title: Brief Report: Preventing HIV-1 Infection in Women Using Oral Preexposure Prophylaxis: A Meta-analysis of Current Evidence.
abstract: The World Health Organization has issued an early release revision to its antiretroviral guidelines in which PrEP (pre-exposure prophylaxis in the form of daily oral, fixed dose combination tenofovir disoproxil fumarate/emtricitabine) is recommended as a prevention option to all people at substantial risk of acquiring HIV. However, lack of effectiveness in 2 major women-only PrEP trials, VOICE and FEM-PrEP, continues to be a cause for concern about achieving effectiveness for women in Southern Africa. We conducted a series of meta-analyses of oral effectiveness of tenofovir disoproxil fumarate/emtricitabine in women including all 5 randomized placebo-controlled trials that included women. An adherence-based meta-analysis model showed that with high levels of adherence (75%), oral PrEP is estimated to be effective (relative risk = 0.39, 95% confidence interval: 0.25 to 0.60). Provided that these results apply to women in Southern Africa, future prevention trial designs in that region should account for potentially reduced HIV incidence when PrEP is available.
authors.affiliation: *Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and †Division of Infectious Diseases, Columbia University Medical Center, New York, NY.
authors.forename: Brett
authors.initials: B
authors.lastname: Hanscom
authors.forename: Holly E
authors.initials: HE
authors.lastname: Janes
authors.forename: Peter D
authors.initials: PD
authors.lastname: Guarino
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Brown
authors.forename: Ying Qing
authors.initials: YQ
authors.lastname: Chen
authors.forename: Scott M
authors.initials: SM
authors.lastname: Hammer
authors.forename: Peter B
authors.initials: PB
authors.lastname: Gilbert
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Donnell
mesh_terms: D000353:Africa, Southern; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D055118:Medication Adherence; D010919:Placebos / Q000008:administration & dosage; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D010919:Placebos