1
|
Adede DO, Sheira LA, Gutin SA, Ochung A, Ayieko B, Olugo P, Lewis-Kulzer J, Charlebois ED, Camlin CS, Thirumurthy H, Agot K, Kwena Z, Gandhi M. Comparing PrEP adherence via objective and self-reported measures among fishermen working on Lake Victoria, Kenya. AIDS Care 2025; 37:749-757. [PMID: 40238797 DOI: 10.1080/09540121.2025.2484312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 03/17/2025] [Indexed: 04/18/2025]
Abstract
Fishermen working along Lake Victoria experience high rates of HIV acquisition that can be mitigated by pre-exposure prophylaxis (PrEP), which requires adequate adherence for effective prevention. We evaluated PrEP adherence among Kenyan fishermen using objective metrics and examine non-adherence. Data are from the Owete study (NCT04772469), a cluster randomized-controlled trial using a social network approach among fishermen to increase HIV testing and linkage to care. Survey and lab data were collected from PrEP users. We measured recent objective adherence via a point-of-care tenofovir urine assay. We conducted a logistic regression to assess the relationship between self-reported adherence data and urine tenofovir detection. Among 71 PrEP users, 34% self-reported ≥90% PrEP adherence. Reasons for non-adherence included not feeling at risk (31%), being away and without medication (27%), or feeling they did not need PrEP (24%). Detectable PrEP in urine was low (17%). Self-reported PrEP non-adherence within 30 days was associated with 13.29 times the odds of non-detection of urine tenofovir (95% CI: 2.20, 80.43). The point-of-care tenofovir assay was a valuable tool for objectively measuring PrEP adherence. Interventions to bolster PrEP adherence are needed to prevent HIV acquisition among fishermen, as are longer-acting products with lower demands for adherence.
Collapse
Affiliation(s)
- Daniel O Adede
- Impact Research and Development Organization, Kisumu, Kenya
| | - Lila A Sheira
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA, USA
| | - Sarah A Gutin
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA
| | - Antony Ochung
- Impact Research and Development Organization, Kisumu, Kenya
| | - Bernard Ayieko
- Impact Research and Development Organization, Kisumu, Kenya
| | - Phoebe Olugo
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Edwin D Charlebois
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Prevention Sciences, University of California, San Francisco, CA, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Zachary Kwena
- Kenya Medical Research Institute, Centre for Microbiology Research, Kisumu, Kenya
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
2
|
Dietrich JJ, Atujuna M, Tshabalala G, Hornschuh S, Mulaudzi M, Koh M, Ahmed N, Muhumuza R, Ssemata AS, Otwombe K, Bekker LG, Seeley J, Martinson NA, Terris-Prestholt F, Fox J. A qualitative study to identify critical attributes and attribute-levels for a discrete choice experiment on oral pre-exposure prophylaxis (PrEP) delivery among young people in Cape Town and Johannesburg, South Africa. BMC Health Serv Res 2021; 21:17. [PMID: 33407395 PMCID: PMC7788832 DOI: 10.1186/s12913-020-05942-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The uptake and adherence of daily oral PrEP has been poor in high-risk populations in South Africa including young people. We used qualitative research methods to explore user preferences for daily and on-demand oral PrEP use among young South Africans, and to inform the identification of critical attributes and attribute-levels for quantitative analysis of user preferences, i.e. a discrete choice experiment (DCE). METHODS Data were collected between September and November 2018 from eight group discussions and 20 in-depth interviews with young people 13 to 24 years in Cape Town and Johannesburg. Using a convenience sampling strategy, participants were stratified by sex and age. Interviewers used a semi-structured interview guide to discuss several attributes (dosing regimen, location, costs, side effects, and protection period) for PrEP access and use. Group discussions and in-depth interviews were audio-recorded, transcribed verbatim and translated to English. We used framework analysis to explore context-specific attributes and attribute-levels for delivering oral PrEP in South Africa. The adolescent community advisory board, expert and study team opinions were consulted for the final DCE attributes and levels. RESULTS We enrolled 74 participants who were 51% (n = 38/74) male, had a median age of 18.5 [Interquartile range = 16-21.25] years, 91% (n = 67/74) identified as heterosexual and 49% (n = 36/74) had not completed 12th grade education. Using the qualitative data, we identified five candidate attributes including (1) dosing regimen, (2) location to get PrEP, (3) cost, (4) route of administration and (5) frequency. After discussions with experts and the study team, we revised the DCE to include the following five attributes and levels: dosing regime: daily, and on-demand PrEP; location: private pharmacy, public clinic, mobile clinic, ATM); cost: free-of-charge, R50 (~2GBP), R265 (~12GBP); side effects: nausea, headache, rash; and duration of protection: fulltime protection versus when PrEP is used). CONCLUSIONS There is limited literature on qualitative research methods describing the step-by-step process of developing a DCE for PrEP in adolescents, especially in resource-constrained countries. We provide the process followed for the DCE technique to understand user preferences for daily and on-demand oral PrEP among young people in South Africa.
