| Title: |
Oral preexposure prophylaxis use and the risk of bacterial sexually transmitted infections and HIV among African women: A prospective observational cohort study |
| Authors: |
Mukasa, David; Kinuthia, John; Meisner, Allison; Matemo, Daniel; Schaafsma, Torin; Morton, Jennifer; Wandera, Cynthia; Budiawan, Elvira; Kemuto, Valarie; Irine, Cherotich; Odhiambo, Stephen; Bii, Mercy; Oduor, Beatrice; Achieng, Esther; Oyombra, Tessy; Ukah, Ugochinyere Vivian; Mugwanya, Kenneth K. |
| Contributors: |
Rosen, Sydney; National Institute of Mental Health |
| Source: |
PLOS Medicine ; volume 23, issue 3, page e1004962 ; ISSN 1549-1676 |
| Publisher Information: |
Public Library of Science (PLoS) |
| Publication Year: |
2026 |
| Collection: |
PLOS Publications (via CrossRef) |
| Description: |
Background Oral preexposure prophylaxis (PrEP) effectively reduces HIV incidence when used with sufficient adherence, but does not protect against bacterial sexually transmitted infections (STIs). Several studies have documented high rates of bacterial STIs among individuals initiating and using PrEP. We evaluated the association between PrEP use and the risk of STI among African women accessing family planning clinics. Methods and findings We conducted a prospective cohort study nested within a large pragmatic stepped-wedge cluster randomized trial of PrEP delivery in Kenyan family planning clinics, with participant enrollment from June 18, 2021, to May 18, 2023, and follow-up through February 02, 2024 (ClinicalTrials.gov: NCT04666792). The study population included sexually active HIV–negative women aged ≥15 years at elevated HIV risk per Kenyan PrEP guidelines. Participants were offered standard-of-care oral PrEP with the option to decline and followed quarterly for 12 months with assessments of HIV status, sexual behavior, and PrEP use. Urine samples were batch tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the GeneXpert CT/NG real-time polymerase chain reaction nucleic acid amplification test assay. The primary exposure was self-reported PrEP initiation and PrEP use consistency through 6 months, categorized as never used PrEP, inconsistently on PrEP, or consistently on PrEP. Multivariable modified Poisson generalized estimating equation (GEE) models with robust standard errors were used to estimate associations between PrEP use and incident STI; clinic-level intracluster correlation coefficients were negligible. The secondary outcomes were incident HIV infection and sexual behaviors, which included condomless sex at last sex, sex with any new partners in the past 3 months, and multiple sex partners. HIV testing was performed at each scheduled visit, at enrollment, and 1, 3, 6, 9, and 12 months following the Kenya national HIV testing algorithm, using Determine HIV-1/2 and Fast Response ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1371/journal.pmed.1004962 |
| Availability: |
https://doi.org/10.1371/journal.pmed.1004962; https://dx.plos.org/10.1371/journal.pmed.1004962 |
| Rights: |
http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.6B7F2097 |
| Database: |
BASE |