of Health clinics according to country guidelines. People randomized to Dynamic Choice got 24/7 phone access to a clinician, HIV testing and prevention counseling every 3 months, and the freedom to switch or stop products over time.
Participants came from antenatal clinics, outpatient departments, and the community. They had to be at least 15 years old, have a negative rapid HIV test, and report risk of HIV infection. If people wanted to use CAB-LA, they had to weigh more than 35 kg and have undetectable HIV RNA; they could not be pregnant when getting their first CAB-LA shot.
About half of participants in the Dynamic Choice and the control groups were Kenyan and half Ugandan. Women made up about three quarters of both study arms because of high recruitment in antenatal clinics. About 30% in both study arms were 15 to 24 years old and the rest 25 or older.
Prevention coverage averaged 69.7% in the Dynamic Choice group versus 13.3% in the SOC group, a difference of 56.4% (95% confidence interval 50.8 to 62.1, P < 0.001). Coverage difference remained hefty and highly significant in women (68.3% vs 15.5%), men (73.1% vs 7.5%), people 15 to 24 years old (71.2% vs 12.2%), and people 25 or older (69.2% vs 13.7%) (P < 0.001 for all differences).
Throughout the 48-week trial, 56% in the intervention arm used CAB-LA (vs 0% in the SOC arm), 53% used oral PrEP (vs 19% in the SOC arm), 2% used PEP (vs 1%), and 28% used two products (vs 0.4%). Among people starting CAB-LA when entering the trial, 42% had used no prevention strategy in the past month.
Seven people in the SOC group and none in the Dynamic Choice group acquired HIV infection during the study period (difference -1.8%, P = 0.01). One infant born to an SOC participant acquired HIV infection (and was not included in the incidence calculation).
Kamya and colleagues concluded that a structured choice among HIV prevention strategies boosted biomedical prevention coverage to 70%. They stressed that “people want product options, chose different options, and changed [products] over time.” Success of this intervention in countries like Kenya and Uganda, they added, depends on wider access to CAB-LA.
1. Kamya MR, Balzer LB, Ayieko J, et al. Randomized trial of SEARCH Dynamic Choice HIV Prevention including injectable cabotegravir (CAB-LA). CROI 2024 (Conference on Retroviruses and Opportunistic Infections), March 3-6, 2024, Denver. Abstract 172.