Collapse
Affiliation(s)
- Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa.
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Gugulethu Tshabalala
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mamakiri Mulaudzi
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Koh
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - Nadia Ahmed
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.,Mortimer Market Centre, Central North West London NHS Trust, Off Caper Street, London, WC1E 6 JB, UK
| | - Richard Muhumuza
- Medical Research Council/Uganda Virus Research Institute , Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew S Ssemata
- Medical Research Council/Uganda Virus Research Institute , Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute , Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil A Martinson
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | |
Collapse
|
3
|
Weinrib R, Browne EN, Shapley-Quinn MK, van der Straten A, Beksinska M, Mgodi N, Musara P, Mphili N, Schwartz JL, Ju S, Hanif H, Montgomery ET. Perspectives from Young South African and Zimbabwean Women on Attributes of Four (Placebo) Vaginal Microbicide Delivery Forms. AIDS Behav 2020; 24:637-647. [PMID: 31254190 PMCID: PMC6988116 DOI: 10.1007/s10461-019-02576-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Incorporating end-user input into the design of new vaginal microbicides for women is key to optimizing their uptake, consistent use, and, ultimately, success in combatting the heterosexual HIV epidemic. Methods The Quatro Study assessed four placebo forms of vaginally inserted HIV-microbicides among young microbicide-naïve African women: on-demand film, insert and gel, and monthly ring. Participants randomly used each product for 1 month and provided product satisfaction ratings (1–5 scale), and opinions on product attributes and potential alternative designs. Qualitative data were collected through focus group discussions at study exit. Multivariable associations between attribute opinions and overall product rating were examined using Poisson regression models with robust standard errors to assess the attributes most influential to satisfaction. Results Overall opinions of products and their individual attributes were generally positive; all products were rated either 4 or a 5 by ≥ 50% of participants. Attributes related to ease of use and interference with normal activities were the most salient predictors of satisfaction. Preferences for duration of use tended toward relatively shorter use periods for the ring (i.e., 1–3 months vs. 12 months) and for coitally independent dosing for the on-demand products. Conclusions How well a product fit in with participants’ lifestyles was important to their overall satisfaction. For on-demand products, greater flexibility around timing of use was desired, to avoid coital dependency of the dosing. Electronic supplementary material The online version of this article (10.1007/s10461-019-02576-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- R Weinrib
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA.
- RTI Health Solutions, RTI International, Barcelona, Spain.
