Acute HIV infection identification and PrEP eligibility, uptake and adherence among MSM followed in a HIV vaccine feasibility cohort study in coastal Kenya

Identifying individuals who would benefit most from acute HIV infection screening and pre-exposure prophylaxis (PrEP) uptake is important for effective HIV prevention. This thesis combines a series of studies involving gay, bisexual, and other men who have sex with men (MSM) in Kenya – a group vulnerable to HIV infection. We highlight current gaps in PrEP eligibility, uptake, and adherence, in order to inform PrEP programming for MSM in Kenya. We also focus on acute HIV infection identification and hepatitis B infection screening among MSM in coastal Kenya to understand more about the incidence and prevalence of these two conditions. This thesis includes the development and validation of symptom screening tools for acute HIV infection testing among at-risk adults. Additionally, we evaluate the performance of an empiric risk score tool developed for assessing HIV acquisition risk among MSM, and discuss which sexual risk behaviours should be assessed among MSM to improve PrEP targeting. Furthermore, we summarize findings on PrEP uptake and factors associated with uptake, PrEP adherence, HIV incidence, and loss to follow-up. In a final study, we describe the frequency and determinants of stopping and re-starting PrEP. We discuss these research findings in the context of other sub-Saharan Africa studies involving MSM and suggest strategies for implementation. Finally, we highlight areas for new and ongoing research and HIV prevention programming to strengthen PrEP uptake and adherence among MSM, and offer suggestions how retention of MSM in HIV prevention services can be strengthened.