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Oral Abstract TUPDC0303 XIX International AIDS Conference Washington, DC, USA July 24, 2012

Acceptability of oral intermittent pre-exposure prophylaxis as a biomedical HIV prevention strategy: Results from the South African ADAPT (HPTN 067) Preparatory Study. Daniella Mark 1 , Rivet Amico 2 , Melissa Wallace 1 , Surita Roux 1 , Robert Grant 3,4 and Linda-Gail Bekker 1,5.

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Oral Abstract TUPDC0303 XIX International AIDS Conference Washington, DC, USA July 24, 2012

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  1. Acceptability of oral intermittent pre-exposure prophylaxis as a biomedical HIV prevention strategy: Results from the South African ADAPT (HPTN 067) Preparatory Study Daniella Mark1, Rivet Amico2, Melissa Wallace1, Surita Roux1, Robert Grant3,4 and Linda-Gail Bekker1,5 1Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town; 2Center for Health Intervention and Prevention, University of Connecticut; 3Gladstone Institute of Virology and Immunology; 4University of California; 5Department of Medicine, University of Cape Town Oral Abstract TUPDC0303 XIX International AIDS Conference Washington, DC, USA July 24, 2012

  2. Background/ Methods • Intermittent PrEP dosing or iPrEP (time- or event-driven) is being explored for the sake of convenience, cost-effectiveness and reduction in side effects • Acceptability data in at-risk communities is needed to evaluate likely uptake and potential impact • 8 focus groups in Cape Town, South Africa - 6 with adults, 2 with counselors working in high-incidence populations (n-52) • Semi-structured guide and sexual exposure/ forecasting survey • Framework analysis for qualitative data

  3. Results ACCEPTABILITY • PreP acceptability due to potential for non-consensual use • Barriers: aversion to novelty, PrEP seen as treatment, fear of stigma, risk compensation • iPrEP favoured for lower time burden and side effects • Concerns around iPrEP complexity • SEXUAL EXPOSURE • Median of 2 sex days in previous week • 0% reported daily sex as average • Highest sex activity over weekends • SEXUAL FORECASTING • 51% forecasted last sex act (men 75% vs. women 32%) • 77% forecasted some, and 51% all sex events in previous week • 88 sex days reported in previous week, of which 67% were forecasted.

  4. Conclusions • PrEP’s potential for non-consensual use is valued → noteworthy given the gap in female-controlled prevention strategies. • Social harms must be monitored and counseling provided. • iPrEP seems most congruent with the intermittent sexual exposure profile seen here. • Time-driven dosing should focus on weekends for maximum impact. • While most had a window to take a pre-exposure dose, 49% of people and 33% of sex days would not have been covered. • Continued investigation of PrEP is warranted and iPrEP may be adopted by high-incidence communities in South Africa. • PrEP will lead to new issues for service providers to address, including enhancement of sexual forecasting for adherence to event-driven PrEP.

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