Adherence to daily, oral TDF/FTC PrEP during periconception among HIV-exposed South African women

Frontiers in Reproductive Health

Reproductive Health

Jessica E. Haberer¹  Mxolisi Mathenjwa²  Kayla R. Hendrickson³  Kathleen E. Hurwitz³  Kara Bennett³  Jared M. Baeten⁴  Christina Psaros⁵  Patricia M. Smith⁶  Lynn T. Matthews⁶  Oluwaseyi O. Isehunwa⁶  Yolandie Kriel⁷  Manjeetha Jaggernath⁷  Jennifer A. Smit⁷  David R. Bangsberg⁸ 

[1] Center for Global Health, Massachusetts General Hospital, Boston, MA, United States;Department of Medicine, Harvard Medical School, Boston, MA, United States;Department of Epidemiology and Prevention, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa;Department of Epidemiology and Statistics, Target RWE, Durham, NC, United States;Department of Medicine, University of Washington, Seattle, WA, United States;Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States;MRU (Maternal, Adolescent and Child Health Research Unit), University of the Witwatersrand, Durban, South Africa;Vin University College of Health Sciences, Hanoi, Vietnam;

关键词: HIV prevention;    oral pre-exposure prophylaxis (PrEP);    adherence;    women;    periconception;    group-based trajectory modeling (GBTM);   

DOI  :  10.3389/frph.2023.1263422

 received in 2023-07-19, accepted in 2023-09-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundDaily, oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as pre-exposure prophylaxis (PrEP) reduces HIV acquisition for African women. Adherence is key to efficacy and patterns of adherence can be highly variable in real-world settings. Using group-based trajectory modeling (GBTM), we sought to identify distinct patterns of periconception PrEP adherence and evaluate potential baseline predictors of such adherence trajectories.MethodsWe conducted a single-arm longitudinal study for women aged 18–35 years living in Durban, South Africa with personal or partner plans for pregnancy with a partner with HIV or of unknown serostatus. Participants were offered safer conception counseling, including daily oral PrEP; women who initiated PrEP were given a bottle with an electronic pillcap that recorded when device opens. Weekly adherence to daily PrEP was modeled using GBTM with a censored normal outcome distribution as a function of weeks since PrEP initiation. The number and functional form of the adherence trajectory groups were primarily selected based on Bayesian information criteria (BIC) and confirmed by mean estimated probabilities of group membership. A multivariable version of the selected model assessed baseline predictors of membership in adherence trajectory groups.ResultsOverall mean (95% CI) adherence to PrEP was 63% (60%, 67%). We identified four groups of women with distinct patterns of adherence: (1) high (i.e., ≥6 doses per week) steady adherence throughout follow-up (22% of PrEP initiators); (2) moderate (i.e., 4–5 doses per week), but steady adherence (31%); (3) initially high, but consistently declining adherence (21%); and (4) initially moderate adherence, followed by a rapid decline and subsequent rebound (26%). In multivariable-adjusted analyses, older age was associated with membership in the high, steady adherence group as compared to the group identified with an adherence trajectory of initially high, then decline, and finally a rebound.ConclusionsGBTM is useful for exploring potential heterogeneity in longitudinal patterns of medication adherence. Although a large proportion of women in this study achieved high levels of adherence by electronic pillcap initially, far fewer women maintained these levels consistently. Knowledge of different adherence trajectories could be used to develop targeted strategies for optimizing HIV prevention during periconception.

【 授权许可】

Unknown   
© 2023 Hurwitz, Isehunwa, Hendrickson, Jaggernath, Kriel, Smith, Mathenjwa, Bennett, Psaros, Baeten, Bangsberg, Haberer, Smit and Matthews.