Interest in Oral Pre-exposure Prophylaxis Among Men Who Have Sex with Men and Transfeminine Persons in HPTN 075, a Multi-center HIV Prevention Study in Sub-Saharan Africa (2015-2017).

Use of oral pre-exposure prophylaxis (O-PrEP) for HIV prevention has not been fully utilized in sub-Saharan Africa, especially among key populations with high HIV incidence and prevalence, including men who have sex with men (MSM) and transgender women (TGW). We examined correlates of interest in O-PrEP among participants in the HIV Prevention Trials Network (HPTN) Study 075, a prospective cohort study, conducted between 2015 and 2017, across 4 sites in Kenya, Malawi, and South Africa. The study included persons assigned male sex at birth, between 18 and 44 years of age, who reported anal intercourse with a man in the past 3 months. Interest in O-PrEP and potential correlates were assessed among 297 participants who were HIV negative. 52% of the participants reported being aware of PrEP and 73% indicated interest in PrEP once informed about it. PrEP interest was not significantly associated with any of the surveyed demographic or psychosocial variables except study site. Our findings suggest a broad and general interest in O-PrEP among MSM and TGW in sub-Saharan Africa, despite relatively low awareness. While the situation around PrEP will have changed in the included countries, major questions about successful implementation still need to be addressed.

RESUMEN: El uso de la profilaxis oral previa a la exposición (O-PrEP) para la prevención del VIH no se ha utilizado plenamente en el África subsahariana, especialmente entre poblaciones clave como los hombres que tienen sexo con hombres (HSH) y las mujeres transgénero (TGW), que demuestran alta Incidencia y prevalencia del VIH. Examinamos los correlatos de interés en O-PrEP entre los participantes en el Estudio 075 de la Red de Ensayos de Prevención del VIH (HPTN), un estudio de cohorte prospectivo, realizado entre 2015 y 2017, en 4 localidades en Kenia, Malawi y Sudáfrica. El estudio involucró a personas asignadas al sexo masculino al nacer que tenían entre 18 y 44 años de edad y que manifestaron haber tenido relaciones anales con un hombre en los últimos 3 meses. Se evaluó el interés en la O-PrEP y sus posibles correlatos entre 297 participantes que eran VIH negativos. El cincuenta y dos por ciento de los participantes reportaron tener conciencia de la existencia de PrEP y el 73% indicó interés en utilizar PrEP una vez informados sobre su existencia. El interés por la PrEP no se asoció significativamente con ninguna de las variables demográficas o psicosociales encuestadas, excepto el lugar del estudio. Nuestros hallazgos sugieren un interés amplio y general en la O-PrEP entre HSH y TGW en el África subsahariana, a pesar de un conocimiento relativamente bajo. Si bien la situación en torno a la PrEP habrá cambiado en los países incluidos, aún quedan importantes cuestiones por abordar sobre su implementación exitosa.

Prevalence and functional profile of SARS-CoV-2 T cells in asymptomatic Kenyan adults.

BackgroundSARS-CoV-2 infection in Africa has been characterized by a less severe disease profile than what has been observed elsewhere, but the profile of SARS-CoV-2-specific adaptive immunity in these mainly asymptomatic patients has not, to our knowledge, been analyzed.MethodsWe collected blood samples from residents of rural Kenya (n = 80), who had not experienced any respiratory symptoms or had contact with individuals with COVID-19 and had not received COVID-19 vaccines. We analyzed spike-specific antibodies and T cells specific for SARS-CoV-2 structural (membrane, nucleocapsid, and spike) and accessory (ORF3a, ORF7, ORF8) proteins. Pre-pandemic blood samples collected in Nairobi (n = 13) and blood samples from mild-to-moderately symptomatic COVID-19 convalescent patients (n = 36) living in the urban environment of Singapore were also studied.ResultsAmong asymptomatic Africans, we detected anti-spike antibodies in 41.0% of the samples and T cell responses against 2 or more SARS-CoV-2 proteins in 82.5% of samples examined. Such a pattern was absent in the pre-pandemic samples. Furthermore, distinct from cellular immunity in European and Asian COVID-19 convalescents, we observed strong T cell immunogenicity against viral accessory proteins (ORF3a, ORF8) but not structural proteins, as well as a higher IL-10/IFN-γ cytokine ratio profile.ConclusionsThe high incidence of T cell responses against different SARS-CoV-2 proteins in seronegative participants suggests that serosurveys underestimate SARS-CoV-2 prevalence in settings where asymptomatic infections prevail. The functional and antigen-specific profile of SARS-CoV-2-specific T cells in African individuals suggests that environmental factors can play a role in the development of protective antiviral immunity.FundingUS Centers for Disease Control and Prevention, Division of Global Health Protection; the Singapore Ministry of Health's National Medical Research Council (COVID19RF3-0060, COVID19RF-001, COVID19RF-008, MOH-StaR17Nov-0001).