Abstract Introduction There has been significant progress in the rollout of oral pre‐exposure prophylaxis (PrEP) for the prevention of HIV. The introduction of long‐acting prevention methods holds the potential to improve HIV prevention uptake and use, however, presents unique complexities regarding HIV diagnosis and potential for resistance. Quantifying and understanding the scenarios within which seroconversions occur may help to inform approaches to identifying acute HIV in programmes delivering PrEP at scale. Methods This paper documents ctra series of seroconversions within a large implementation study conducted in eight Department of Health facilities and four linked mobile clinics in four areas of South Africa. Using routinely collected data, we conducted a descriptive analysis of clients who seroconverted after initiating oral PrEP and determined the distribution of time from oral PrEP initiation to seroconversion as well as the proportion of days covered by oral PrEP. A seroconversion was defined as any HIV‐positive diagnosis after initiation of PrEP. Time to seroconversion was calculated as the number of days between the first PrEP initiation and the date of HIV diagnosis. The proportion of days covered by PrEP was calculated as the number of days of PrEP prescribed over the number of days between PrEP initiation and HIV seroconversion. We conducted a logistic regression to determine factors associated with seroconversion. Results Of the 11,882 clients initiated on PrEP between January 2019 and October 2022 who attended at least one follow‐up visit, 112 (0.9%) seroconverted after PrEP initiation. Among those who seroconverted, the median proportion of days covered by PrEP between initiation and seroconversion was 33%. In the period between PrEP initiation and seroconversion, almost all ( n = 93, 83.0%) had not used PrEP consistently, with only 19 (17.0%) having consistent PrEP use, all of whom were identified at the 1‐month follow‐up visit and were likely missed acute acquisitions. Younger age and geographical area were associated with seroconversion. Conclusions This study reports a low number of seroconversions among a large cohort of PrEP users in a real‐world implementation study, the majority of which occurred among clients who had interrupted or discontinued PrEP use.
Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be contributing to an increase in AMR in the region. This systematic review aimed to synthesize data on the prevalence of AMR in common STIs in SSA and identify some research gaps that exist.We searched three electronic databases for studies published between 1 January 2000 and 26 May 2020. We screened the titles and abstracts for studies that potentially contained data on AMR in SSA. Then we reviewed the full text of these studies to identify articles that reported data on the prevalence of AMR in Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in SSA. We summarized the data using a narrative synthesis.The 40 included studies reported on AMR data from 7961 N. gonorrhoeae isolates from 15 countries in SSA and 350 M. genitalium specimens from South Africa. All four SSA regions reported very high rates of ciprofloxacin, tetracycline and penicillin resistance in N. gonorrhoeae. Resistance to cefixime or ceftriaxone was observed in all regions except West Africa. Azithromycin resistance, recommended as part of dual therapy with an extended-spectrum cephalosporin for gonorrhoea, was reported in all the regions. Both macrolide and fluoroquinolone-associated resistance were reported in M. genitalium in South Africa. Studies investigating AMR in C. trachomatis and T. vaginalis were not identified.There is a need to strengthen AMR surveillance in SSA for prompt investigation and notification of drug resistance in STIs.
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