Background HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women (TGW) in South Africa have not been widely implemented. Objectives The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility. Method In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP, and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations. Results Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305 days (interquartile range: 232-325 days). Across the follow-up time points, 57% - 72% of participants self-reported taking protective levels of PrEP and 59% - 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation. Conclusion Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP.

中文翻译：

---

南非男男性行为者和跨性别女性的口服暴露前预防措施的摄取、依从性和不良事件。

背景 HIV 预防计划，包括针对男男性行为者 (MSM) 和跨性别女性 (TGW) 的暴露前预防 (PrEP) 在南非尚未得到广泛实施。目标 作者检查了未感染 HIV 的 MSM 和 TGW 的口服 PrEP 摄取、依从性和不良事件，以告知干预的可接受性和可行性。方法 2015 年，为南非两个城市的 MSM 和 TGW 提供了一套全面的 HIV 预防服务，包括每日口服 PrEP，并进行了为期一年的随访。每个站点都使用了不同的 PrEP 交付模型。使用自我报告和药丸计数数据以及替诺福韦二磷酸 (TFV-DP) 浓度来衡量依从性。结果 在符合 PrEP 条件的 135 名参与者中，82 名 (61%) 开始了 PrEP，其中 67 名 (82%) 在研究结束时接受了 PrEP。在 314.5 天（93% 的受保护天数）中，参与者接受 PrEP 的中位数为 294 天。从 PrEP 开始到停止或研究结束的中位时间为 305 天（四分位间距：232-325 天）。在后续时间点，57% - 72% 的参与者自我报告服用了保护水平的 PrEP，59% - 74% 的参与者坚持服用 PrEP，如药丸计数所示。更少 (≤ 18%) 在干血斑中达到 ≥ 700 fmol/punch 的保护性 TFV-DP 浓度。副作用虽然通常很轻微，但却是参与者最常提到的早期停用 PrEP 的原因。结论 许多 MSM 和 TGW 发起并维护了 PrEP，表明 PrEP 可以在不同的计划环境中成功地交付给南非 MSM 和 TGW。生物依从性措施表明 MSM 和 TGW 可能会遇到定期服用 PrEP 的挑战。建议为应对副作用和鼓励每日服药提供咨询，以支持南非 MSM 和 TGW 通过 PrEP 实现保护。