Maximizing the impact of HIV prevention technologies in sub-Saharan Africa Guest Editors: Helen Ward, Geoff rey P Garnett, Kenneth H Mayer, Gina A Dallabetta Supplement Editors: Marlène Bras, Elisa de Castro Alvarez Volume 22, Supplement 4, July 2019 Acknowledgements The Guest Editors - Helen Ward, Geoff rey P Garnett, Kenneth H Mayer, Gina A Dallabetta - would like to thank all of the authors who responded to our request for contributions, prepared manuscripts, and participated in the rigorous review and selection process. We wish that many more studies could have been included, but hope that this eff ort to compile the latest evidence and scholarship around prevention will continue. We also thank the editors and staff of the Journal of the International AIDS Society for thoughtful guidance, rigorous support, and encouragement throughout the process. Support This supplement was supported by Imperial College London with funding from the Bill & Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the views of the funding agency. Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affi liated. Maximizing the impact of HIV prevention technologies in sub-Saharan Africa Guest Editors: Helen Ward, Geoff rey P Garnett, Kenneth H Mayer, Gina A Dallabetta Supplement Editors: Marlène Bras, Elisa de Castro Alvarez Contents Maximizing the impact of HIV prevention technologies in sub-Saharan Africa Helen Ward, Geoffrey P Garnett, Kenneth H Mayer and Gina A Dallabetta 1 Contextual drivers of HIV risk among young African women Sanyu A Mojola and Joyce Wamoyi 7 Facilitating engagement with PrEP and other HIV prevention technologies through practice-based combination prevention Morten Skovdal 14 Reaching and targeting more effectively: the application of market segmentation to improve HIV prevention programmes Anabel Gomez, Rebecca Loar, Andrea E Kramer and Geoffrey P Garnett 20 HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery Connie L Celum, Sinead Delany-Moretlwe, Jared M Baeten, Ariane van der Straten, Sybil Hosek, Elizabeth A Bukusi, Margaret McConnell, Ruanne V Barnabas and Linda-Gail Bekker 23 Understanding user perspectives of and preferences for oral PrEP for HIV prevention in the context of intervention scale-up: a synthesis of evidence from sub-Saharan Africa Robyn Eakle, Peter Weatherburn and Adam Bourne 30 The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub-Saharan Africa: a mixed methods systematic review Samuel Ensor, Bethan Davies, Tanvi Rai and Helen Ward 40 Cash plus: exploring the mechanisms through which a cash transfer plus financial education programme in Tanzania reduced HIV risk for adolescent girls and young women Audrey Pettifor, Joyce Wamoyi, Peter Balvanz, Margaret W Gichane and Suzanne Maman 54 Strengthening the scale-up and uptake of effective interventions for sex workers for population impact in Zimbabwe Frances M Cowan, Sungai T Chabata, Sithembile Musemburi, Elizabeth Fearon, Calum Davey, Tendayi Ndori-Mharadze, Loveleen Bansi-Matharu, Valentina Cambiano, Richard Steen, Joanna Busza, Raymond Yekeye, Owen Mugurungi, James R Hargreaves and Andrew N Phillips 61 The role of costing in the introduction and scale-up of HIV pre-exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya D Allen Roberts, Ruanne V Barnabas, Felix Abuna, Harison Lagat, John Kinuthia, Jillian Pintye, Aaron F Bochner, Steven Forsythe, Gabriela B Gomez, Jared M Baeten, Grace John-Stewart and Carol Levin 71 HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya Parinita Bhattacharjee, Helgar K Musyoki, Marissa Becker, Janet Musimbi, Shem Kaosa, Japheth Kioko, Sharmistha Mishra, Shajy K Isac, Stephen Moses and James F Blanchard 78 Application of the HIV prevention cascade to identify, develop and evaluate interventions to improve use of prevention methods: examples from a study in east Zimbabwe Louisa Moorhouse, Robin Schaefer, Ranjeeta Thomas, Constance Nyamukapa, Morten Skovdal, Timothy B Hallett and Simon Gregson 86 Author Index 93 Volume 22, Supplement 4 July 2019 Ward H et al. Journal of the International AIDS Society 2019, 22(S4):e25319 http://onlinelibrary.wiley.com/doi/10.1002/jia2.25319/full | https://doi.org/10.1002/jia2.25319 EDITORIAL Maximizing the impact of HIV prevention technologies in sub-Saharan Africa Helen Ward1§ , Geoffrey P Garnett2, Kenneth H Mayer3 and Gina A Dallabetta2 §Corresponding author: Helen Ward, Infectious Disease Epidemiology, School of Public Health, Norfolk Place, London W2 1PG, United Kingdom. Tel: +44 (0) 207 594 3303. ([email protected]) Keywords: HIV; prevention; pre-exposure prophylaxis; Africa South of the Sahara; health technology Received 24 April 2019; Accepted 16 May 2019 Copyright © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. 