When are declines in condom use while using PrEP a concern? Modelling insights from a Hillbrow, South Africa case study

Hannah Grant, Zindoga Mukandavire, Robyn Eakle, Holly Prudden, Gabriela B. Gomez, Helen Rees, Charlotte Watts Journal of the International AIDS Society, 2017; Read full paper online

Oral pre-exposure prophylaxis (PrEP) is a promising new prevention approach for those most at risk of HIV infection. However, there are concerns that behavioural changes, specifically reductions in condom use, might limit PrEP’s protective effect. This study uses the case of female sex workers (FSWs) in Johannesburg, South Africa, to assess whether decreased levels of condom use following the introduction of PrEP may limit HIV risk reduction.

For the study, researchers developed a static model of HIV risk and compared HIV-risk estimates before and after the introduction of PrEP to determine the maximum tolerated reductions in condom use with regular partners and clients for HIV risk not to change. The results show that PrEP is likely to be of benefit in reducing HIV risk, even if reductions in condom use occur. Efforts to promote consistent condom use will be critical for FSWs with high initial levels of condom use, but with challenges in adhering to PrEP.

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