Browsing by Author "Deenan Pillay"

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    Antiretroviral therapy based HIV prevention targeting young women who sell sex: A mixed method approach to understand the implementation of PrEP in a rural area of KwaZulu-Natal, South Africa
    (2022-02) Natsayi Chimbindi; Nondumiso Mthiyane; Thembelihle Zuma; Kathy Baisley; Deenan Pillay; Nuala McGrath; Guy Harling; Lorraine Sherr; Isolde Birdthistle; Sian Floyd; Jaco Dreyer; Sarah Nakasone; Janet Seeley; Maryam Shahmanesh§
    Pre-Exposure Prophylaxis (PrEP) is a potential game-changer for HIV. We used PrEP introduction for Young Women Who Sell Sex (YWSS) in a rural South Africa district to understand community norms and PrEP coverage in YWSS. Between 2017 and 2018, we measured awareness and uptake of PrEP in a representative cohort of 2184 Adolescent Girls and Young Women (AGYW) aged 13-22. We conducted group discussions with young people and community members (19); key informant interviews (9), in-depth interviews with 15-24 year-olds (58) and providers (33). Interviews were analysed using thematic analysis. PrEP awareness increased from 2% to 9%. Among 965 AGYW sexually-active by 2018, 13.4% (95%CI: 11.4%-15.7%) reported transactional sex and 10.6% (95%CI: 8.85-12.7%) sex for money. Of the 194 YWSS, 21 were aware of PrEP, but none had used it. Youth were enthusiastic about PrEP as tool for HIV prevention; whilst older community members were cautious about a technology they had limited experience with but could benefit select groups. Teachers and healthcare providers were concerned that PrEP would lower personal responsibility for sexual health. In conclusion, the narrow and limited introduction of PrEP to YWSS reduced the accessibility and reach. Introducing PrEP as part of sexual healthcare may improve demand and access for YWSS.
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    Isisekelo Sempilo study protocol for the efectiveness of HIV prevention embedded in sexual health with or without peer navigator support (Thetha Nami) to reduce prevalence of transmissible HIV amongst adolescents and young adults in rural KwaZulu-Natal: a 2×2 factorial randomised controlled trial
    (2022) Glory Chidumwa; Natsayi Chimbindi; Carina Herbst; Nonhlanhla Okeselo; Jaco Dreyer; Thembelihle Zuma; Theresa Smith; Jean‑Michel Molina; Thandeka Khoza; Nuala McGrath; Janet Seeley; Deenan Pillay; Frank Tanser; Guy Harling; Lorraine Sherr; Andrew Copas; Kathy Baisley; Maryam Shahmanesh
    Background: Antiretroviral therapy (ART) through universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) substantially reduces HIV-related mortality, morbidity and incidence. Efective individual-level prevention modalities have not translated into population-level impact in southern Africa due to sub-optimal coverage among adolescents and youth who are hard to engage. We aim to investigate the feasibility, acceptability, and preliminary population level efectiveness of HIV prevention services with or without peer support to reduce prevalence of trans‑ missible HIV amongst adolescents and young adults in KwaZulu-Natal. Methods: We are conducting a 2×2 factorial trial among young men and women aged 16–29 years, randomly selected from the Africa Health Research Institute demographic surveillance area. Participants are randomly allocated to one of four intervention combinations: 1) Standard of Care (SOC): nurse-led services for HIV testing plus ART if posi‑ tive or PrEP for those eligible and negative; 2) Sexual and Reproductive Health (SRH): Baseline self-collected vaginal and urine samples with study-organized clinic appointments for results, treatment and delivery of HIV testing, ART and PrEP integrated with SRH services; 3) Peer-support: Study referral of participants to a peer navigator to assess their health, social and educational needs and provide risk-informed HIV prevention, including facilitating clinic attendance; or 4) SRH+peer-support. The primary outcomes for efectiveness are: (1) the proportion of individuals with infectious HIV at 12 months and (2) uptake of risk-informed comprehensive HIV prevention services within 60 days of enrolment. At 12 months, all participants will be contacted at home and the study team will collect a dried blood spot for HIV ELISA and HIV viral load testing. Discussion: This trial will enable us to understand the relative importance of SRH and peer support in creating demand for efective and risk informed biomedical HIV prevention and preliminary data on their efectiveness on reducing the prevalence of transmissible HIV amongst all adolescents and youth. Trial registration: Trial Registry: clincialtrials.gov. ClinicalTrials.gov Identifer NCT04532307. Registered: March 2020. Keywords: Peer navigator, HIV prevention, Community-based care, Contraception, Pre-Exposure prophylaxis