1 | INTRODUCTION populations in sub-Saharan Africa [10]. In particular, the lack of widely available efficacious female-controlled methods has There have been substantial gains in the range and efficacy of left many young women vulnerable to HIV when their part- technologies available for HIV prevention, with voluntary ners are unwilling to use condoms [11]. While newer technolo- medical male circumcision (VMMC), treatment as prevention, gies such as long-acting injectable PrEP have potential for and pre-exposure prophylaxis (PrEP) being added to the existing additional impact, they too may disappoint if the lessons of toolbox of condoms, lubricant, behaviour change, harm reduc- existing programmes are not learned and programmes not tion, structural interventions and advocacy programmes. These scaled sufficiently. advances led to the optimism of calls to end the AIDS epidemic Adolescent girls and young women are at particular risk, by 2030 with a target of fewer than 500,000 new cases a year accounting for 25% of new HIV infections among adults in sub- by 2020 and 200,000 by 2030 [1,2]. However, progress Saharan Africa, and with three to five times the prevalence of towards these goals is slow with an estimated 1.9 million new adolescent boys and young men [7,10]. Reducing the high inci- infections in 2017 globally, including over a million in sub- dence in these young populations is perhaps the most urgent Saharan Africa [3]. Although these numbers represent a sub- global challenge, particularly as 60% of the population in sub- stantial reduction from the height of the epidemic in the late Saharan Africa is aged under 25 and absolute numbers of young 1990s, they are well off target despite intensive efforts to pro- people will continue to rise over the coming decades [12]. mote HIV combination prevention encompassing structural, It will be important to identify the mix of prevention tech- behavioural and biomedical interventions. The targets were nologies and approaches that will meet the needs of these based on modelling which estimated the coverage needed to young people, in order to design the interventions that will achieve these reductions, namely meeting 90-90-90 treatment support their adoption. This requires an interdisciplinary targets, 90% coverage of key populations with combination pre- approach, with the appropriate mix of social, behavioural, epi- vention programmes, 90% reported condom use rates with demiological and programme science, with learning from key non-regular partners and 90% male circumcision [2]. However, stakeholders including young people themselves, service provi- investment in prevention has been lower than required to ders, policy makers, industry and governments. The community achieve this coverage [4], and results from trials of intensive perspectives about health and HIV, and their health seeking population “test and treat” approaches show a lower impact behaviour need to be taken into account along with the deter- than hoped for, with up to 30% reduction in incidence, but with minants of decisions about the HIV risk behaviours and the lower engagement and coverage of younger people [5,6]. use of HIV prevention technologies. Demographic, geographic Reducing incident infections is a key to sustainable HIV con- and other characteristics should inform how HIV prevention trol, and epidemic models suggest that further primary pre- interventions are prioritized and should be designed around vention is necessary in addition to treatment for those the needs and preferences of priority users. already infected if the 2030 targets are to be reached [7]. This all points to the need for increased efforts in order to maximize the impact of technologies, including those currently 2 | THE TECHNOLOGIES in development. While there is good evidence for efficacy of the technologies and strategies in some populations [8,9], they Condoms provide triple protection against HIV, pregnancy have failed to reach their potential in many high incidence and many other sexually transmitted infections [13]. They