| | - E N Browne
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - M K Shapley-Quinn
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - A van der Straten
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of San Francisco, San Francisco, CA, USA
| | - M Beksinska
- MatCH Research Unit, Department of Obstetrics and Gynaecology, School of Clinical Sciences, University of the Witwatersrand, Durban, South Africa
| | - N Mgodi
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, Harare, Zimbabwe
| | - P Musara
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, Harare, Zimbabwe
| | - N Mphili
- MatCH Research Unit, Department of Obstetrics and Gynaecology, School of Clinical Sciences, University of the Witwatersrand, Durban, South Africa
| | - J L Schwartz
- Eastern Virginia Medical School, CONRAD, Arlington, VA, USA
| | - S Ju
- Eastern Virginia Medical School, CONRAD, Arlington, VA, USA
| | - H Hanif
- Eastern Virginia Medical School, CONRAD, Arlington, VA, USA
| | - E T Montgomery
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| |
Collapse
|
4
|
Why I Quit Pre-Exposure Prophylaxis (PrEP)? A Mixed-Method Study Exploring Reasons for PrEP Discontinuation and Potential Re-initiation Among Gay and Bisexual Men. AIDS Behav 2018; 22:3566-3575. [PMID: 29404756 DOI: 10.1007/s10461-018-2045-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Literature concerning pre-exposure prophylaxis (PrEP) among gay and bisexual identifying men (GBM) has explored facilitators and barriers to uptake and adherence. Far less reported are the reasons why GBM discontinue PrEP use. A national sample of 1071 GBM completed surveys about PrEP use and discontinuation. Participants who were still taking PrEP the 24-month follow up were compared to those that had stopped. Eighteen percent (n = 31) of GBM who reported ever using PrEP discontinued use. Younger (AOR = 0.96; 95% CI 0.92-1.00), and unemployed (AOR = 4.58; 95% CI 1.43-14.70) GBM were more likely to discontinue PrEP than their counterparts. Those that discontinued provided details on why via a free response question. The most common reasons for discontinuation were lower perceived HIV risk (50%) and cost/insurance (30%). Reasons for potential re-initiation included higher-risk sexual activities and changes to structural related barriers. More research is needed to inform interventions on how GBM can continue taking PrEP during changes to employment that effect insurance coverage and cost.
Collapse
|
5
|
Franks J, Hirsch-Moverman Y, Loquere AS, Amico KR, Grant RM, Dye BJ, Rivera Y, Gamboa R, Mannheimer SB. Sex, PrEP, and Stigma: Experiences with HIV Pre-exposure Prophylaxis Among New York City MSM Participating in the HPTN 067/ADAPT Study. AIDS Behav 2018; 22:1139-1149. [PMID: 29143163 PMCID: PMC5878834 DOI: 10.1007/s10461-017-1964-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The HPTN 067/Alternative Dosing to Augment Pre-Exposure Prophylaxis Pill Taking (ADAPT) study evaluated daily and non-daily dosing schedules for oral pre-exposure prophylaxis (PrEP) to prevent HIV. A qualitative sub-study including focus groups and in-depth interviews was conducted among men who have sex with men participating in New York City to understand their experience with PrEP and study dosing schedules. The 37 sub-study participants were 68% black, 11% white, and 8% Asian; 27% were of Hispanic/Latino ethnicity. Mean age was 34 years. Themes resulting from qualitative analysis include: PrEP is a significant advance for HIV prevention; non-daily dosing of PrEP is congruent with HIV risk; and pervasive stigma connected to HIV and risk behavior is a barrier to PrEP adherence, especially for non-daily dosing schedules. The findings underscore how PrEP intersects with other HIV prevention practices and highlight the need to understand and address multidimensional stigma related to PrEP use.
Collapse
Affiliation(s)
- Julie Franks
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA.
| | - Yael Hirsch-Moverman
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Avelino S Loquere
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Robert M Grant
- Gladstone Institutes, University of California, San Francisco, San Francisco, CA, USA
| | | | - Yan Rivera
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
| | - Robert Gamboa
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
| | - Sharon B Mannheimer
- ICAP at Columbia University, Harlem Prevention Center, 215 W. 125th St., Suite A, New York, NY, 10027, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Harlem Hospital Center, New York, NY, USA
| |
Collapse
|
6
|
Will Gay and Bisexual Men Taking Oral Pre-exposure Prophylaxis (PrEP) Switch to Long-Acting Injectable PrEP Should It Become Available? AIDS Behav 2018; 22:1184-1189. [PMID: 28913659 DOI: 10.1007/s10461-017-1907-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Oral pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV transmission risk and is CDC recommended for many gay, bisexual, and other men who have sex with men (GBM). We sought to investigate awareness of and preference for using long-acting injectable PrEP (LAI-PrEP) among GBM currently taking oral PrEP (n = 104), and identify their concerns. About half of GBM had heard of LAI-PrEP, and 30.8% specifically preferred LAI-PrEP. GBM with more concerns about the level of protection and drug half-life of LAI-PrEP had lower odds of preferring LAI-PrEP. Given that daily pill adherence is a challenge for some on PrEP, it is important to investigate the degree to which those on PrEP might consider LAI-PrEP as an alternative.
Collapse
|
7
|
Robinson JA, Marzinke MA, Fuchs EJ, Bakshi RP, Spiegel HML, Coleman JS, Rohan LC, Hendrix CW. Comparison of the Pharmacokinetics and Pharmacodynamics of Single-Dose Tenofovir Vaginal Film and Gel Formulation (FAME 05). J Acquir Immune Defic Syndr 2018; 77:175-182. [PMID: 29135651 PMCID: PMC5821271 DOI: 10.1097/qai.0000000000001587] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Although preexposure prophylaxis with oral tenofovir (TFV) disoproxil fumarate/emtricitabine reduces HIV acquisition rates, poor adherence to and acceptability of daily vaginal gels have led to development of vaginal film formulations to improve adherence and, potentially, to enable episodic use. STUDY DESIGN In this 2-arm, cross-over study of a fast-dissolving tenofovir film (40 mg) compared with a previously studied semisolid tenofovir 1% gel (40 mg), 10 healthy women received a single vaginal dose of each study product. Clinical, pharmacokinetic, and antiviral assessments were performed over 1 week after dose. RESULTS Nine of 10 participants experienced mild to moderate adverse effects, similar between products, with no severe adverse events or events attributed to study products. TFV concentrations after film dosing exceeded concentrations after gel dosing in plasma between 8 and 24 hours (P ≤ 0.02). TFV concentrations in cervicovaginal fluid and both TFV and TFV diphosphate concentrations in cervical tissue homogenates were higher after film dosing (all P values < 0.04). The differences ranged from median (interquartile range) 2.9-fold (1.1, 9.0; midvaginal cervicovaginal fluid) to 4.4-fold (2.9, 7.7; plasma). Neither film nor gel demonstrated reduced cervical tissue biopsy infectivity after ex vivo HIV challenge. CONCLUSION Single-dose tenofovir film demonstrated consistently higher concentrations in plasma and cervicovaginal samples when compared with gel during the first day after dosing. Single-dose cervical tissue TFV-diphosphate concentrations at 5 hours exceeded steady-state concentrations previously reported with daily oral Truvada dosing. Tenofovir film may provide an alternative to tenofovir oral and gel formulations. Clinical efficacy remains to be tested.
Collapse
Affiliation(s)
- Jennifer A. Robinson
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Mark A. Marzinke
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Edward J. Fuchs
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Rahul P. Bakshi
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Hans M. L. Spiegel
- Kelly Government Solutions, Contractor to Division of AIDS, PMPRB/Prevention Sciences Program, Division of AIDS, NIAID, NIH, Rockville, MD
| | - Jenell S. Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Lisa C. Rohan
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Craig W. Hendrix
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
8
|
Closson EF, Mitty JA, Malone J, Mayer KH, Mimiaga MJ. Exploring strategies for PrEP adherence and dosing preferences in the context of sexualized recreational drug use among MSM: a qualitative study. AIDS Care 2018; 30:191-198. [PMID: 28830220 DOI: 10.1080/09540121.2017.1360992] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The use of recreational drugs while having sex is associated with increased HIV incidence among men who have sex with men (MSM). Taking a daily antiretroviral pill, or pre-exposure prophylaxis (PrEP) is a biomedical intervention to prevent HIV. However, the efficacy of PrEP is closely tied with high levels of adherence. While PrEP has the potential to reduce HIV acquisition, the use of recreational drugs may impede adherence. We explored perceptions of PrEP utilization and regimen preferences among 40 HIV-negative, MSM who reported concurrent recreational drug use and condomless anal sex with a man. Semi-structured qualitative interviews were conducted and the data were analyzed using a qualitative descriptive approach. Participants perceived that it would be challenging to take PrEP while high on crystal meth, crack, powder cocaine, ecstasy and/or GHB. However, men identified strategies for using PrEP when they were not high on these drugs, including taking the pill when they started their day and integrating PrEP into an established routine, such as when taking other medications or preparing for sex. PrEP regimen preferences seemed to be shaped by the frequency in which participants used drugs and their ability to plan for sex. Taking PrEP everyday was appealing for those who regularly engaged in sexualized recreational drug use. Accounts depict these sexual interactions as frequent but unpredictable. A daily regimen would allow them to be prepared for sex without having to plan. An event-driven regimen was acceptable to men who occasionally used recreational drugs in the context of sex. For this group, sex usually occurred was generally prearranged. Patterns of sex and recreational drug use figured largely into participants' framings of how they would use PrEP. These behaviors will likely play a role in the uptake of and adherence to PrEP among this population.
Collapse
Affiliation(s)
- Elizabeth F Closson
- a The Fenway Institute , Fenway Health , Boston , MA , USA
- b Department of Social and Environmental Health , The London School of Hygiene and Tropical Medicine , London , UK
| | - Jennifer A Mitty
- c Brown University Alpert Medical School , Providence , RI , USA
| | - Jowanna Malone
- a The Fenway Institute , Fenway Health , Boston , MA , USA
- d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Kenneth H Mayer
- a The Fenway Institute , Fenway Health , Boston , MA , USA
- c Brown University Alpert Medical School , Providence , RI , USA
- d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Matthew J Mimiaga
- a The Fenway Institute , Fenway Health , Boston , MA , USA
- c Brown University Alpert Medical School , Providence , RI , USA
- e Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
- f Departments of Epidemiology and Behavioral & Social Health Sciences , Brown University School of Public Health , Providence , RI , USA
- g Institute for Community Health Promotion, Brown University , Providence , RI , USA
| |
Collapse
|
9
|
Vaccher SJ, Gianacas C, Templeton DJ, Poynten IM, Haire BG, Ooi C, Foster R, McNulty A, Grulich AE, Zablotska IB. Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project. Front Public Health 2017; 5:341. [PMID: 29326917 PMCID: PMC5736869 DOI: 10.3389/fpubh.2017.00341] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The effectiveness of daily pre-exposure prophylaxis (PrEP) is well established. However, there has been increasing interest in non-daily dosing schedules among gay and bisexual men (GBM). This paper explores preferences for PrEP dosing schedules among GBM at baseline in the PRELUDE demonstration project. MATERIALS AND METHODS Individuals at high-risk of HIV were enrolled in a free PrEP demonstration project in New South Wales, Australia, between November 2014 and April 2016. At baseline, they completed an online survey containing detailed behavioural, demographic, and attitudinal questions, including their ideal way to take PrEP: daily (one pill taken every day), event-driven (pills taken only around specific risk events), or periodic (daily dosing during periods of increased risk). RESULTS Overall, 315 GBM (98% of study sample) provided a preferred PrEP dosing schedule at baseline. One-third of GBM expressed a preference for non-daily PrEP dosing: 20% for event-driven PrEP, and 14% for periodic PrEP. Individuals with a trade/vocational qualification were more likely to prefer periodic to daily PrEP [adjusted odds ratio (aOR) = 4.58, 95% confidence intervals (95% CI): (1.68, 12.49)], compared to individuals whose highest level of education was high school. Having an HIV-positive main regular partner was associated with strong preference for daily, compared to event-driven PrEP [aOR = 0.20, 95% CI: (0.04, 0.87)]. Participants who rated themselves better at taking medications were more likely to prefer daily over periodic PrEP [aOR = 0.39, 95% CI: (0.20, 0.76)]. DISCUSSION Individuals' preferences for PrEP schedules are associated with demographic and behavioural factors that may impact on their ability to access health services and information about PrEP and patterns of HIV risk. At the time of data collection, there were limited data available about the efficacy of non-daily PrEP schedules, and clinicians only recommended daily PrEP to study participants. Further research investigating how behaviours and PrEP preferences change correspondingly over time is needed. TRIAL REGISTRATION ClinicalTrials.gov NCT02206555. Registered 28 July 2014.
Collapse
Affiliation(s)
| | | | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- RPA Sexual Health, Sydney Local Health District and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Catriona Ooi
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Rosalind Foster
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Clinic 16 Northern Sydney Sexual Health, Royal North Shore Community Health Centre, St Leonards, NSW, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | | |
Collapse
|
10
|
Koechlin FM, Fonner VA, Dalglish SL, O'Reilly KR, Baggaley R, Grant RM, Rodolph M, Hodges-Mameletzis I, Kennedy CE. Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature. AIDS Behav 2017; 21:1325-1335. [PMID: 27900502 PMCID: PMC5378753 DOI: 10.1007/s10461-016-1627-z] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative people to prevent HIV infection. WHO released new guidelines in 2015 recommending PrEP for all populations at substantial risk of HIV infection. To prepare these guidelines, we conducted a systematic review of values and preferences among populations that might benefit from PrEP, women, heterosexual men, young women and adolescent girls, female sex workers, serodiscordant couples, transgender people and people who inject drugs, and among healthcare providers who may prescribe PrEP. A comprehensive search strategy reviewed three electronic databases of articles and HIV-related conference abstracts (January 1990-April 2015). Data abstraction used standardised forms to categorise by population groups and relevant themes. Of 3068 citations screened, 76 peer-reviewed articles and 28 conference abstracts were included. Geographic coverage was global. Most studies (N = 78) evaluated hypothetical use of PrEP, while 26 studies included individuals who actually took PrEP or placebo. Awareness of PrEP was low, but once participants were presented with information about PrEP, the majority said they would consider using it. Concerns about safety, side effects, cost and effectiveness were the most frequently cited barriers to use. There was little indication of risk compensation. Healthcare providers would consider prescribing PrEP, but need more information before doing so. Findings from a rapidly expanding evidence base suggest that the majority of populations most likely to benefit from PrEP feel positively towards it. These same populations would benefit from overcoming current implementation challenges with the shortest possible delay.
Collapse
Affiliation(s)
- Florence M Koechlin
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland.
| | - Virginia A Fonner
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Sarah L Dalglish
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kevin R O'Reilly
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Rachel Baggaley
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Robert M Grant
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Michelle Rodolph
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Ioannis Hodges-Mameletzis
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Caitlin E Kennedy
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| |
Collapse
|
11
|
Robinson JA, Marzinke MA, Bakshi RP, Fuchs EJ, Radebaugh CL, Aung W, Spiegel HM, Coleman JS, Rohan LC, Hendrix CW. Comparison of Dapivirine Vaginal Gel and Film Formulation Pharmacokinetics and Pharmacodynamics (FAME 02B). AIDS Res Hum Retroviruses 2017; 33:339-346. [PMID: 27809557 DOI: 10.1089/aid.2016.0040] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While preexposure prophylaxis with oral tenofovir/emtricitabine reduces HIV acquisition rates, poor adherence to and acceptability of vaginal gels and the potential for evolving drug resistance have led to development of vaginal film formulations and other antiretroviral drugs, respectively, including the non-nucleoside reverse transcriptase inhibitor dapivirine. In this two-arm crossover study of a novel fast-dissolving dapivirine film and a previously studied semisolid dapivirine gel, 10 healthy women received a single 1.25 mg vaginal dose of each study product; one withdrew after the first dose. Clinical, pharmacokinetic, and antiviral pharmacodynamic assessments (ex vivo HIV-BaL challenge of tissue explants) were performed over 168 h postdose. Six of ten participants experienced mild to moderate adverse effects, similar between products, with no severe adverse events or adverse events attributed to study products. There were no statistically significant differences in plasma, cervicovaginal fluid (CVF), or cervical tissue dapivirine concentrations between the gel and film (all p > .05). CVF dapivirine concentrations were 1.5 and 6 log10 greater than tissue and plasma concentrations, respectively (p < .001). Both film and gel demonstrated reduced cervical tissue infectivity after ex vivo HIV challenge 5 h postdose, compared to baseline and 72-h postdose biopsies (p < .05 for gel, p = .06 for film). There was no difference in ex vivo explant HIV challenge between gel and film. The dapivirine film and gel performed similarly in terms of tolerability, pharmacokinetics, and antiviral effect. Dapivirine film may provide an alternative to pharmacokinetically comparable dapivirine gel formulations. Effectiveness remains to be tested.
Collapse
Affiliation(s)
- Jennifer A. Robinson
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Mark A. Marzinke
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Rahul P. Bakshi
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Edward J. Fuchs
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Christine L. Radebaugh
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Wutyi Aung
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| | - Hans M.L. Spiegel
- HJF-DAIDS, a Division of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Jenell S. Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Lisa C. Rohan
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Craig W. Hendrix
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
12
|
Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, Novak DS, Krakower DS, Stall R, Mayer KH. Seasons of Risk: Anticipated Behavior on Vacation and Interest in Episodic Antiretroviral Pre-exposure Prophylaxis (PrEP) Among a Large National Sample of U.S. Men Who have Sex with Men (MSM). AIDS Behav 2016; 20:1400-7. [PMID: 26538056 DOI: 10.1007/s10461-015-1238-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The current analysis evaluates interest in and acceptability of daily PrEP during short episodes of anticipated increased risk (i.e. Epi-PrEP). In 2013, U.S. members of an internet-based MSM sexual networking site were invited to complete a survey about HIV prevention practices in the context of vacationing. 7305 MSM responded to the survey. Of respondents who had vacationed in the past year, 25.6 % reported condomless anal sex (CAS) with new male sex partners while vacationing. Most (92.6 %) respondents agreed that having to use PrEP every day was a barrier to PrEP use and 74.3 % indicated they would take PrEP if they knew it would be helpful for short periods of anticipated increased risk. MSM who reported increased CAS while on vacation in the past year were more likely to indicate that they would take PrEP if it were helpful when used for short periods than respondents who did not (aOR = 2.02, 95 % CI 1.59-2.56, p < 0.001). Studies designed to evaluate uptake, adherence, and protective benefit of short PrEP courses are warranted.
Collapse
Affiliation(s)
- Steven A Elsesser
- The Fenway Institute, Fenway Health, 8th floor, 1340 Boylston Street, Boston, MA, 02115, USA
| | - Catherine E Oldenburg
- The Fenway Institute, Fenway Health, 8th floor, 1340 Boylston Street, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Katie B Biello
- The Fenway Institute, Fenway Health, 8th floor, 1340 Boylston Street, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, 8th floor, 1340 Boylston Street, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Steven A Safren
- The Fenway Institute, Fenway Health, 8th floor, 1340 Boylston Street, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - David S Novak
- OLB Research Institute, Online Buddies, Inc., Cambridge, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, 8th floor, 1340 Boylston Street, Boston, MA, 02115, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ron Stall
- Department of Behavioral and Social Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 8th floor, 1340 Boylston Street, Boston, MA, 02115, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
| |
Collapse
|
13
|
Stack C, Oldenburg C, Mimiaga M, Elsesser SA, Krakower D, Novak DS, Egan JE, Stall R, Safren S, Mayer KH. Sexual Behavior Patterns and PrEP Dosing Preferences in a Large Sample of North American Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2016; 71:94-101. [PMID: 26371786 PMCID: PMC4713279 DOI: 10.1097/qai.0000000000000816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP), taken as a single daily coformulated pill containing tenofovir -emtricitabine, is a promising intervention to reduce the likelihood of HIV acquisition in at-risk individuals, including men who have sex with men. Little is known about the acceptability of less than daily, intermittent PrEP regimens. METHODS We conducted an online survey of North American men who have sex with men to characterize their sexual frequency and planning behaviors and correlate these with PrEP dosing preferences. RESULTS Of the 3217 respondents who completed the survey, 46% reported engaging in unplanned condomless anal intercourse (CAI) at least once in previous 3 months and 8% reported engaging in CAI more than once per week. In multivariable analysis, reporting unplanned CAI was associated with lower educational level, identifying as homosexual/gay as compared with bisexual, being in a monogamous relationship, having a higher self-perceived risk of HIV acquisition, reporting higher income, engaging in CAI more than five times in the last 3 months, and not having visited a health care provider in the previous year. Frequent CAI (>1 time per week) was associated with being younger, identifying as homosexual/gay as compared with bisexual, being in a monogamous relationship, and having a higher self-perceived risk of HIV. Having only planned sex over the last 3 months was associated with a preference for event-based PrEP, whereas having frequent or unplanned CAI was associated with a preference for daily or time-driven PrEP regimens, respectively. CONCLUSION Our findings suggest that preferences for different PrEP regimens are associated with the sexual frequency and planning behaviors of potential users.
Collapse
Affiliation(s)
- Conor Stack
- *Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA;†Department of Epidemiology, Harvard School of Public Health, Boston, MA;‡Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI;§The Fenway Institute, Fenway Health, Boston, MA;¶Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA;#On-Line Buddies, Cambridge, MA;**Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA; and††Department of Psychology, University of Miami, Coral Gables, FL
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Mmeje O, Njoroge B, Cohen CR, Temmerman M, Vermund SH, van der Poel S. Achieving Pregnancy Safely in HIV-Affected Individuals and Couples: An Important Strategy to Eliminate HIV Transmission From Mother-To-Child and Between Sexual Partners. J Acquir Immune Defic Syndr 2015; 70:e155-9. [PMID: 26334740 PMCID: PMC10767706 DOI: 10.1097/qai.0000000000000814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Okeoma Mmeje
- *Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, MI †Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research (CMR) Nairobi, Kenya ‡Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA §Division of Reproductive Health and Research, World Health Organization, Geneva, Switzerland ‖Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
Serodiscordant couples play an important role in maintaining the global HIV epidemic. This review summarizes biobehavioral and biomedical HIV prevention options for serodiscordant couples focusing on advances in 2013 and 2014, including World Health Organization guidelines and best evidence for couples counseling, couple-based interventions, and the use of antiviral agents for prevention. In the past few years, marked advances have been made in HIV prevention for serodiscordant couples and numerous ongoing studies are continuously expanding HIV prevention tools, especially in the area of pre-exposure prophylaxis. Uptake and adherence to antiviral therapy remains a key challenge. Additional research is needed to develop evidence-based interventions for couples, and especially for male-male couples. Randomized trials have demonstrated the prevention benefits of antiretroviral-based approaches among serodiscordant couples; however, residual transmission observed in recognized serodiscordant couples represents an important and resolvable challenge in HIV prevention.
Collapse
Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
| | | |
Collapse
|
16
|
Accuracy of highly sexually active gay and bisexual men's predictions of their daily likelihood of anal sex and its relevance for intermittent event-driven HIV pre-exposure prophylaxis. J Acquir Immune Defic Syndr 2015; 68:449-55. [PMID: 25559594 DOI: 10.1097/qai.0000000000000507] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to examine highly sexually active gay and bisexual men's accuracy in predicting their sexual behavior for the purposes of informing future research on intermittent event-driven HIV Pre-Exposure Prophylaxis. DESIGN For 30 days, 92 HIV-negative men completed a daily survey about their sexual behavior (n = 1688 days of data) and indicated their likelihood of having anal sex with a casual male partner next day. METHOD We used multilevel modeling to analyze the association between self-reported likelihood of and subsequent engagement in anal sex. RESULTS We found a linear association between men's reported likelihood of anal sex with casual partners and the actual probability of engaging in sex, although men overestimated the likelihood of sex. Overall, we found that men were better at predicting when they would not have sex than when they would, particularly if any likelihood value greater than 0% was treated as indicative that sex might occur. We found no evidence that men's accuracy of prediction was affected by whether it was a weekend or whether they were using substances, although both did increase the probability of sex. DISCUSSION These results suggested that, men taking event-driven intermittent Pre-Exposure Prophylaxis, 14% of doses could have been safely skipped with a minimal rate of false negatives using guidelines of taking a dose unless there was no chance (ie, 0% likelihood) of sex on next day. This would result in savings of over US $1300 per year in medication costs per participant.
Collapse
|