BACKGROUND: HIV pre-exposure prophylaxis (PrEP) has been integrated into sexually transmitted infection (STI) care in Malawi/sub-Saharan Africa (SSA); however, the success and prevention impact of integration has not been evaluated. Expanding prevention services to sexual partners of persons with STIs is another opportunity to increase PrEP reach. We evaluated an integrated PrEP and assisted partner notification (aPN) program in an STI clinic in Lilongwe, Malawi.
METHODS: We enrolled “index” participants who were initiating oral PrEP at the Bwaila District Hospital STI Clinic (=15 years, STI symptoms or exposure, HIV-seronegative). Participants completed surveys and provided contact information for sexual partners. Clinic staff contacted named partners who did not report to clinic within 14 days for STI treatment and HIV testing. Returning partners were screened for PrEP eligibility and, if interested and eligible, initiated PrEP and enrolled in the study.
RESULTS: 175 index participants enrolled between March-December, 2022. The median age was 27 (interquartile range [IQR]: 23-32) and most were male (110/175; 63%). Twenty-one percent (36/175) were adolescent girls and young women. In the preceding month, 40% (70/175) reported exchanging sex for goods/money/favors and 13% (23/175) had =1 known HIV-positive partner. Before enrollment, 34% (60/175) had heard of PrEP. Forty-nine percent (86/175) of participants provided contact information for 100 sexual partners. Fifty-eight partners returned to clinic: 34% (20/58) were HIV-seropositive and ineligible (4 newly diagnosed; 16 previously diagnosed). Of eligible partners, 71% (27/38) initiated PrEP and enrolled, and 29% (11/38) declined PrEP and/or study procedures. Median age of enrolled partners was 26 (IQR: 22-31) and most were female (20/27; 74%).
CONCLUSIONS: Ours is the first to demonstrate successful integration of PrEP within an STI clinic in SSA and highlights the benefits of aPN for promoting partner engagement in HIV prevention services. Although STI clinic-based PrEP does not explicitly target key populations, more than half of indexes fell into at least one priority category (exchanged sex for goods/money/favors or young women), and many were in serodiscordant relationships. Engaging young heterosexual men in PrEP care has been a historically under-examined opportunity to interrupt transmission and may be particularly powerful when coupled with PrEP referral for female partners.