title: Tenofovir-based oral preexposure prophylaxis prevents HIV infection among women.
abstract: OBJECTIVE
  Despite tremendous promise as a female-controlled HIV prevention strategy, implementation of preexposure prophylaxis (PrEP) among women has been limited, in part because of disparate efficacy results from randomized trials in this population. This review synthesizes existing evidence regarding PrEP efficacy for preventing HIV infection in women and considerations for delivering PrEP to women.
  
  
  RESULTS
  In three efficacy trials, conducted among men and women, tenofovir-based oral PrEP reduced HIV acquisition in subgroups of women by 49-79% in intent-to-treat analyses, and by >85% when accounting for PrEP adherence. Two trials did not demonstrate an HIV prevention benefit from PrEP in women, but substantial evidence indicates those results were compromised by very low adherence to the study medication. Qualitative research has identified risk perception, stigma, and aspects of clinical trial participation as influencing adherence to study medication. Pharmacokinetic studies provide supporting evidence that PrEP offers HIV protection in women who are adherent to the medication.
  
  
  CONCLUSIONS
  Tenofovir-based daily oral PrEP prevents HIV acquisition in women. Offering PrEP as an HIV prevention option for women at high risk of HIV acquisition is a public health imperative and opportunities to evaluate implementation strategies for PrEP for women are needed.
authors.affiliation: aDepartment of Global Health bDepartment of Epidemiology cDepartment of Medicine, University of Washington, Seattle, USA dSexual Reproductive Adolescent and Child Health Program, Kenya Medical Research Institute, Nairobi, Kenya eThe Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Thomson
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Nelly R
authors.initials: NR
authors.lastname: Mugo
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.forename: Connie L
authors.initials: CL
authors.lastname: Celum
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
mesh_terms: D000284:Administration, Oral; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D055118:Medication Adherence; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D000068698:Tenofovir / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir