1
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Beauchamp G, Hosek S, Donnell D, Chan KCG, Anderson PL, Dye BJ, Mgodi N, Bekker LG, Delany-Moretlwe S, Celum C. The Effect of Disclosure of PrEP Use on Adherence Among African Young Women in an Open-Label PrEP Study: Findings from HPTN 082. AIDS Behav 2024; 28:1512-1521. [PMID: 37768427 PMCID: PMC11069481 DOI: 10.1007/s10461-023-04175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
To develop effective PrEP adherence interventions, it is important to understand the interplay between disclosure of pre-exposure prophalxis (PrEP) use, social support, and PrEP adherence. We leveraged the HPTN 082 study conducted among 451 adolescent girls and young women (AGYW) (ages 16 to 25 years, 2016 to 2019) in South Africa and Zimbabwe. Among the 349 who had month three disclosure and PrEP adherence data, 60% (n = 206) felt supported by adults, and 89% (n = 309) disclosed PrEP use to at least one person. PrEP disclosure was not associated with increased adherence, measured by intracellular tenofovir-diphosphate concentrations in dried blood spots. Women who reported having supportive adults, and disclosed to their parents, had higher adherence at 6 months with an increase of 177 fmol/punch (95% CI 12 to 343, t = 2.11, p = 0.04). PrEP interventions that help AGYW identify supportive relationships and effectively communicate the benefits of PrEP may improve PrEP adherence.Clinicaltrials.gov ID number: NCT02732730.
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Affiliation(s)
- Geetha Beauchamp
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, Seattle, WA, 98109, USA.
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Deborah Donnell
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, Seattle, WA, 98109, USA
| | - Kwun C G Chan
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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2
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Kestelyn E, Van Nuil JI, Umulisa MM, Umutoni G, Uwingabire A, De Baetselier I, Uwineza M, Agaba S, Crucitti T, Delvaux T, van de Wijgert JHHM. High adherence to intermittent and continuous use of a contraceptive vaginal ring among women in a randomized controlled trial in Kigali, Rwanda. Front Glob Womens Health 2024; 5:1278981. [PMID: 38680542 PMCID: PMC11047128 DOI: 10.3389/fgwh.2024.1278981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background The introduction of female-initiated drug-delivery methods, including vaginal rings, have proven to be a promising avenue to address sexually transmitted infections and unintended pregnancies, which disproportionally affects women and girls in sub-Saharan Africa. Efficient uptake of existing and new technologies such as vaginal rings requires in depth understanding of product adherence. This remains a major challenge as data on adherence to vaginal rings from African countries is limited. In this study, we explored adherence of contraceptive vaginal ring (NuvaRing®) use in Kigali, Rwanda using a mixed methods approach. Methods We collected quantitative and qualitative data at multiple time points from women participating in a clinical trial exploring the safety and acceptability of either intermittent or continuous use of the NuvaRing®. Various adherence categories were used including monthly and cumulative adherence measurement. The quantitative data were analysed using R and the qualitative data were analysed using a deductive, content-analytical approach based on categories related to the quantitative adherence measures. All data were compared and triangulated. Results Data from 120 enrolled participants showed that self-reported adherence was high at every study visit in both study groups. At first study visit 80% of the intermittent ring users and 79.7% of the continuous ring users reported perfect adherence (assessed as "the ring was never out"). Reporting of ring expulsions and removals were highest (28.3%) at the beginning of the trial. Self-reported perfect ring adherence increased during the study and reports of ring expulsions and removals declined as familiarity with this contraceptive method increased. The percentage of women with perfect cumulative adherence was non-significantly higher in the intermittent (61.7%) than in the continuous use group (54.3%). The low rate of discrepant adherence data after triangulation (6%) is in line with the perception of the participants as adherent throughout the study. Conclusions Self-reported adherence in both study groups was high with removals and expulsions being within the expected product range. Comprehensive adherence data triangulation allowed for a deeper understanding of context-driven behaviour that shaped adherence patterns and challenges. Our data categorisation and triangulation approach has shown potential for implementation in future vaginal ring studies aiming to better understand and measure adherence.
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Affiliation(s)
- Evelyne Kestelyn
- Rinda Ubuzima, Kigali, Rwanda
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer Ilo Van Nuil
- Rinda Ubuzima, Kigali, Rwanda
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Janneke H. H. M. van de Wijgert
- Rinda Ubuzima, Kigali, Rwanda
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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3
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Boering P, Seeley J, Buule J, Kamacooko O, King R. A Comparison of Self-reported Condomless Sex and Yc-DNA Biomarker Data from Young Women Engaged in High Risk Sexual Activity in Kampala, Uganda. AIDS Behav 2024; 28:320-331. [PMID: 37751111 PMCID: PMC10803388 DOI: 10.1007/s10461-023-04177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
Reporting of condom-use can limit researchers' understanding of high-risk sexual behaviours. We compared self-reported condom-use with the Yc-DNA biomarker data and investigated potential factors influencing participation in, and reporting of, sexual behaviours. Self-reported data were collected using Audio Computer Assisted Self Interviews (ACASI) and samples for Yc-DNA biomarker were collected using self-administered and health worker-collected vaginal swabs from 644 women (aged 15-24 years) who were not living with HIV. Yc-DNA results and interview data were compared using McNemar-Bowker Analysis and Cohen's Kappa. Test statistics for Yc-DNA biomarker were calculated. Log Binomial models for Yc-DNA and self-reported results were conducted to assess for association. We found strong evidence (p < 0.001) for a difference between Yc-DNA and self-reported results. 13.7% of participants reported consistent condom-use with all partners, regardless of HIV status. Self-reported condom-use was discordant in 50.0% (n = 206) of cases, when compared to Yc-DNA results. Positive Yc-DNA results were found to be associated with older age (RR 1.36; 95%CI 1.04, 1.76 p = 0.023). Self-reported condom-use with partners with unknown HIV status was associated with higher education (RR 0.76; 95%CI 0.58,0.99 p = 0.043). Sensitivity analysis did not determine difference between methods for controlling for missing data. We found significant under-reporting of condomless sex in the self-reported data when compared to Yc-DNA results.
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Affiliation(s)
- Pippa Boering
- London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK.
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
| | - Joshua Buule
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Rachel King
- University of California, San Francisco, CA, USA
- INSERM, 60 Rue de Navacelles, 34090, Montpellier, France
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4
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Silhol R, Nordsletten A, Maheu-Giroux M, Elmes J, Staunton R, Owen B, Shacklett B, McGowan I, Feliciano KG, van der Straten A, Eller LA, Robb M, Marrazzo J, Dimitrov D, Boily MC. The Association Between Heterosexual anal Intercourse and HIV Acquisition in Three Prospective Cohorts of Women. AIDS Behav 2023; 27:4010-4021. [PMID: 37392271 PMCID: PMC10598156 DOI: 10.1007/s10461-023-04115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
The extent to which receptive anal intercourse (RAI) increases the HIV acquisition risk of women compared to receptive vaginal intercourse (RVI) is poorly understood. We evaluated RAI practice over time and its association with HIV incidence during three prospective HIV cohorts of women: RV217, MTN-003 (VOICE), and HVTN 907. At baseline, 16% (RV 217), 18% (VOICE) of women reported RAI in the past 3 months and 27% (HVTN 907) in the past 6 months, with RAI declining during follow-up by around 3-fold. HIV incidence in the three cohorts was positively associated with reporting RAI at baseline, albeit not always significantly. The adjusted hazard rate ratios for potential confounders (aHR) were 1.1 (95% Confidence interval: 0.8-1.5) for VOICE and 3.3 (1.6-6.8) for RV 217, whereas the ratio of cumulative HIV incidence by RAI practice was 1.9 (0.6-6.0) for HVTN 907. For VOICE, the estimated magnitude of association increased slightly when using a time-varying RAI exposure definition (aHR = 1.2; 0.9-1.6), and for women reporting RAI at every follow-up survey (aHR = 2.0 (1.3-3.1)), though not for women reporting higher RAI frequency (> 30% acts being RAI vs. no RAI in the past 3 months; aHR = 0.7 (0.4-1.1)). Findings indicated precise estimation of the RAI/HIV association, following multiple RVI/RAI exposures, is sensitive to RAI exposure definition, which remain imperfectly measured. Information on RAI practices, RAI/RVI frequency, and condom use should be more systematically and precisely recorded and reported in studies looking at sexual behaviors and HIV seroconversions; standardized measures would aid comparability across geographies and over time.
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Affiliation(s)
- Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK.
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK.
| | - Ashley Nordsletten
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Jocelyn Elmes
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
| | - Roisin Staunton
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
| | - Branwen Owen
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
| | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Ian McGowan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ariane van der Straten
- Center for AIDS Prevention studies, University of California, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | - Leigh Anne Eller
- Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Merlin Robb
- Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jeanne Marrazzo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK
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5
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Young AM, Mancuso N, Atujuna M, Tenza S, Chitukuta M, Kemigisha D, Ngure K, van der Straten A, Garcia M, Szydlo D, Soto-Torres L, Roberts ST. Adolescent Girls and Young Women's Experiences with Disclosing Oral PrEP or Dapivirine Vaginal Ring Use: a Multi-Country Qualitative Analysis. AIDS Behav 2023; 27:3941-3951. [PMID: 37392268 PMCID: PMC10598125 DOI: 10.1007/s10461-023-04109-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/03/2023]
Abstract
Effective use of oral pre-exposure prophylaxis (PrEP) has been low among adolescent girls and young women (AGYW) in Eastern and Southern Africa, partly due to stigma and opposition from key influencers. Understanding AGYW's experiences of disclosure of different PrEP modalities to key influencers may inform strategies to motivate uptake and adherence. We analyzed qualitative in-depth interviews and focus group discussions data from 119 participants in the MTN-034/REACH (Reversing the Epidemic in Africa with Choices in HIV Prevention) study of oral PrEP and the dapivirine vaginal ring (ring) to explore AGYW's disclosure experiences. We found that AGYW disclosure experiences varied across influencers and product type. The ring was disclosed less often to most influencers, except partners, because it was discreet. Oral PrEP was disclosed more often, because pills were more common and to avoid HIV stigma given that oral PrEP resembled HIV treatment. Ultimately, disclosure typically led most key influencers to support product use through reminders and encouragement. While disclosure yielded positive support from influencers, further community awareness of both PrEP products is essential to reduce potential opposition and perceived stigma.Clinical Trial Number: NCT03593655.
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Affiliation(s)
- Alinda M Young
- Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA.
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Noah Mancuso
- Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
| | | | - Siyanda Tenza
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Miria Chitukuta
- University of Zimbabwe Clinical Trials Research Centre (UZ-CTRC), Harare, Zimbabwe
| | - Doreen Kemigisha
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Ariane van der Straten
- ASTRA Consulting, Kensington, CA and CAPS, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Danny Szydlo
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Maryland, MD, USA
| | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA, 94704, USA
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Roberts ST, Mancuso N, Williams K, Nabunya HK, Mposula H, Mugocha C, Mvinjelwa P, Garcia M, Szydlo DW, Soto‐Torres L, Ngure K, Hosek S. How a menu of adherence support strategies facilitated high adherence to HIV prevention products among adolescent girls and young women in sub-Saharan Africa: a mixed methods analysis. J Int AIDS Soc 2023; 26:e26189. [PMID: 37936551 PMCID: PMC10630658 DOI: 10.1002/jia2.26189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION Effective use of pre-exposure prophylaxis (PrEP) has been low among adolescent girls and young women (AGYW) in sub-Saharan Africa. The MTN-034/REACH trial offered AGYW a menu of adherence support strategies and achieved high adherence to both daily oral PrEP and the monthly dapivirine vaginal ring. Understanding how these strategies promoted product use could inform the design of adherence support systems in programmatic settings. METHODS REACH was a randomized crossover trial evaluating the safety of and adherence to the ring and oral PrEP among 247 HIV-negative AGYW (ages 16-21) in South Africa, Uganda and Zimbabwe from January 2019 to September 2021 (NCT03593655). Adherence support included monthly counselling sessions with drug-level feedback (DLF) plus optional daily short message service (SMS) reminders, weekly phone or SMS check-ins, peer support clubs, "peer buddies" and additional counselling. Counsellors documented adherence support choices and counselling content on standardized forms. Through focus groups, serial in-depth interviews (IDIs) and single IDIs (n = 119 total), we explored participants' experiences with adherence support and how it encouraged product use. RESULTS Participants received counselling at nearly all visits. DLF was provided at 54.3% of sessions and, across sites, 49%-68% received results showing high adherence for oral PrEP, and 73%-89% for the ring. The most popular support strategies were in-person clubs and weekly calls, followed by online clubs, additional counselling and SMS. Preferences differed across sites but were similar for both products. Qualitative results demonstrated that the REACH strategies supported adherence by providing information about HIV and PrEP, continually motivating participants, and supporting the development of behavioural skills and self-efficacy, aligning with the Information, Motivation, and Behavioural Skills (IMB) model. Effectiveness was supported by three foundational pillars: strong interpersonal relationships with counsellors; ongoing, easily accessible support and resources; and establishing trust in the counsellors and study products through counsellor relationships, peer-to-peer exchange and DLF. CONCLUSIONS Implementation programmes could support effective PrEP use by offering a small menu of counsellor- and peer-based support options that are youth-friendly and developmentally appropriate. The same menu options can support both ring and oral PrEP users, though content should be tailored to the individual products.
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Affiliation(s)
- Sarah T. Roberts
- Women's Global Health Imperative, RTI InternationalBerkeleyCaliforniaUSA
| | - Noah Mancuso
- Women's Global Health Imperative, RTI InternationalAtlantaGeorgiaUSA
| | - Kristin Williams
- Applied Public Health Research CenterRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | | | - Hlengiwe Mposula
- Wits Reproductive Health and HIV InstituteJohannesburgSouth Africa
| | - Caroline Mugocha
- University of Zimbabwe Clinical Trials Research CentreHarareZimbabwe
| | | | | | - Daniel W. Szydlo
- Statistical Center for HIV/AIDS Research and PreventionFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Lydia Soto‐Torres
- Division of AIDSNational Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaMarylandUSA
| | - Kenneth Ngure
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Sybil Hosek
- Center for Dissemination and Implementation ScienceUniversity of Illinois ChicagoChicagoIllinoisUSA
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7
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Beauchamp G, Donnell D, Hosek S, Anderson PL, Chan KCG, Dye BJ, Mgodi N, Bekker LG, Delany-Moretlwe S, Celum C. Trust in the provider and accurate self-reported PrEP adherence among adolescent girls and young women in South Africa and Zimbabwe: HPTN 082 study. BMC Womens Health 2023; 23:276. [PMID: 37208687 PMCID: PMC10199602 DOI: 10.1186/s12905-023-02418-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Trust is an important cornerstone of patient-provider communication. Accurate reporting of pre-exposure prophylaxis (PrEP) adherence is vital for providers to determine who needs adherence support, especially adolescent girls and young women (AGYW) disproportionately affected by newly diagnosed HIV. METHODS This is a secondary analysis of the HPTN 082 open-label PrEP demonstration trial. From 2016-2018, 451 AGYW aged 16-25 years were enrolled in South Africa (Cape Town and Johannesburg) and Zimbabwe (Harare). PrEP was initiated by 427, and 354 (83%) had month three patient-reported adherence responses and intracellular tenofovir diphosphate (TFV-DP) measurements. The patient-reported adherence response to 'In the past month, how often did you take the tablet?' was dichotomized as 'high' if the response was every day or most days, and 'low' if some days or not many days or never. The biomarker marker evidence of adherence in dried blood spots was defined as 'high' if TFV-DP ≥ 700, and 'low' if < 350 fmol/punch. We used multinomial logistic regression to examine if trust in the PrEP provider was associated with concordance between patient-reported adherence and intracellular tenofovir-diphosphate (TFV-DP). RESULTS AGYW who reported trust in their providers were almost four-fold (aOR 3.72, 95% CI 1.20-11.51) more likely to have concordant adherence (high self-reported adherence and high TFV-DP concentrations) compared to discordant non-adherence (high self-reported adherence and low TFV-DP concentrations). CONCLUSION Education and training of providers to build trusting relationships with AGYW may lead to more accurate reporting of PrEP adherence. With accurate reporting, adequate support can be provided to bolster adherence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02732730.
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Affiliation(s)
- Geetha Beauchamp
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, WA, 98109, Seattle, USA.
| | - Deborah Donnell
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, WA, 98109, Seattle, USA
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Kwun C G Chan
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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8
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Katz AWK, Balán IC, Reddy K, Etima J, Weber K, Tauya T, Atujuna M, Scheckter R, Ngure K, Soto-Torres L, Mgodi N, Palanee-Phillips T, Baeten JM, van der Straten A. Women's experience receiving drug feedback and adherence counseling in MTN-025/HOPE - an HIV Prevention open-label trial of the Dapivirine Vaginal Ring. AIDS Behav 2022; 26:3607-3619. [PMID: 35536519 PMCID: PMC9561023 DOI: 10.1007/s10461-022-03663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
In the Phase IIIB MTN-025/HOPE open label extension trial, participants were offered the dapivirine vaginal ring as HIV prophylaxis, and those who accepted the ring received semi real-time individual adherence feedback, based on residual drug level (RDL) from returned rings, during Motivational Interviewing-based counseling. Counseling messages, based on the best knowledge at the time, framed RDL results in terms of ring use and HIV protection, from no use /no protection (0 RDL) to high use /high protection (3 RDL). At six HOPE sites, in-depth-Interviews (IDIs) about RDL were conducted with 64 participants who had received at least one RDL result. We found mixed interpretations of what the RDL meant and strong emotional reactions with a focus on the external validation of the level itself. Counseling was critical to help participants process their reactions to the RDL and make decisions accordingly (i.e., persistence, adherence improvement, and/or switching to another HIV prevention method). Providing drug adherence feedback was complex to implement yet proved useful as a component of a multi-pronged adherence support strategy.
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Affiliation(s)
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States
- Present affiliation Florida State University College of Medicine, Tallahassee, FL, USA
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa
| | - Juliane Etima
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Thelma Tauya
- College of Health Sciences Clinical Trials Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Millicent Atujuna
- Desmond Tutu AIDS Foundation, University of Cape Town, Cape Town, South Africa
| | | | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Nyaradzo Mgodi
- College of Health Sciences Clinical Trials Unit, University of Zimbabwe, Harare, Zimbabwe
| | | | - Jared M Baeten
- University of Washington, Seattle, WA, USA
- Present affiliation Gilead Sciences, Foster City, CA, USA
| | - Ariane van der Straten
- Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA, USA
- Present affiliation ASTRA Consulting, Kensington, CA, USA
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9
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Clinical Considerations in the Selection of Preexposure Prophylaxis for HIV Prevention in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:3913439. [PMID: 36081603 PMCID: PMC9448580 DOI: 10.1155/2022/3913439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
According to the Public Health Agency of Canada, approximately 62,050 people were living with HIV in Canada in 2018, and of those, 13% were undiagnosed. Currently, no single strategy provides complete protection or is universally effective across all demographic groups at risk for HIV. However, HIV preexposure prophylaxis (PrEP) is the newest HIV prevention strategy that shows promise. To date, two products have received an indication for PrEP by Health Canada: emtricitabine/tenofovir disoproxil fumarate (Truvada®; FTC/TDF) and emtricitabine/tenofovir alafenamide (Descovy®; FTC/TAF). Despite the high efficacy of these PrEP intervention methods, access to PrEP in Canada remains low. Identifying and addressing barriers to PrEP access, especially in high-risk groups, are necessary to reduce HIV transmission in Canada. While guidelines published by the Center for Disease Control and Prevention (CDC) include FTC/TAF information, the efficacy of FTC/TAF for PrEP has not yet been considered in Canada's clinical practice guidelines. Thus, the current paper reviews data regarding the use of FTC/TDF and FTC/TAF for PrEP, which may be useful for Canadian healthcare providers when counseling and implementing HIV prevention methods. The authors highlight these data in relation to various at-risk populations and review ongoing clinical trials investigating novel PrEP agents. Overall, FTC/TDF PrEP is effective for many populations, including men who have sex with men, transgender women, heterosexuals with partners living with HIV, and people who use drugs. While there is fewer data reported on the efficacy of FTC/TAF to date, recent clinical trials have demonstrated noninferiority of FTC/TAF in comparison to FTC/TDF. Notably, as studies have shown that FTC/TAF maintains renal function and bone mineral density to a greater extent than FTC/TDF, FTC/TAF may be a safer option for patients experiencing renal and/or bone dysfunction, for those at risk of renal and bone complications, and for those who develop FTC/TDF-related adverse events.
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Stewart J, Bukusi E, Sesay FA, Oware K, Donnell D, Soge OO, Celum C, Odoyo J, Kwena ZA, Scoville CW, Violette LR, Morrison S, Simoni J, McClelland RS, Barnabas R, Gandhi M, Baeten JM. Doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections among Kenyan women using HIV pre-exposure prophylaxis: study protocol for an open-label randomized trial. Trials 2022; 23:495. [PMID: 35710444 PMCID: PMC9201793 DOI: 10.1186/s13063-022-06458-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/09/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women in Africa face disproportionate risk of human immunodeficiency virus (HIV) acquisition, accounting for more than half of new infections in Africa and similarly face a disproportionate burden of sexually transmitted infections (STIs). Very high STI prevalence is being observed globally, especially among people taking pre-exposure prophylaxis (PrEP) for HIV prevention. Doxycycline post-exposure prophylaxis (dPEP) has been proposed as an STI prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea, and trials are ongoing among cisgender men who have sex with men (MSM) and transgender women who are taking PrEP in high-income settings. We designed and describe here the first open-label trial to determine the effectiveness of dPEP to reduce STI incidence among cisgender women. METHODS We are conducting an open-label 1:1 randomized trial of dPEP versus standard of care (STI screening and treatment and risk-reduction counseling without dPEP) among 446 Kenyan women aged ≥ 18 and ≤ 30 years old women taking PrEP. Women are followed for 12 months, with quarterly STI testing, treatment, and adherence counseling. The primary trial outcome will be the combined incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, compared between the randomized groups. We will also assess dPEP acceptability, tolerability, safety, impact on sexual behavior, adherence, and occurrence of antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis isolates. Finally, we will estimate cost per incident STI case and complications averted accounting for nonadherence and benefits relative AMR or side effects. DISCUSSION The results of this trial may have immediate implications for the global epidemic of STIs and sexual health. If effective, dPEP could put STI prevention into women's hands. While dPEP may be able to prevent STIs, it carries important risks that could counter its benefits; global debate about the balance of these potential risks and benefits requires data to inform policy and implementation and our study aims to fill this gap. TRIAL REGISTRATION ClinicalTrials.gov NCT04050540 .
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Affiliation(s)
- Jenell Stewart
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Fredericka A. Sesay
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Kevin Oware
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Deborah Donnell
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Olusegun O. Soge
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | | | | | - Caitlin W. Scoville
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
| | - Lauren R. Violette
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Susan Morrison
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, USA
| | - R. Scott McClelland
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
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Rogers Z, Pintye J, Kinuthia J, O’Malley G, Abuna F, Escudero J, Mugambi M, Awuor M, Dollah A, Dettinger JC, Kohler P, John-Stewart G, Beima-Sofie K. Key influences on the decision to initiate PrEP among adolescent girls and young women within routine maternal child health and family planning clinics in Western Kenya. AIDS Care 2022; 34:363-370. [PMID: 34543077 PMCID: PMC8934309 DOI: 10.1080/09540121.2021.1981217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We sought to understand influences on PrEP uptake among Kenyan adolescent girls and young women (AGYW) whose decision on PrEP use was misaligned with their risk for HIV acquisition. In-depth interviews were conducted with 47 Kenyan HIV-negative AGYW aged 15-24 years who were offered PrEP during routine maternal and child health and family planning services. AGYW were sampled from two groups (1) declined PrEP and had ≥1 sexual partner(s) of unknown HIV status and (2) initiated PrEP and reported having one HIV-negative partner. AGYW with HIV-negative partners initiated PrEP due to known or suspected infidelity. AGYW with partners of unknown HIV status recognized PrEP as a helpful HIV prevention tool, yet worried about partner reactions and prioritized avoiding uncomfortable or unsafe situations over PrEP. Among pregnant AGYW, the responsibility of motherhood and providing a future for one's family, through staying healthy and remaining HIV-free, was a strong PrEP use motivator. Among AGYW who desired future motherhood, fears that PrEP could negatively impact fertility or reduce contraceptive effectiveness led to declining PrEP. Peers positively influenced PrEP decision-making, especially personally knowing a PrEP user. Strategies are needed to enhance messaging and delivery approaches that are tailored to AGYW, including peer-led strategies.
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Affiliation(s)
- Zoe Rogers
- University of Washington Department of Global Health, Seattle, WA, USA
| | - Jillian Pintye
- University of Washington, Department of Biobehavioral Nursing and Health Informatics, Seattle, WA, USA
| | - John Kinuthia
- University of Washington Department of Global Health, Seattle, WA, USA,Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Jaclyn Escudero
- University of Washington Department of Global Health, Seattle, WA, USA
| | - Melissa Mugambi
- University of Washington Department of Global Health, Seattle, WA, USA
| | | | | | - Julia C Dettinger
- University of Washington Department of Global Health, Seattle, WA, USA
| | - Pamela Kohler
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington Child, Family, and Population Health, Seattle, WA, USA
| | - Grace John-Stewart
- University of Washington Department of Global Health, Seattle, WA, USA,University of Washington, Department of Epidemiology, Seattle, WA, USA,University of Washington, Department of Medicine, Seattle, WA, USA,University of Washington, Department of Pediatrics, Seattle, WA, USA
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Greenwood GL, Wilson A, Bansal GP, Barnhart C, Barr E, Berzon R, Boyce CA, Elwood W, Gamble-George J, Glenshaw M, Henry R, Iida H, Jenkins RA, Lee S, Malekzadeh A, Morris K, Perrin P, Rice E, Sufian M, Weatherspoon D, Whitaker M, Williams M, Zwerski S, Gaist P. HIV-Related Stigma Research as a Priority at the National Institutes of Health. AIDS Behav 2022; 26:5-26. [PMID: 33886010 PMCID: PMC8060687 DOI: 10.1007/s10461-021-03260-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
The National Institutes of Health (NIH) recognizes that, despite HIV scientific advances, stigma and discrimination continue to be critical barriers to the uptake of evidence-based HIV interventions. Achieving the Ending the HIV Epidemic: A Plan for America (EHE) goals will require eliminating HIV-related stigma. NIH has a significant history of supporting HIV stigma research across its Institutes, Centers, and Offices (ICOs) as a research priority. This article provides an overview of NIH HIV stigma research efforts. Each ICO articulates how their mission shapes their interest in HIV stigma research and provides a summary of ICO-relevant scientific findings. Research gaps and/or future opportunities are identified throughout, with key research themes and approaches noted. Taken together, the collective actions on the part of the NIH, in tandem with a whole of government and whole of society approach, will contribute to achieving EHE's milestones.
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Affiliation(s)
- Gregory L Greenwood
- Division of AIDS Research, National Institute of Mental Health, National Institutes of Health, 5601 Fishers Lane, 9G19, Bethesda, MD, 20852, USA.
| | - Amber Wilson
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Geetha P Bansal
- Division of International Training and Research, Fogarty International Center, Bethesda, MD, 20814, USA
| | - Christopher Barnhart
- Sexual and Gender Minority Research Office, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Rick Berzon
- Division of Scientific Programs, National Institute of Minority Health and Health Disparities, Bethesda, MD, 20892, USA
| | - Cheryl Anne Boyce
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, 20892, USA
| | - William Elwood
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, 20814, USA
| | | | - Mary Glenshaw
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Rebecca Henry
- Division of Extramural Science Programs, National Institute of Nursing Research, Bethesda, MD, 20892, USA
| | - Hiroko Iida
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Richard A Jenkins
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, 20852, USA
| | - Sonia Lee
- Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20817, USA
| | - Arianne Malekzadeh
- Division of International Science Policy, Planning and Evaluation, Fogarty International Center, Bethesda, MD, 20814, USA
| | - Kathryn Morris
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Peter Perrin
- Division of Digestive Diseases & Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 20892, USA
| | - Elise Rice
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Meryl Sufian
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Darien Weatherspoon
- Division of Extramural Research, National Institute of Dental and Craniofacial Research, Bethesda, MD, 20892, USA
| | - Miya Whitaker
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Makeda Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, MD, 20892, USA
| | - Sheryl Zwerski
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, 20852, USA
| | - Paul Gaist
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, 20852, USA
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Evidence for use of a healthy relationships assessment tool in the CHARISMA pilot study. PLoS One 2022; 16:e0261526. [PMID: 34972141 PMCID: PMC8719706 DOI: 10.1371/journal.pone.0261526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/03/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction The CHARISMA intervention, nested within the MTN-025/HOPE vaginal ring trial in Johannesburg, South Africa, seeks to facilitate women’s use of HIV prevention products by promoting partner dialogue and mitigating intimate partner violence (IPV). We developed “HEART”, a lay counselor-administered relationship assessment tool, for the CHARISMA pilot. The five-scale tool assesses participants’ endorsement of Traditional Values (TV), her HIV Prevention Readiness (HPR) and levels of partner support (PS), abuse and control (PAC), and resistance to HIV prevention (PR), guiding decisions about which of three counselling modules to offer (partner communication/A; ring disclosure/B; and IPV prevention/C). Methods We correlated baseline scores on HEART subscales with a) independent measures of relationship stability, disclosure and IPV to assess construct validity, and b) with specific modules offered to determine how HEART was used in the pilot. We examined changes in HEART scores at three and six months. Finally, we ran separate growth models for each subscale to examine changes in scores, accounting for partnership changes and counseling module(s) received. Results Baseline HEART scores correlated as predicted among subscales and with other measures. Reliabilities for four subscales were 0.75 or higher. Women who disclosed study participation and ring use scored higher on PS and lower on PR. Women experiencing IPV scored lower on PS, and higher on PAC and PR. During the pilot, 82% of women received one and 17% received two or more modules; over half received the IPV module. Women with higher PAC and PR scores were more likely to receive the IPV than the communication or disclosure modules. Over time, the TV, PAC and PR scores decreased, and PS score increased. Receiving the IPV module was associated with a decreased PAC score. Conclusions These data offer preliminary evidence for HEART construct and predictive validity and support its further evaluation to guide implementation and monitor the impact of the CHARISMA intervention in a randomized controlled evaluation.
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Joseph Davey DL, Dovel K, Mvududu R, Nyemba D, Mashele N, Bekker LG, Gorbach PM, Coates TJ, Myer L. Pre-exposure Prophylaxis Recent Adherence With Real-Time Adherence Feedback and Partner Human Immunodeficiency Virus Self-Testing: A Pilot Trial Among Postpartum Women. Open Forum Infect Dis 2021; 9:ofab609. [PMID: 35097151 PMCID: PMC8794072 DOI: 10.1093/ofid/ofab609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is safe and effective in postpartum women. Human immunodeficiency virus self-testing (HIVST) for male partners combined with biofeedback counseling through real-time adherence measures may improve PrEP use among postpartum women. Methods Between August 2020 and April 2021, we randomized postpartum women who initiated PrEP in pregnancy 1:1 to the intervention group (HIVST + biofeedback counseling after urine tenofovir test) or to standard of care ([SOC] facility-based human immunodeficiency virus [HIV] tests and routine counseling without biofeedback). The outcomes of interest were PrEP adherence in the past 48–72 hours via urine tenofovir tests and partner HIV testing, measured 1-month after randomization. Secondary outcomes included the proportion of partners who tested for HIV and the discrepancy between self-reported PrEP adherence and urine tenofovir result. Results We enrolled 106 women (median age = 26 years). At enrollment, 72% of women reported missing <2 doses in the past 7 days; 36% of women had tenofovir present in her urine. One month after enrollment, 62% (n = 33) of women in the intervention arm had tenofovir present in their urine compared to 34% (n = 18) in SOC (risk ratio [RR] = 1.83; 95% confidence interval [CI] = 1.19–2.82; P = .001). Two thirds of women in the intervention arm reported that her partner tested for HIV (66%; n = 35), compared to 17% (n = 9) in SOC (RR = 3.89; 95% CI = 2.08–7.27; P < .001). Self-reported PrEP adherence (took PrEP >5 of last week) with no tenofovir in urine test was lower in the intervention group (17% vs 46%; RR = 0.33; 95% CI = 0.17–0.67; P = .03). No social or clinical adverse events were reported in the intervention arm. Conclusions The HIVST for partners and biofeedback counseling increased levels of recent PrEP adherence, pointing to the importance of these interventions to support PrEP use in this population.
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Affiliation(s)
- Dvora Leah Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dorothy Nyemba
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nyiko Mashele
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Cambou MC, Landovitz RJ. Challenges and Opportunities for Preexposure Prophylaxis. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:399-406. [PMID: 34856093 PMCID: PMC8670824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Despite major advances in the HIV prevention toolbox in the past decade, there remain substantial social, economic, and structural barriers to access to preexposure prophylaxis (PrEP) that prevent a universal, population-level reduction in HIV incidence. Daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) has been the flagship PrEP regimen, and data support a pericoital/on-demand "2-1-1" dosing schedule for men who have sex with men. Daily oral PrEP with tenofovir alafenamide combined with emtricitabine (TAF/FTC) was approved by the US Food and Drug Administration (FDA) in 2019 for all routes of exposure other than vaginal exposures. The effectiveness of daily oral TDF/FTC has not been consistent in cisgender women outside of serodifferent couples, likely owing to differences in vaginal tissue penetration of PrEP agents resulting in less "forgiveness" of nonadherence. These observations have highlighted the need for additional choices of HIV prevention strategies. Injectable long-acting cabotegravir was recently shown to be superior to daily oral TDF/FTC across risk populations. PrEP studies of islatravir are underway for a monthly oral formulation and a drug-eluting subdermal implant. Lenacapavir, with a novel mechanism of action, is under investigation as a subcutaneous injection at 6-month intervals.
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Affiliation(s)
- Mary Catherine Cambou
- Send correspondence to Mary Catherine Cambou, 10833 Le Conte Ave, CHS 52-215, Los Angeles, CA, USA, 90095, or email
| | - Raphael J. Landovitz
- Professor of Medicine at the David Geffen School of Medicine of the University of California, Los Angeles
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Celum C, Hosek S, Tsholwana M, Kassim S, Mukaka S, Dye BJ, Pathak S, Mgodi N, Bekker LG, Donnell DJ, Wilson E, Yuha K, Anderson PL, Agyei Y, Noble H, Rose SM, Baeten JM, Fogel JM, Adeyeye A, Wiesner L, Rooney J, Delany-Moretlwe S. PrEP uptake, persistence, adherence, and effect of retrospective drug level feedback on PrEP adherence among young women in southern Africa: Results from HPTN 082, a randomized controlled trial. PLoS Med 2021; 18:e1003670. [PMID: 34143779 PMCID: PMC8253429 DOI: 10.1371/journal.pmed.1003670] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/02/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is highly effective and an important prevention tool for African adolescent girls and young women (AGYW), but adherence and persistence are challenging. PrEP adherence support strategies for African AGYW were studied in an implementation study. METHODS AND FINDINGS HIV Prevention Trials Network (HPTN) 082 was conducted in Cape Town, Johannesburg (South Africa) and Harare (Zimbabwe) from October 2016 to October 2018 to evaluate PrEP uptake, persistence, and the effect of drug level feedback on adherence. Sexually active HIV-negative women ages 16-25 were offered PrEP and followed for 12 months; women who accepted PrEP were randomized to standard adherence support (counseling, 2-way SMS, and adherence clubs) or enhanced adherence support with adherence feedback from intracellular tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS). PrEP uptake, persistence through 12 months (no PrEP hold or missed visits), and adherence were assessed. The primary outcome was high adherence (TFV-DP ≥700 fmol/punch) at 6 months, compared by study arm. Of 451 women enrolled, median age was 21 years, and 39% had curable sexually transmitted infections (STIs). Most (95%) started PrEP, of whom 55% had uninterrupted PrEP refills through 12 months. Of those with DBS, 84% had detectable TFV-DP levels at month 3, 57% at month 6, and 31% at month 12. At 6 months, 36/179 (21%) of AGYW in the enhanced arm had high adherence and 40/184 (22%) in the standard adherence support arm (adjusted odds ratio [OR] of 0.92; 95% confidence interval [CI] 0.55, 1.34; p = 0.76). Four women acquired HIV (incidence 1.0/100 person-years), with low or undetectable TFV-DP levels at or prior to seroconversion, and none of whom had tenofovir or emtricitabine resistance mutations. The study had limited power to detect a modest effect of drug level feedback on adherence, and there was limited awareness of PrEP at the time the study was conducted. CONCLUSIONS In this study, PrEP initiation was high, over half of study participants persisted with PrEP through month 12, and the majority of young African women had detectable TFV-DP levels through month 6 with one-fifth having high adherence. Drug level feedback in the first 3 months of PrEP use did not increase the proportion with high adherence at month 6. HIV incidence was 1% in this cohort with 39% prevalence of curable STIs and moderate PrEP adherence. Strategies to support PrEP use and less adherence-dependent formulations are needed for this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02732730.
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Affiliation(s)
- Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, United States of America
| | | | - Sheetal Kassim
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Shorai Mukaka
- University of Zimbabwe, College of Health Sciences Clinical Trials Unit Research Unit, Harare, Zimbabwe
| | - Bonnie J. Dye
- Family Health International 360, Durham, North Carolina, United States of America
| | - Subash Pathak
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Nyaradzo Mgodi
- University of Zimbabwe, College of Health Sciences Clinical Trials Unit Research Unit, Harare, Zimbabwe
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Deborah J. Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Ethan Wilson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Krista Yuha
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, United States of America
| | - Yaw Agyei
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Heather Noble
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Scott M. Rose
- Family Health International 360, Durham, North Carolina, United States of America
| | - Jared M. Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Jessica M. Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Adeola Adeyeye
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Division of AIDS, Rockville, Maryland, United States of America
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - James Rooney
- Gilead Sciences, Foster City, California, United States of America
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Celum CL, Gill K, Morton JF, Stein G, Myers L, Thomas KK, McConnell M, van der Straten A, Baeten JM, Duyver M, Mendel E, Naidoo K, Dallimore J, Wiesner L, Bekker LG. Incentives conditioned on tenofovir levels to support PrEP adherence among young South African women: a randomized trial. J Int AIDS Soc 2021; 23:e25636. [PMID: 33247553 PMCID: PMC7695999 DOI: 10.1002/jia2.25636] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction HIV incidence remains high among African adolescent girls and young women (AGYW), who would benefit from pre‐exposure prophylaxis (PrEP). Strategies to increase PrEP adherence and persistence need to be evaluated in African AGY, including incentives conditional on high adherence. Methods The 3Ps for Prevention Study was a 12‐month prospective cohort of 200 women ages 16 to 25 initiating PrEP in South Africa from 2017 to 2018. Participants received retrospective feedback about drug levels at Months 1, 2 and 3; half was randomized to receive a 200 Rand shopping voucher ($13 US) at Months 2, 3 and 4, conditioned on high intracellular tenofovir diphosphate (TFV‐DP) levels in dried blood spots (≥500 fmol/punch at Month 1, ≥700 fmol/punch at Months 2 and 3). The primary analysis was intention‐to‐treat, comparing the proportion with high PrEP adherence (≥700 fmol/punch) at Month 3 by randomized group, based on 100% efficacy among men who have sex with men. Results Median age of the 200 women was 19 years (interquartile range [IQR] 17, 21); 86% had a primary sexual partner. At Month 3, the mean TFV‐DP level was 822 fmol/punch (SD 522) in the incentive group and 689 fmol/punch (SD 546) in the control group (p = 0.11). Forty‐five (56%) of 85 women in the incentive group and 35 (41%) of 85 women in the control group had TFV‐DP levels ≥700 fmol/punch (RR 1.35; 95% CI 0.98, 1.86; p = 0.067), which declined to 8% and 5% in the incentive and control groups at Month 12 (no significant difference by arm). 44% refilled PrEP without gaps, 14% had a gap of ≥3 weeks in coverage subsequently restarted PrEP and 54% accepted at the final dispensing visit at Month 9. No new HIV infections were observed after PrEP initiation. Conclusions Among South African AGYW initiating PrEP, drug levels indicated high PrEP adherence in almost half of women at Month 3, with a non‐statistically significant higher proportion with high adherence among those in the incentive group. Over half persisted with the 12‐month PrEP programme although high adherence declined after Month 3. Strategies to support PrEP adherence and persistence and longer‐acting PrEP formulations are needed.
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Affiliation(s)
- Connie L Celum
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Katherine Gill
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Jennifer F Morton
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Gabrielle Stein
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Laura Myers
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Ariane van der Straten
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA.,Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Menna Duyver
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Eve Mendel
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Keshani Naidoo
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Jacqui Dallimore
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Department of Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Naidoo K, Mansoor LE, Katz AWK, Garcia M, Kemigisha D, Morar NS, Zimba CC, Chitukuta M, Reddy K, Soto-Torres L, Naidoo S, Montgomery ET. Qualitative Perceptions of Dapivirine VR Adherence and Drug Level Feedback Following an Open-Label Extension Trial. J Acquir Immune Defic Syndr 2021; 86:e90-e96. [PMID: 33278181 PMCID: PMC7902420 DOI: 10.1097/qai.0000000000002590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/20/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND There continues to be a need for HIV prevention options that women can initiate and use autonomously. The dapivirine vaginal ring (VR) has been shown to have a favorable safety profile and reduce the risk of HIV-1 acquisition. We report on women's experiences with VR adherence during the MTN-025/HIV Open-label Prevention Extension (HOPE) study and responses to Residual Drug Level (RDL) results. SETTING Ten women at each of the 6 HOPE research sites in Lilongwe, Malawi; Durban (2 sites) and Johannesburg, South Africa; Kampala, Uganda; and Chitungwiza, Zimbabwe, were randomly selected (n = 60). METHODS After confirmation of eligibility criteria, in-depth interviews were conducted where available RDL results were presented. RESULTS Many women with low RDL release measurements deflected blame onto other factors (the ring, the drug, and faulty testing machines) and distrust of the testing method. The disclosure of RDL results enabled some users to discuss their challenges experienced (fear of partner objections, perceived side effects, and removals during menses). Consistent users reported important motivators (support from others, protection from HIV, and enhanced sexual experiences from the VR). CONCLUSION The VR provided a sense of security for some women; however, adherence was still challenging for others regardless of it being a female controlled, long-acting HIV prevention technology. Adherence measurements may not be sustainable in the real-world implementation of the VR, although they can be seen as a benefit as they provide a better understanding of actual product use and provide women with a platform to discuss their experiences.
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Affiliation(s)
- Kalendri Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Leila E. Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Ariana WK. Katz
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
| | - Morgan Garcia
- FHI 360, Durham, North Carolina, United States of America
| | - Doreen Kemigisha
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Neetha S. Morar
- HIV Prevention Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | | | - Miria Chitukuta
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre (UZCHS-CTRC), Harare, Zimbabwe
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Sarita Naidoo
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa (Present affiliation: The Aurum Institute, Johannesburg, South Africa)
| | - Elizabeth T. Montgomery
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
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19
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Ngowi K, Pima F, Mmbaga BT, Aarnoutse RE, Reiss P, Nieuwkerk PT, Sprangers M, Sumari-de Boer M. "I Wish to Continue Receiving the Reminder Short Messaging Service": A Mixed Methods Study on the Acceptability of Digital Adherence Tools Among Adults Living with HIV on Antiretroviral Treatment in Tanzania. Patient Prefer Adherence 2021; 15:559-568. [PMID: 33727801 PMCID: PMC7955743 DOI: 10.2147/ppa.s290079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Digital Adherence Tools (DAT) to promote adherence to antiretroviral treatment (ART) for HIV are being increasingly adopted globally, however their effectiveness and acceptability in limited resource settings has been challenging. In this study, we examine the acceptability of DATs to improve adherence to ART. METHODS This study was part of a three-arm randomized controlled trial (REMIND) which investigated the effect of two different DAT's: SMS text messages (SMS) or real-time medication monitoring (RTMM) on treatment adherence; compared to standard of care. Exit interviews and in-depth interviews were conducted at 48 weeks follow-up, to collect data on their experiences (successes, challenges, and barriers) and behaviours regarding the implementation of the interventions. Translated transcripts, memos and field notes were imported to NVivo software version 12. We used a thematic framework analysis which drew from Sekhon's theoretical framework of acceptability (TFA), which comprises of seven constructs (affective attitude, perceived burden, perceived effectiveness, ethicality, self-efficacy, intervention coherence and opportunity costs). RESULTS Of the 166 participants enrolled, 143 (86%) were interviewed (68 in the SMS arm and 75 in the RTMM arm). Participants were highly satisfied (98%) with the DAT system and the majority of them reported it motivated them to take their medication (99%). The majority of participants reported they were confident in their ability to comply with the intervention and understood how the intervention worked (97%). Very few reported negatively about the devices (carrying the device), with only 6% reporting that they did not feel comfortable and 8% had ethical concerns with the SMS-content A few participants reported challenges with their connectivity/network and that the visits were too time-consuming. A few participants reported that they incurred extra cost for the sake of the study. CONCLUSION Overall, the acceptability of these DATs was high. However, several factors may hamper their acceptability including the content and number of SMS, carrying the devices and the network availability.
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Affiliation(s)
- Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Francis Pima
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rob E Aarnoutse
- Radboudumc, Radboud Institute for Health Sciences & Department of Pharmacy, Nijmegen, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Global Health, And Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Pythia T Nieuwkerk
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Mirjam Sprangers
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
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20
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Kutner BA, Giguere R, Lentz C, Kajura-Manyindo C, Dolezal C, Butheliezi S, Gwande M, Nampiira S, Ndlovu T, Mvinjelwa P, Mwenda W, Balán IC. Sharing Objective Measures of Adherence to a Vaginal Microbicide Promotes Candor About Actual Use and Bolsters Motivation to Prevent HIV. AIDS Behav 2021; 25:721-731. [PMID: 32920652 PMCID: PMC7887002 DOI: 10.1007/s10461-020-03026-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
Discrepancies between self-reported and actual adherence to biomedical HIV interventions is common and in clinical trials can compromise the integrity of findings. One solution is to monitor adherence biomarkers, but it is not well understood how to navigate biomarker feedback with participants. We surveyed 42 counselors and interviewed a subset of 22 to characterize their perspectives about communicating with participants about residual drug levels, an objective marker of adherence, within MTN-025/HOPE, a Phase 3b clinical trial of a vaginal ring to prevent HIV. When biomarkers indicated low drug levels that mismatched high adherence by self-report, counselors encountered barriers to acceptance and comprehension among participants. However, discrepancies between low self-report and higher drug levels generally stimulated candor. Women recollected times they had not used the product and disclosed problems that counselors thought might otherwise have remained forgotten or concealed. Navigating conversations toward HIV prevention was easier at mid-range drug levels and when women indicated motivation to prevent HIV. Ratings of residual drug level offered a somewhat objective measure of adherence and protection that counselors perceived as meaningful to participants and as a valuable catalyst for broaching conversation about HIV prevention. However, communication about drug levels required that counselors navigate emotional barriers, respond skillfully to questions about accuracy, and pivot conversations non-judgmentally away from numerical results and toward the priority of HIV prevention. Findings suggest a role for biomarker feedback in future clinical trials as well as other clinical contexts where biomarkers may be monitored, to motivate disclosure of actual adherence and movement toward HIV prevention.Clinical Trial Number NCT02858037.
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Affiliation(s)
- Bryan Andrew Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | | | - Miriam Gwande
- University of Zimbabwe College of Health Sciences Clinical Trials Research Center, Harare, Zimbabwe
| | - Susan Nampiira
- Makerere University - Johns Hopkins University Research Collaboration Clinical Research Site, Kampala, Uganda
| | - Thakasile Ndlovu
- South African Medical Research Council Clinical Trials Unit, Durban, South Africa
| | | | - Wezi Mwenda
- College of Medicine Clinical Research Site, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
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21
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Roth AM, Tran NK, Felsher MA, Gadegbeku AB, Piecara B, Fox R, Krakower DS, Bellamy SL, Amico KR, Benitez JA, Van Der Pol B. Integrating HIV Preexposure Prophylaxis With Community-Based Syringe Services for Women Who Inject Drugs: Results From the Project SHE Demonstration Study. J Acquir Immune Defic Syndr 2021; 86:e61-e70. [PMID: 33148998 PMCID: PMC7878321 DOI: 10.1097/qai.0000000000002558] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/14/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION To guide future preexposure prophylaxis (PrEP) implementation for women who inject drugs (WWID), a population increasingly represented in new HIV cases in the United States, we present results from a demonstration project integrated within a syringe services program (SSP) in Philadelphia, PA. METHODS WWID ≥18 years were educated about and offered 24 weeks of daily PrEP. Participants completed surveys and clinical assessments at baseline and at weeks 1, 3, 12, and 24. We used descriptive statistics to estimate feasibility/acceptability, engagement in the care cascade, HIV/sexually transmitted diseases (STI) and pregnancy, issues of safety/tolerability, and preferences/satisfaction with PrEP services. Multivariable logistic regression with generalized estimating equations was used to identify factors associated with PrEP uptake and retention. RESULTS We recruited 136 WWID. Of those, 95 were included in the final sample, and 63 accepted a PrEP prescription at week 1. Uptake was associated with greater baseline frequency of SSP access [adjusted odds ratio (aOR) = 1.85; 95% confidence interval (CI): 1.24 to 2.77], inconsistent condom use (aOR = 3.38; 95% CI: 1.07 to 10.7), and experiencing sexual assault (aOR = 5.89; 95% CI: 1.02, 33.9). Of these 95, 42 (44.2%) were retained at week 24. Retention was higher among women who reported more frequent baseline SSP access (aOR = 1.46; 95% CI: 1.04 to 2.24). Self-reported adherence was high but discordant with urine-based quantification of tenofovir. Baseline STI prevalence was 17.9%; there were 2 HIV seroconversions and 1 pregnancy. Safety/tolerability issues were uncommon, and acceptability/satisfaction was high. CONCLUSIONS Integrating PrEP with SSP services is feasible and acceptable for WWID. This suggests that daily PrEP is a viable prevention tool for this vulnerable population.
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Affiliation(s)
- Alexis M. Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Nguyen K. Tran
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Marisa A. Felsher
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Annette B. Gadegbeku
- Department of Family, Community, and Preventive Medicine, College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Brogan Piecara
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rachel Fox
- Partnership Comprehensive Care Practice, Drexel University, Philadelphia, PA, USA
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Scarlett L. Bellamy
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Barbara Van Der Pol
- Division of Infectious Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Point-of-care and Near Real-time Testing for Antiretroviral Adherence Monitoring to HIV Treatment and Prevention. Curr HIV/AIDS Rep 2021; 17:487-498. [PMID: 32627120 DOI: 10.1007/s11904-020-00512-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW In this report, we review the need for point-of-care (POC) or near real-time testing for antiretrovirals, progress in the field, evidence for guiding implementation of these tests globally, and future directions in objective antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP) adherence monitoring. RECENT FINDINGS Two cornerstones to end the HIV/AIDS pandemic are ART, which provides individual clinical benefits and eliminates forward transmission, and PrEP, which prevents HIV acquisition with high effectiveness. Maximizing the individual and public health benefits of these powerful biomedical tools requires high and sustained antiretroviral adherence. Routine monitoring of medication adherence in individuals receiving ART and PrEP may be an important component in interpreting outcomes and supporting optimal adherence. Existing practices and subjective metrics for adherence monitoring are often inaccurate or unreliable and, therefore, are generally ineffective for improving adherence. Laboratory measures of antiretroviral concentrations using liquid chromatography tandem mass spectrometry have been utilized in research settings to assess medication adherence, although these are too costly and resource-intensive for routine use. Newer, less costly technologies such as antibody-based methods can provide objective drug-level measurement and may allow for POC or near-patient adherence monitoring in clinical settings. When coupled with timely and targeted counseling, POC drug-level measures can support adherence clinic-based interventions to ART or PrEP in near real time.
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23
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Balán IC, Giguere R, Lentz C, Kutner BA, Kajura-Manyindo C, Byogero R, Asiimwe FB, Makala Y, Jambaya J, Khanyile N, Chetty D, Soto-Torres L, Mayo A, Mgodi NM, Palanee-Phillips T, Baeten JM. Client-Centered Adherence Counseling with Adherence Measurement Feedback to Support Use of the Dapivirine Ring in MTN-025 (The HOPE Study). AIDS Behav 2021; 25:447-458. [PMID: 32833192 DOI: 10.1007/s10461-020-03011-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fostering adherence and open communication about adherence challenges is key to harnessing the potential of biomedical HIV prevention products. We describe the counseling intervention and objective adherence measure feedback process implemented to support adherence to the dapivirine vaginal ring among participants in four sub-Saharan countries and present findings on the counselors' likeability and acceptability of the intervention. Most counselors (N = 42; 86%) liked Options counseling "very much" and during in-depth interviews (N = 22), reported that the intervention reshaped their adherence counselling approach by emphasizing understanding participants' experiences using the ring, which facilitated open discussion of adherence challenges. Counselors found that reframing residual drug level (RDL) discussions from the "adherence" to "protection" perspective encouraged adherence among consistent users and facilitated decisions to switch to a different HIV prevention approach among infrequent users. Among counselors, 24% said participants "liked it very much" while 26% said that participants "liked it a little" possibly due to two main complaints: perceived repetitiousness of sessions and variability in the RDL assay, which at times resulted in unexpected low RDLs.
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Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Counseling, Montclair State University, Montclair, NJ, USA
- Department of Social Sciences, Essex County College, Newark, NJ, USA
| | - Rose Byogero
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Florence Biira Asiimwe
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Yvonne Makala
- University of North Carolina Lilongwe Clinical Research Site, Lilongwe, Malawi
| | - Jane Jambaya
- University of Zimbabwe College of Health Sciences Zengeza Clinical Trials Unit, Harare, Zimbabwe
| | - Nombuso Khanyile
- South African Medical Research Council Tongaat Clinical Trials Unit, Durban, South Africa
| | - Diane Chetty
- CAPRISA Clinical Trials Unit for AIDS/Tuberculosis Prevention and Treatment, Durban, South Africa
| | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | | | - Nyaradzo M Mgodi
- University of Zimbabwe - University of California San Francisco Collaborative Research Program, Harare, Zimbabwe
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Jared M Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
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Guthrie KM, Fava JL, Vargas SE, Rosen RK, Shaw JG, Kojic EM, Ham AS, Rohan LC, Katz D, Panameño A, Colleran C, Friend DF, Buckheit KW, Buckheit RW. The Role of Volume in the Perceptibility of Topical Vaginal Formulations: User Sensory Perceptions and Experiences of Heterosexual Couples During Vaginal Sex. AIDS Res Hum Retroviruses 2020; 36:1059-1070. [PMID: 32988214 DOI: 10.1089/aid.2020.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Users' sensory perceptions and experiences (USPEs; perceptibility) of drug formulations can critically impact product adoption and adherence, especially when products rely on appropriate user behaviors (timing of administration, dosing measurement) for effectiveness. The use of topical gel formulations for effective antihuman immunodeficiency virus/sexually transmitted infection (HIV/STI) vaginal microbicides has been associated with messiness and other use-associated challenges, resulting in low adherence. Nonetheless, such formulations remain attractive due to good pharmacokinetics and resulting pharmacodynamics through their volume and surface contact for drug delivery into luminal fluids and mucosa. Consequently, advocates and scientists continue to pursue topical forms [semisolid (e.g., gel, suppository); solid (e.g., film)] to deliver select drugs and offer user choice in HIV/STI prevention. The current data build on previously validated USPE scales evaluating perceptibility of gels with various biophysical/rheological properties. Specifically, increased formulation parameter space adds a new set of properties inherent in quick-dissolving film. We compared film, a product adding no discernable volume to the vaginal environment, to 2 and 3.5 mL hydroxyethyl cellulose gel to consider the impact of volume on user experience. We also examined the USPE scales for evaluation of male sexual partners' experiences. The original USPE scales functioned as expected. Additionally, six new USPE scales were identified in this enhanced parameter space. Significant differences were noted between USPEs in pairwise comparisons, with largest differences between film and high-volume gel. Product developers and behavioral scientists can use these scales to design products, optimizing user experience and maximizing adherence and delivery of efficacious anti-HIV/STI pharmaceuticals. They can be extended to evaluation of additional formulations, devices, and compartments, as well as single- and multipurpose pharmaceuticals. In broader contexts, USPEs could be of value in evaluating formulations and devices to prevent/treat other diseases (e.g., ophthalmologic, dermatologic). Steadfast attention should be given to patient experience, and, where applicable, experiences of partners and/or caregivers.
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Affiliation(s)
- Kate M. Guthrie
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joseph L. Fava
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Sara E. Vargas
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rochelle K. Rosen
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Julia G. Shaw
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Erna M. Kojic
- Division of Infectious Disease, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Lisa C. Rohan
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Katz
- Department of Bioengineering, Duke University, Durham, North Carolina, USA
- Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina, USA
| | - Anacecilia Panameño
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Christopher Colleran
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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Grant-McAuley W, Fogel JM, Galai N, Clarke W, Breaud A, Marzinke MA, Mbwambo J, Likindikoki S, Aboud S, Donastorg Y, Perez M, Barrington C, Davis W, Kerrigan D, Eshleman SH. Antiretroviral drug use and HIV drug resistance in female sex workers in Tanzania and the Dominican Republic. PLoS One 2020; 15:e0240890. [PMID: 33119663 PMCID: PMC7595323 DOI: 10.1371/journal.pone.0240890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/05/2020] [Indexed: 02/04/2023] Open
Abstract
Objective Female sex workers (FSW) have increased risk of HIV infection. Antiretroviral treatment (ART) can improve HIV outcomes and prevent HIV transmission. We analyzed antiretroviral (ARV) drug use and HIV drug resistance among HIV-positive FSW in the Dominican Republic and Tanzania. Methods Plasma samples collected at study entry with viral loads >1,000 copies/mL were tested for ARV drugs and HIV drug resistance. ARV drug testing was performed using a qualitative assay that detects 22 ARV drugs in five classes. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System. Phylogenetic analyses were performed to determine HIV subtype and assess transmission clusters. Results Among 410 FSW, 144 (35.1%) had viral loads >1,000 copies/mL (DR: n = 50; Tanzania: n = 94). ARV drugs were detected in 36 (25.0%) of 144 samples. HIV genotyping results were obtained for 138 (95.8%) cases. No transmission clusters were observed in either country. HIV drug resistance was detected in 54 (39.1%) of 138 samples (31/35 [88.6%] with drugs detected; 23/103 [22.3%] without drugs detected); 29/138 (21.0%) had multi-class resistance (MCR). None with MCR had integrase strand transfer inhibitor resistance. In eight cases, one or more ARV drug was detected without corresponding resistance mutations; those women were at risk of acquiring additional drug resistance. Using multivariate logistic regression, resistance was associated with ARV drug detection (p<0.001), self-reported ART (full adherence [p = 0.034]; partial adherence [p<0.001]), and duration of HIV infection (p = 0.013). Conclusions In this cohort, many women were on ART, but were not virally suppressed. High levels of HIV drug resistance, including MCR, were observed. Resistance was associated with detection of ARV drugs, self-report of ART with full or partial adherence, and duration of HIV infection. These findings highlight the need for better HIV care among FSW to improve their health, reduce HIV drug resistance, and decrease risk of transmission to others.
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Affiliation(s)
- Wendy Grant-McAuley
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jessica M. Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mark A. Marzinke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- Unidad de Investigacion de Vacunas, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Unidad de Investigacion de Vacunas, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Wendy Davis
- Center on Health, Risk and Society, American University, Washington, District of Columbia, United States of America
| | - Deanna Kerrigan
- Center on Health, Risk and Society, American University, Washington, District of Columbia, United States of America
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Ngowi KM, Masika L, Lyamuya F, Muro E, Mmbaga BT, Sprangers MAG, Nieuwkerk PT, Aarnoutse RE, Reiss P, Sumari-de Boer IM. Returning of antiretroviral medication dispensed over a period of 8 months suggests non-adherence despite full adherence according to real time medication monitoring. AIDS Res Ther 2020; 17:57. [PMID: 32912282 PMCID: PMC7488262 DOI: 10.1186/s12981-020-00313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/29/2020] [Indexed: 11/16/2022] Open
Abstract
Real-time medication monitoring (RTMM) may potentially enhance adherence to antiretroviral treatment (ART). We describe a participant in an ongoing trial who, shortly after completing trial participation, died of cryptococcal meningitis despite high levels of adherence according to self-report, pill-counts and RTMM (> 99%). However, she evidenced consistently high HIV viral load throughout the 48-week study follow-up. Subsequently, her relatives unsolicitedly returned eight months’ dispensed ART medication that she was supposed to have taken. This brief report illustrates the challenges of adherence measurements including RTMM, and reinforces the need to combine adherence assessments with viral load monitoring in HIV care.
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Valente PK, Wu Y, Cohen YZ, Caskey M, Meyers K. Behavioral and social science research to support development of educational materials for clinical trials of broadly neutralizing antibodies for HIV treatment and prevention. Clin Trials 2020; 18:17-27. [PMID: 32838558 DOI: 10.1177/1740774520948042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Early integration of behavioral and social sciences research into clinical trials can improve trial conduct and facilitate future implementation of biomedical interventions. We sought to examine participants' experiences in clinical trials with broadly neutralizing antibodies and describe the development of educational materials for use in future broadly neutralizing antibody research. METHODS We conducted semi-structured interviews with trial participants in phase 1 trials evaluating safety and efficacy of broadly neutralizing antibodies for HIV prevention and treatment and key informants (i.e. trial staff involved in broadly neutralizing antibody research). Semi-structured interviews were transcribed and analyzed thematically. Based on findings from the interviews, we developed educational materials addressing concerns and misconceptions identified among trial participants with input from community and research stakeholders. Educational materials were used in subsequent clinical trials with broadly neutralizing antibodies. We evaluated trial staff's experiences with newly developed educational materials in follow-up key informant interviews. RESULTS Although most participants were concerned about long-term harms related to the investigational product upon enrollment, absence of severe side effects in the trial led to an underestimation of risks related to the study during trial participation. Participants showed a poor understanding of what broadly neutralizing antibodies are and the differences between broadly neutralizing antibodies and other HIV prevention and treatment products, such as antiretrovirals. Many trial participants overestimated the possible public health impact of the broadly neutralizing antibody trials in which they were enrolled, associating broadly neutralizing antibody research with the development of vaccine or cure for HIV in the near future. Based on these concerns and misconceptions among trial participants, we developed a frequently asked questions document and adapted an existing educational video about broadly neutralizing antibodies. In follow-up interviews, key informants reported that materials helped address trial participants' concerns and questions related to the trial. Key informants reported using the educational materials not only during informed consent but also throughout trial participation, which contributed to making informed consent an "ongoing" process. CONCLUSION Integration of behavioral research into clinical trials with broadly neutralizing antibodies is key to identify and address key concerns among trial participants. Behavioral and social sciences research promotes communication between trial participants and biomedical researchers, facilitates engagement of participants and trial staff, and strengthens trial conduct. Development of educational materials collaboratively by behavioral and clinical scientists, trial staff, and community stakeholders is feasible and may help to address trial participants' concerns and misconceptions. Future research should evaluate the impact of educational materials in recruitment and retention of trial participants.
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Affiliation(s)
- Pablo K Valente
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Yehuda Z Cohen
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA.,Translational Medicine and Clinical Pharmacology, Sanofi, Bridgewater, NJ, USA
| | - Marina Caskey
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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28
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Redd AD, Mukonda E, Hu NC, Philips TK, Zerbe A, Lesosky M, Hsiao NY, Clarke W, Reynolds SJ, Abrams EJ, Myer L. ART Adherence, Resistance, and Long-term HIV Viral Suppression in Postpartum Women. Open Forum Infect Dis 2020; 7:ofaa346. [PMID: 33072803 DOI: 10.1093/ofid/ofaa346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023] Open
Abstract
HIV+ South African women who achieved viral suppression during routine antenatal care, but later experienced a viremic episode (viral load >1000 copies/mL), were examined for presence of antiretrovirals and classified as "nonadherers" or "suboptimal adherers." Women were tested for drug resistance mutations (DRMs) at several time points and underwent viral load testing 36-60 months postpartum. Suboptimal adherers were more likely to have DRM detected during their viremic episode (P = .03) and at a subsequent viremic time point (P = .05). There was no difference in levels of viral suppression 36-60 months later in women with DRM detected vs women who had no evidence of DRM (P = .5).
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Affiliation(s)
- Andrew D Redd
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Elton Mukonda
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Nai-Chung Hu
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Philips
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University Mailman School of Public Health, New York, New York, USA
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - William Clarke
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Steven J Reynolds
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Rakai Health Sciences Program, Kalisizo, Uganda
| | - Elaine J Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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The Power of the Shared Experience: MTN-020/ASPIRE Trial Participants' Descriptions of Peer Influence on Acceptability of and Adherence to the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav 2020; 24:2387-2399. [PMID: 31980993 DOI: 10.1007/s10461-020-02799-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Women are disproportionately at risk of acquiring HIV in East and Southern Africa, despite global declines in incidence. Female-initiated HIV prevention methods, like the dapivirine vaginal ring, are needed to end the HIV epidemic. In-depth interviews and focus groups retrospectively explored peer influence on acceptability of and adherence to the ring during the ASPIRE trial, a phase III placebo-controlled trial. Results were analyzed using an inductive analytic approach. Study participants (peers) of all ages and adherence groups developed important interpersonal connections and reported being more open and honest with each other than with external peers or study staff. Study peers who knew each other prior to joining appeared to have a stronger influence on each other's adherence than peers who met in the study. External peers provided primarily negative input about the ring and study, which sometimes led to ring removals. Peers' influence on each other's behavior in both prosocial and detrimental manners could have repercussions on adherence to a biomedical intervention, and consequently, individual disease risk and clinical trial outcomes. Future ring demonstration and implementation studies could use peer networks to intentionally influence uptake and adherence to the ring.
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30
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Rapid-Release Griffithsin Fibers for Dual Prevention of HSV-2 and HIV-1 Infections. Antimicrob Agents Chemother 2020; 64:AAC.02139-19. [PMID: 32229493 DOI: 10.1128/aac.02139-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/21/2020] [Indexed: 12/18/2022] Open
Abstract
The biologic griffithsin (GRFT) has recently emerged as a candidate to safely prevent sexually transmitted infections (STIs), including human immunodeficiency virus type 1 (HIV-1) and herpes simplex virus 2 (HSV-2). However, to date, there are few delivery platforms that are available to effectively deliver biologics to the female reproductive tract (FRT). The goal of this work was to evaluate rapid-release polyethylene oxide (PEO), polyvinyl alcohol (PVA), and polyvinylpyrrolidone (PVP) fibers that incorporate GRFT in in vitro (HIV-1 and HSV-2) and in vivo (HSV-2) infection models. GRFT loading was determined via enzyme-linked immunosorbent assay (ELISA), and the bioactivity of GRFT fibers was assessed using in vitro HIV-1 pseudovirus and HSV-2 plaque assays. Afterwards, the efficacy of GRFT fibers was assessed in a murine model of lethal HSV-2 infection. Finally, murine reproductive tracts and vaginal lavage samples were evaluated for histology and cytokine expression, 24 and 72 h after fiber administration, to determine safety. All rapid-release formulations achieved high levels of GRFT incorporation and were completely efficacious against in vitro HIV-1 and HSV-2 infections. Importantly, all rapid-release GRFT fibers provided potent protection in a murine model of HSV-2 infection. Moreover, histology and cytokine levels, evaluated from collected murine reproductive tissues and vaginal lavage samples treated with blank fibers, showed no increased cytokine production or histological aberrations, demonstrating the preliminary safety of rapid-release GRFT fibers in vaginal tissue.
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31
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Tyo KM, Lasnik AB, Zhang L, Mahmoud M, Jenson AB, Fuqua JL, Palmer KE, Steinbach-Rankins JM. Sustained-release Griffithsin nanoparticle-fiber composites against HIV-1 and HSV-2 infections. J Control Release 2020; 321:84-99. [PMID: 32035194 DOI: 10.1016/j.jconrel.2020.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Human immunodeficiency virus (HIV-1) and herpes simplex virus 2 (HSV-2) affect hundreds of millions of people worldwide. The antiviral lectin, Griffithsin (GRFT), has been shown to be both safe and efficacious against HSV-2 and HIV-1 infections in vivo. The goal of this work was to develop a multilayered nanoparticle (NP)-electrospun fiber (EF) composite to provide sustained-release of GRFT, and to examine its safety and efficacy in a murine model of lethal HSV-2 infection. Composites were fabricated from polycaprolactone (PCL) fibers surrounding polyethylene oxide (PEO) fibers that incorporated methoxy poly(ethylene glycol)-b-poly(lactide-co-glycolide) (mPEG-PLGA) GRFT NPs. GRFT loading and release were determined via ELISA, showing that NP-EF composites achieved high GRFT loading, and provided sustained-release of GRFT for up to 90 d. The in vitro efficacy of GRFT NP-EFs was assessed using HIV-1 pseudovirus assays, demonstrating complete in vitro protection against HIV-1 infection. Additionally, sustained-release NP-EFs, administered 24 h prior to infection, prevented against a lethal dose of HSV-2 infection in a murine model. In parallel, histology and cytokine expression from murine reproductive tracts and vaginal lavages collected 24 and 72 h post-administration were similar to untreated mice, suggesting that NP-EF composites may be a promising and safe sustained-delivery platform to prevent HSV-2 infection. Future work will evaluate the ability to provide prolonged protection against multiple virus challenges, and different administration times with respect to infection.
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Affiliation(s)
- Kevin M Tyo
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Amanda B Lasnik
- Center for Predictive Medicine, Louisville, KY, United States
| | - Longyun Zhang
- Center for Predictive Medicine, Louisville, KY, United States; Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, United States
| | - Mohamed Mahmoud
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Alfred B Jenson
- James Graham Brown Cancer Center, University of Louisville School of Medicine, University of Louisville, Louisville, KY, United States
| | - Joshua L Fuqua
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Kenneth E Palmer
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville School of Medicine, University of Louisville, Louisville, KY, United States; Department of Microbiology and Immunology, School of Medicine, University of Louisville, KY, United States
| | - Jill M Steinbach-Rankins
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville School of Medicine, University of Louisville, Louisville, KY, United States; Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, United States; Department of Microbiology and Immunology, School of Medicine, University of Louisville, KY, United States.
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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: 1.8] [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.
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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
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If You Build It, Will They Use It? Preferences for Antiretroviral Therapy (ART) Adherence Monitoring Among People Who Inject Drugs (PWID) in Kazakhstan. AIDS Behav 2019; 23:3294-3305. [PMID: 30741397 DOI: 10.1007/s10461-019-02421-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adherence to antiretroviral therapy (ART) is an important predictor of long-term treatment success and is associated with optimal individual and public health outcomes. Novel technologies, such as electronic monitoring devices (EMDs) or pharmacokinetic testing, provide more objective measures of ART adherence than traditional measures of adherence (e.g., self-report) and may facilitate improved adherence through the provision of patient feedback. This study examines preferences for ART adherence monitoring among people who inject drugs (PWID) in Kazakhstan. In-depth interviews were conducted with 20 HIV-positive PWID, 18 of their intimate partners, and 7 AIDS Center healthcare providers in Almaty, Kazakhstan. Results indicated that patients varied in their preferences of which strategies would be most effective and acceptable to use in monitoring their adherence. Overall, patients were highly enthusiastic about the potential use of pharmacokinetic testing. Many participants supported the use of EMDs, though some were concerned about having their adherence tracked. Other participants thought reminders through text messaging or smart phone applications would be helpful, though several had concerns about confidentiality and others worried about technological difficulties operating a smart phone. Future studies should evaluate the feasibility and impact of providing quantitative drug levels as feedback for ART adherence using biomarkers of longer-term ART exposure, (i.e., hair sampling or dried blood spot testing).
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Harling G, Tsai AC. Using Social Networks to Understand and Overcome Implementation Barriers in the Global HIV Response. J Acquir Immune Defic Syndr 2019; 82 Suppl 3:S244-S252. [PMID: 31764260 PMCID: PMC6923140 DOI: 10.1097/qai.0000000000002203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the development of several efficacious HIV prevention and treatment methods in the past 2 decades, HIV continues to spread globally. Uptake of interventions is nonrandomly distributed across populations. Such inequality is socially patterned and reinforced by homophily arising from both social selection (becoming friends with similar people) and influence (becoming similar to friends). METHODS We conducted a narrative review to describe how social network analysis methods-including egocentric, sociocentric, and respondent-driven sampling designs-provide tools to measure key populations, to understand how epidemics spread, and to evaluate intervention take-up. RESULTS Social network analysis-informed designs can improve intervention effectiveness by reaching otherwise inaccessible populations. They can also improve intervention efficiency by maximizing spillovers, through social ties, to at-risk but susceptible individuals. Social network analysis-informed designs thus have the potential to be both more effective and less unequal in their effects, compared with social network analysis-naïve approaches. Although social network analysis-informed designs are often resource-intensive, we believe they provide unique insights that can help reach those most in need of HIV prevention and treatment interventions. CONCLUSION Increased collection of social network data during both research and implementation work would provide important information to improve the roll-out of existing studies in the present and to inform the design of more data-efficient, social network analysis-informed interventions in the future. Doing so will improve the reach of interventions, especially to key populations, and to maximize intervention impact once delivered.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard University, Cambridge MA, United States
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C. Tsai
- Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard University, Cambridge MA, United States
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston MA United States
- Mbarara University of Science and Technology, Mbarara, Uganda
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Simoni JM, Beima-Sofie K, Amico KR, Hosek SG, Johnson MO, Mensch BS. Debrief Reports to Expedite the Impact of Qualitative Research: Do They Accurately Capture Data from In-depth Interviews? AIDS Behav 2019; 23:2185-2189. [PMID: 30666522 DOI: 10.1007/s10461-018-02387-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
"Debrief reports" (DRs) use structured forms to capture key concepts from in-depth interviews and focus group discussions. They are completed by interviewers and rapidly disseminated to key team members to facilitate identification of potential problems with study procedures, recruitment, or participant engagement and to inform critical adjustments, which can be especially pertinent in intervention studies. Their reliability and validity have yet to be formally evaluated. To assess the accuracy of DRs in capturing key content, raters analyzed a random sub-sample of 20 pairs of de-identified transcripts and their linked DRs from the VOICE-D trial. Analyses generally supported the accuracy of DRs; however, pertinent information from transcripts was occasionally missed or recorded with discrepancies or lack of detail. Longer transcripts and DR sections describing complex topic areas were more likely to involve discrepancies. Recommendations are offered for further research and optimizing the use of DRs.
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36
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Celum CL, Delany‐Moretlwe S, Baeten JM, van der Straten A, Hosek S, Bukusi EA, McConnell M, Barnabas RV, Bekker L. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc 2019; 22 Suppl 4:e25298. [PMID: 31328444 PMCID: PMC6643076 DOI: 10.1002/jia2.25298] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/10/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) in Africa have high HIV incidence despite scale-up of HIV testing and HIV treatment. Placebo-controlled trials of tenofovir-based pre-exposure prophylaxi (PrEP) in diverse populations demonstrated that PrEP works with close to 100% effectiveness if taken with high, but not perfect, adherence. Divergent efficacy estimates among African AGYW led to demonstration and implementation projects to better understand motivations for HIV prevention, uptake, adherence and persistence to PrEP. To inform PrEP programmes, the design and initial findings from PrEP demonstration projects for AGYW are reviewed. DISCUSSION Early lessons from PrEP implementation projects among young African women include: (1) awareness and demand creation with positive messaging about the benefits of PrEP are critical to motivate AGYW to consider this novel prevention technology and to foster awareness among peers, partners, parents and guardians to support AGYW's effective PrEP use; (2) PrEP initiation is high in projects that are integrating PrEP into youth-friendly clinics, family planning clinics and mobile clinics; (3) young African women at risk are initiating PrEP, based on behavioural characteristics, history of intimate partner violence, depression and 30% prevalence of chlamydia and/or gonorrhoea; (4) provision of youth-friendly PrEP delivery programmes that integrate reproductive health services, including contraception and the diagnosis and treatment of sexually transmitted infections, increase health impact; (5) messages that emphasize the necessity for high adherence while at potential risk of HIV exposure and support strategies that addresses AGYW's adherence challenges are essential; and, (6) a substantial proportion of AGYW do not persist with PrEP, and strategies are needed to help AGYW assess their ongoing need, motivation and challenges with persisting with PrEP. CONCLUSIONS PrEP is feasible to implement in integrated reproductive health service delivery models to reach African AGYW. While PrEP demonstration projects indicate that women with behavioural risks and high rates of sexually transmitted diseases are initiating PrEP; effective strategies to support AGYW's adherence and persistence with PrEP are needed. Lessons learned from oral PrEP delivery, a novel first generation HIV prevention product, are relevant to longer-acting and less adherence-dependent strategies which are currently in clinical trials.
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Affiliation(s)
- Connie L Celum
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Sinead Delany‐Moretlwe
- Wits Reproductive Health and HIV InstituteUniversity of WitswatersrandJohannesburgSouth Africa
| | - Jared M Baeten
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | | | - Sybil Hosek
- Department of PsychiatryStroger HospitalChicagoILUSA
| | - Elizabeth A Bukusi
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Kenya Medical Research InstituteNairobiKenya
- Departments of Obstetrics‐GynecologyUniversity of WashingtonSeattleWAUSA
| | - Margaret McConnell
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Ruanne V Barnabas
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
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HIV Drug Resistance in Adults Receiving Early vs. Delayed Antiretroviral Therapy: HPTN 052. J Acquir Immune Defic Syndr 2019; 77:484-491. [PMID: 29293156 DOI: 10.1097/qai.0000000000001623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We evaluated HIV drug resistance in adults who received early vs. delayed antiretroviral therapy (ART) in a multinational trial [HIV Prevention Trials Network (HPTN) 052, enrollment 2005-2010]. In HPTN 052, 1763 index participants were randomized to start ART at a CD4 cell count of 350-550 cells/mm (early ART arm) or <250 cells/mm (delayed ART arm). In May 2011, interim study results showed benefit of early ART, and all participants were offered ART regardless of CD4 cell count; the study ended in 2015. METHODS Virologic failure was defined as 2 consecutive viral loads >1000 copies/mL >24 weeks after ART initiation. Drug resistance testing was performed for pretreatment (baseline) and failure samples from participants with virologic failure. RESULTS HIV genotyping results were obtained for 211/249 participants (128 early ART arm and 83 delayed ART arm) with virologic failure. Drug resistance was detected in 4.7% of participants at baseline; 35.5% had new resistance at failure. In univariate analysis, the frequency of new resistance at failure was lower among participants in the early ART arm (compared with delayed ART arm, P = 0.06; compared with delayed ART arm with ART initiation before May 2011, P = 0.032). In multivariate analysis, higher baseline viral load (P = 0.0008) and ART regimen (efavirenz/lamivudine/zidovudine compared with other regimens, P = 0.024) were independently associated with higher risk of new resistance at failure. CONCLUSIONS In HPTN 052, the frequency of new drug resistance at virologic failure was lower in adults with early ART initiation. The main factor associated with reduced drug resistance with early ART was lower baseline viral load.
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Mensch BS, Richardson BA, Husnik M, Brown ER, Kiweewa FM, Mayo AJ, Baeten JM, Palanee-Phillips T, van der Straten A. Vaginal Ring Use in a Phase 3 Microbicide Trial: A Comparison of Objective Measures and Self-reports of Non-adherence in ASPIRE. AIDS Behav 2019; 23:504-512. [PMID: 30218318 DOI: 10.1007/s10461-018-2261-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This analysis compares self-reports of product use with objective measures of non-adherence-quarterly plasma dapivirine levels and monthly residual dapivirine (DPV) levels in used rings-in MTN-020/ASPIRE, a phase 3 trial of a monthly DPV vaginal ring among women aged 18-45 years in Malawi, South Africa, Uganda and Zimbabwe. For participants on active product (N = 1211) we assessed self-reported monthly non-adherence, as measured by (1) whether the ring was ever out, and out for ≥ 12 h in the previous month and, (2) by a self-rating scale assessing ability to keep the vaginal ring inserted, and compared the self-reports to two biomarkers of non-use separately and as a composite measure. For this analysis, a plasma DPV value ≤ 95 pg/ml and residual ring ≥ 23.5 mg were used to classify non-adherence (i.e. the ring never being in the vagina the previous month). Compared to self-reports, non-adherence was found to be substantially higher for the composite measure as well as its two components, an indication that ring removal was likely underreported in the trial. The discrepancy between the self-report measure of ring outage and the composite indicator was greater for those aged 18-21 than for those older, evidence that younger women are more likely to underreport non-adherence. Despite underreporting of non-adherence, self-reports of the ring never being out were significant in predicting the composite objective measure. Furthermore, the association between the self-rating scale and the objective measure was in the expected direction and significant, although 11% of those 18-21 and 7% of those 22+ who rated their ability to keep the ring inserted as good, very good or excellent in the 4 weeks prior to exit were considered non-adherent according to the objective measure. This analysis indicates that while self-reports are significantly associated with objective measures of adherence in the ASPIRE trial, they were inflated-more so by those younger-and therefore may have limited utility identifying those who have challenges using products as directed. ClinicalTrials.gov number NCT01617096.
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Katz AWK, Mensch BS, Woeber K, Musara P, Etima J, van der Straten A. Understanding women's motivations to participate in MTN-003/VOICE, a phase 2b HIV prevention trial with low adherence. BMC WOMENS HEALTH 2019; 19:18. [PMID: 30683103 PMCID: PMC6347781 DOI: 10.1186/s12905-019-0713-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 01/11/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND In biomedical prevention trials, correct and consistent use of the investigational product is crucial to determine efficacy. Product adherence in VOICE, a phase 2B randomized trial of a vaginal gel and oral tablets for HIV prevention, was low (~ 34%), yet self-reported adherence and retention was high (> 90%). This analysis from VOICE-D, a post-trial qualitative ancillary study, explores motivations to participate in VOICE, and possible sources of misalignment between the stated priorities of the trial and the participants. METHODS VOICE-D enrolled 171 former VOICE participants to investigate, among other things, reasons for joining and remaining in the trial. Local language in-depth interviews and focus groups were transcribed and translated into English and coded and analyzed using NVivo. Data on motivation to join obtained from a VOICE termination visit survey of 106 participants were also analyzed to corroborate the VOICE-D findings. RESULTS Participants primarily participated for personal health benefits (e.g. free healthcare and HIV testing) and reported remaining enrolled from a sense of commitment to the trial. Altruistic motivations were the most commonly stated motivation on the termination visit survey; qualitatively, many of those stating altruistic reasons also desired personal health benefits. Joining for financial reimbursement was not commonly mentioned. Social networks influenced recruitment and spread therapeutic misconception. CONCLUSIONS Women's participation for personal health benefits highlighted their desire to monitor their HIV risk and overall health. Helping participants view use of investigational products as improving social capital and reminding participants of their study responsibilities may improve trial outcomes. Understanding the reasons for participating in studies will help to ensure alignment between priorities of researchers and participants. TRIAL REGISTRATION NCT02358616 ; Posted February 9, 2015, retrospectively registered.
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Affiliation(s)
- Ariana W K Katz
- Women's Global Health Imperative, RTI International, 351 California St, Suite 500, San Francisco, CA, 94104, USA.
| | | | - Kubashni Woeber
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Petina Musara
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre (UZCHS-CTRC), Harare, Zimbabwe
| | - Juliane Etima
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Ariane van der Straten
- Women's Global Health Imperative, RTI International, 351 California St, Suite 500, San Francisco, CA, 94104, USA.,Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA, USA
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Fernandez Lynch H, Joffe S, Thirumurthy H, Xie D, Largent EA. Association Between Financial Incentives and Participant Deception About Study Eligibility. JAMA Netw Open 2019; 2:e187355. [PMID: 30681707 PMCID: PMC6484547 DOI: 10.1001/jamanetworkopen.2018.7355] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Offers of payment for research participation are ubiquitous but may lead prospective participants to deceive about eligibility, jeopardizing study integrity and participant protection. To date, neither the rate of payment-induced deception nor the influence of payment amount has been systematically studied in a nationally representative randomized survey experiment. OBJECTIVES To estimate payment-associated deception about eligibility for an online survey and to assess whether there is an association between payment amount and deception frequency. DESIGN, SETTING, AND PARTICIPANTS Randomized, 7-group survey experiment. Data were collected in March 2018 and analyzed from March to August 2018. The setting was a nationally representative online survey among US adults drawn from the GfK KnowledgePanel. INTERVENTIONS Varying payment amounts for participation ($5, $10, or $20 cash equivalent) and direction of eligibility criterion (having received or not having received an influenza vaccination in the past 6 months). MAIN OUTCOMES AND MEASURES Proportion of respondents reporting recent influenza vaccination. RESULTS In total, 2275 individuals participated in the survey, a 59.4% (2275 of 3829) response rate; 51.8% (1108) were female, and 21.1% of respondents (399) were aged 18 to 29 years, 24.9% (532) were aged 30 to 44 years, 26.0% (601) were aged 45 to 59 years, and 28.0% (738) were 60 years or older. For participants offered a $5 incentive, the reported frequency of recent influenza vaccination was 16.6% higher (95% CI, 9.1%-24.1%) among those told that eligibility (and thus payment) required recent vaccination than among those told that eligibility required no recent vaccination. The corresponding differences were 21.0% (95% CI, 13.5%-28.5%) among those offered $10 and 15.4% (95% CI, 7.8%-23.0%) among those offered $20. Estimated proportions of ineligible individuals who responded deceptively regarding eligibility ranged from 10.5% to 22.8% across study groups. There was no evidence that higher payment was associated with higher frequency of deception. CONCLUSIONS AND RELEVANCE In a nationally representative randomized survey experiment to evaluate whether and to what extent payment is associated with participants misleading investigators about their research eligibility, this study found evidence of significant deception. However, no association was observed between payment amount and frequency of deception. Further research is needed to extend these findings to clinical research. These data suggest that, when possible, investigators should rely on objective tests of eligibility rather than self-report.
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Affiliation(s)
- Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Children’s Hospital of Philadelphia, Pennsylvania
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Dawei Xie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Emily A. Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Geng EH, Glidden DV, Padian N. Strengthening HIV-prevention trials: a dose of implementation science? THE LANCET. INFECTIOUS DISEASES 2018; 18:1166-1168. [PMID: 30507394 DOI: 10.1016/s1473-3099(18)30567-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Elvin H Geng
- University of California, San Francisco, CA 94117, USA.
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Krogstad EA, Atujuna M, Montgomery ET, Minnis A, Ndwayana S, Malapane T, Shapley‐Quinn MK, Manenzhe K, Bekker L, van der Straten A. Perspectives of South African youth in the development of an implant for HIV prevention. J Int AIDS Soc 2018; 21:e25170. [PMID: 30152004 PMCID: PMC6111144 DOI: 10.1002/jia2.25170] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Implants are a new dosage form in development for HIV pre-exposure prophylaxis (PrEP) with potential for high adherence given that they are provider-administered and are intended for long-acting protection. Integrating end-user preference into early stage product development may further overcome challenges with future product uptake and adherence. Hence, we sought to optimize the design of a PrEP implant in early-stage development by gathering opinions about implant attributes from potential end-users in South Africa. METHODS We conducted 14 focus group discussions (FGDs) with young women and men aged 18 to 24 in Cape Town and Soshanguve, South Africa, inviting participants into discussion as co-designers. FGDs were homogenous by gender and previous implant experience. During FGDs, we showed prototype devices and followed a semi-structured guide with questions on history of contraceptive implant use, preferences for physical characteristics of an implant, implant biodegradability, insertion process, participant-driven ideas for implant design, and social adoption considerations. FGDs were facilitated in English, isiXhosa, Tswana, isiZulu, or Tsonga, audio-recorded, transcribed into English, and qualitatively coded and analysed. RESULTS In this qualitative sample of 105 youth (68 women and 37 men), 58 participants were from Soshanguve and 47 from Cape Town, and 23% had previously used contraceptive implants. Participants expressed preferences for several implant design features; specifically, longer duration (≥6 months) was more important to most participants than the size or number of devices implanted. A majority preferred a flexible versus stiff implant to minimize palpability, thereby increasing discreetness and comfort. Nearly all participants favoured a biodegradable implant to avoid removal and thus reduce clinic visits. Concerns about the implant centred on its possible side effects and the "plastic" look of the prototype displayed for demonstration. CONCLUSIONS This study offers preliminary insights into an implant for HIV prevention that provides long-lasting protection may be well received among young South Africans. Additionally, flexibility, discreetness, and biodegradability may increase acceptability of the implant. Such end-user feedback is being incorporated into current implant designs in the hope of creating an effective long-acting PrEP product that is likely to achieve high uptake and adherence in target populations.
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Affiliation(s)
- Emily A Krogstad
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- RTI InternationalWomen's Global Health ImperativeSan FranciscoCaliforniaUSA
| | | | | | - Alexandra Minnis
- RTI InternationalWomen's Global Health ImperativeSan FranciscoCaliforniaUSA
| | - Sheily Ndwayana
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | | | | | | | | | - Ariane van der Straten
- RTI InternationalWomen's Global Health ImperativeSan FranciscoCaliforniaUSA
- Center for AIDS Prevention StudiesUniversity of California – San FranciscoSan FranciscoCaliforniaUSA
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Reasons for nonadherence to the dapivirine vaginal ring: narrative explanations of objective drug-level results. AIDS 2018; 32:1517-1525. [PMID: 29957723 DOI: 10.1097/qad.0000000000001868] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE(S) MTN-020/ASPIRE trial and IPM-027/Ring Study recently proved the dapivirine vaginal ring was safe and effective with consistent use. To optimize the ring's impact, the barriers and facilitators to ring adherence must be understood and addressed. METHODS Former ASPIRE participants were stratified by age group (18-21; 22-45) and randomly selected at seven sites in Malawi, South Africa, Uganda and Zimbabwe, 12-17 months after trial exit. Using in-depth interviews or focus group discussions, ring use barriers were explored using structured guides and visual tools including individual-level depictions of dapivirine levels detected in plasma and returned rings. RESULTS A total of 187 were enrolled; 37% were 18-21 years when they began ASPIRE. Most (75%) had drug-level results, suggesting inconsistent ring use throughout ASPIRE. Participants viewed themselves as adherent, while simultaneously describing regular instances and reasons for ring removal (e.g. for sex or menses). Less adherent women reported fears that partners would oppose the ring or feel it during sex. High adherers expressed altruistic motivations for ring use. Women of all ages attributed young women's nonadherence to their tendency to be less 'serious' about the future, HIV prevention and the study; motivated predominantly by benefits; more fearful of fertility-related consequences; and to having less relationship control. CONCLUSION When presented with objective adherence data, participants provided reasons for intermittent ring use, while simultaneously portraying themselves as consistent ring users. Further research is needed to understand how women could use the ring in a way that fits into the context of their relationships and their lives while still conferring adequate HIV prophylaxis.
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How Presentation of Drug Detection Results Changed Reports of Product Adherence in South Africa, Uganda and Zimbabwe. AIDS Behav 2018; 22:877-886. [PMID: 28110473 DOI: 10.1007/s10461-017-1685-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Accurate estimates of study product use are critical to understanding and addressing adherence challenges in HIV prevention trials. The VOICE trial exposed a significant gap between self-reported adherence and drug detection. The VOICE-D qualitative study was designed to better understand non-adherence during VOICE, and was conducted in 2 stages: before (stage 1) and after (stage 2) drug detection results were provided to participants. Transcripts from 44 women who participated in both stages were analysed to understand the effect of presenting drug detection data on narratives of product use. Thirty-six women reported high adherence in stage 1, yet admitted non-use in stage 2, three reported high adherence in both stages (contrary to their drug detection results) and five had consistent responses across both stages and drug results. Presenting objective measures of use may facilitate more accurate product use reporting and should be evaluated in future prevention trials.
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The Vaginal Microbiome and its Potential to Impact Efficacy of HIV Pre-exposure Prophylaxis for Women. Curr HIV/AIDS Rep 2018; 14:153-160. [PMID: 28812207 DOI: 10.1007/s11904-017-0362-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW This review describes existing evidence addressing the potential modulation of pre-exposure prophylaxis (PrEP) products, specifically 1% tenofovir (TFV) gel and oral tenofovir-based PrEP, by vaginal dysbiosis and discusses future considerations for delivering novel, long-acting PrEP products to women at high risk for vaginal dysbiosis and HIV. RECENT FINDINGS We describe results from analyses investigating the modification of PrEP efficacy by vaginal dysbiosis and studies of biological mechanisms that could render PrEP ineffective in the presence of specific microbiota. A secondary analysis from the CAPRISA-004 cohort demonstrated that there is no effect of the 1% TFV gel in the presence of non-Lactobacillus dominant microbiota. Another recent analysis comparing oral tenofovir-based PrEP efficacy among women with and without bacterial vaginosis in the Partners PrEP Study found that oral PrEP efficacy is not modified by bacterial vaginosis. Gardnerella vaginalis, commonly present in women with vaginal dysbiosis, can rapidly metabolize TFV particularly when it is locally applied and thereby prevent TFV integration into cells. Given that vaginal dysbiosis appears to modulate efficacy for 1% TFV gel but not for oral tenofovir-based PrEP, vaginal dysbiosis is potentially less consequential to HIV protection from TFV in the context of systemic drug delivery and high product adherence. Vaginal dysbiosis may undermine the efficacy of 1% TFV gel to protect women from HIV but not the efficacy of oral PrEP. Ongoing development of novel ring, injectable, and film-based PrEP products should investigate whether vaginal dysbiosis can reduce efficacy of these products, even in the presence of high adherence.
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Acceptability of and Adherence to an Antiretroviral-Based Vaginal Microbicide among Pregnant Women in the United States. AIDS Behav 2018; 22:402-411. [PMID: 28550377 DOI: 10.1007/s10461-017-1811-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The MTN-008 trial was the first multi-dose study conducted to evaluate the safety of a microbicide gel (2:1 randomized to tenofovir 1% or hydroxycellulose (HEC) placebo gel) during pregnancy. The study aim was to evaluate safety, tolerability and pharmacokinetics of the study products. Procedures included daily gel administration, with Day 0 and Day 6 in clinic, and Days 1-5 at home. Because pregnancy may pose unique challenges to consistent gel use and acceptability, evaluation of adherence and acceptability was a secondary objective of the trial. The study enrolled healthy, HIV-negative, pregnant women aged 18-40 in Pittsburgh, PA and Birmingham, AL, USA in 2 consecutive groups: cohort 1 was 37-39 weeks gestation, cohort 2 was 34-36 weeks. Ninety-one women completed the study (45 and 46 in each cohort, respectively) and were evaluable per protocol. Adherence was evaluated using self-reports: participants completed a web-based computer-assisted self-interview (CASI) at Days 0 and 6 about gel attitudes and behaviors. At Day 6 trained research staff conducted a short interviewer-administered questionnaire with both structured and open-ended questions. Frequencies of quantitative data were tabulated in SAS and descriptive statistics are presented; open-ended textual data were summarized by a behavioral scientist experienced in qualitative analysis. Participants reported generally neutral perceptions of gel characteristics. A small number of women (7-8%) reported pain (6/90), other physical discomfort (7/90), or mental discomfort (7/90) associated with the process of applicator insertion. About 5% reported the same for the gel itself. Two-thirds (61/90) thought the gel was runny, many complained of bothersome gel leakage and several cited this reason for not inserting a full dose. The majority were not worried the gel would cause problems for their pregnancy or babies. Ninety-seven percent (83/86) said they would use the gel in the future if they were pregnant, and 90% (81/90) when nonpregnant. Self-reported adherence was high with 88% (79/90) reporting daily gel use on both the computerized and interviewer-administered questionnaires. The majority (67/90) reported no difficulty with daily use. However, drug was undetectable (<0.31 ng/mL) among 45% (27/60; 95% CI 32-58%) of the women on active product prior to observed dosing at Day 6. The most common reason for reported nonuse (N = 6) was forgetting. Study gel was generally acceptable, but many complained of a runny consistency (61/90) and leakage (83/90). No frequent or strong concerns about the effects of the study gel on the pregnancy/fetus were reported. Self-reported adherence to study gel self-administered at home for 5 days was high, however plasma drug levels suggest actual use may have been considerably lower. Findings from this study can provide insights relevant to use of other antiretroviral-based, vaginally-inserted HIV prevention methods during pregnancy.
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End-Users' Product Preference Across Three Multipurpose Prevention Technology Delivery Forms: Baseline Results from Young Women in Kenya and South Africa. AIDS Behav 2018; 22:133-145. [PMID: 29052018 PMCID: PMC5758675 DOI: 10.1007/s10461-017-1911-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A multipurpose prevention technology (MPT) that combines HIV and pregnancy prevention is a promising women’s health intervention, particularly for young women. However, little is known about the drivers of acceptability and product choice for MPTs in this population. This paper explores approval ratings and stated choice across three different MPT delivery forms among potential end-users. The Trio Study was a mixed-methods study in women ages 18–30 that examined acceptability of three MPT delivery forms: oral tablets, injections, and vaginal ring. Approval ratings and stated choice among the products was collected at baseline. Factors influencing stated product choice were explored using multivariable multinomial logistic regression. The majority (62%) of women in Trio stated they would choose injections, 27% would choose tablets and 11% would choose the ring. Significant predictors of choice included past experience with similar contraceptive delivery forms, age, and citing frequency of use as important. Ring choice was higher for older (25–30) women than for younger (18–24) women (aRR = 3.1; p < 0.05). These results highlight the importance of familiarity in MPT product choice of potential for variations in MPT preference by age.
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Belknap R, Holland D, Feng PJ, Millet JP, Caylà JA, Martinson NA, Wright A, Chen MP, Moro RN, Scott NA, Arevalo B, Miró JM, Villarino ME, Weiner M, Borisov AS. Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine Treatment of Latent Tuberculosis Infection: A Randomized Trial. Ann Intern Med 2017; 167:689-697. [PMID: 29114781 PMCID: PMC5766341 DOI: 10.7326/m17-1150] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Expanding latent tuberculosis treatment is important to decrease active disease globally. Once-weekly isoniazid and rifapentine for 12 doses is effective but limited by requiring direct observation. OBJECTIVE To compare treatment completion and safety of once-weekly isoniazid and rifapentine by self-administration versus direct observation. DESIGN An open-label, phase 4 randomized clinical trial designed as a noninferiority study with a 15% margin. Seventy-five percent or more of study patients were enrolled from the United States for a prespecified subgroup analysis. (ClinicalTrials.gov: NCT01582711). SETTING Outpatient tuberculosis clinics in the United States, Spain, Hong Kong, and South Africa. PARTICIPANTS 1002 adults (aged ≥18 years) recommended for treatment of latent tuberculosis infection. INTERVENTION Participants received once-weekly isoniazid and rifapentine by direct observation, self-administration with monthly monitoring, or self-administration with weekly text message reminders and monthly monitoring. MEASUREMENTS The primary outcome was treatment completion, defined as 11 or more doses within 16 weeks and measured using clinical documentation and pill counts for direct observation, and self-reports, pill counts, and medication event-monitoring devices for self-administration. The main secondary outcome was adverse events. RESULTS Median age was 36 years, 48% of participants were women, and 77% were enrolled at the U.S. sites. Treatment completion was 87.2% (95% CI, 83.1% to 90.5%) in the direct-observation group, 74.0% (CI, 68.9% to 78.6%) in the self-administration group, and 76.4% (CI, 71.3% to 80.8%) in the self-administration-with-reminders group. In the United States, treatment completion was 85.4% (CI, 80.4% to 89.4%), 77.9% (CI, 72.7% to 82.6%), and 76.7% (CI, 70.9% to 81.7%), respectively. Self-administered therapy without reminders was noninferior to direct observation in the United States; no other comparisons met noninferiority criteria. A few drug-related adverse events occurred and were similar across groups. LIMITATION Persons with latent tuberculosis infection enrolled in South Africa would not routinely be treated programmatically. CONCLUSION These results support using self-administered, once-weekly isoniazid and rifapentine to treat latent tuberculosis infection in the United States, and such treatment could be considered in similar settings when direct observation is not feasible. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Robert Belknap
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - David Holland
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Pei-Jean Feng
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Joan-Pau Millet
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Joan A Caylà
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Neil A Martinson
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Alicia Wright
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Michael P Chen
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Ruth N Moro
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Nigel A Scott
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Bert Arevalo
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - José M Miró
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Margarita E Villarino
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Marc Weiner
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Andrey S Borisov
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
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Hair levels of preexposure prophylaxis drugs measure adherence and are associated with renal decline among men/transwomen. AIDS 2017; 31:2245-2251. [PMID: 28832411 PMCID: PMC5633521 DOI: 10.1097/qad.0000000000001615] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The US preexposure prophylaxis (PrEP) Demonstration Project (U.S. Demo) evaluated MSM on PrEP postmarketing and found low seroconversion rates. The objective of this study is to examine hair levels as an adherence measure to PrEP. DESIGN Using an 'opt-in' design, participants of PrEP Demo were invited to enroll into a substudy where hair was collected quarterly. METHODS Tenofovir concentrations were measured in hair by liquid chromatography/tandem mass spectrometry. Hair levels consistent with ≥4 doses/week (protective in other studies) defined adequate adherence. Mixed effects multivariate logistic regression models examined factors associated with ≥4 doses/week. Separate mixed effects models evaluated the relationship between hair PrEP levels and changes in creatinine clearance (CrCl) over time. RESULTS Overall, 58% of U.S. Demo participants enrolled into this opt-in study; reasons for nonparticipation included insufficient hair (61%) and concerns about hairstyle (27%). Hair and dried blood spots levels consistent with ≥4 doses/week were highly concordant (84%). Hair levels showed adequate adherence in 87% of 875 person-visits (among 280 participants). Factors associated with adequate adherence in multivariate models were amphetamine use [adjusted odds ratio (aOR) 2.59 (0.97-6.9, P 0.06)], condomless receptive anal sex [aOR 2.28 (1.19-4.40, P 0.01)], and stable housing [aOR 2.63 (1.03-6.67), P 0.04]. Hair levels of tenofovir showed a monotonic relationship with decline in CrCl (P 0.01 for trend). CONCLUSION In this substudy of the U.S. PrEP demonstration project, hair and dried blood spots levels were highly concordant and hair concentrations demonstrated adequate adherence 87% of the time, with stable housing and high-risk behavior associated with higher adherence. Daily PrEP drug taking is associated with modest declines in CrCl.
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Tyo KM, Vuong HR, Malik DA, Sims LB, Alatassi H, Duan J, Watson WH, Steinbach-Rankins JM. Multipurpose tenofovir disoproxil fumarate electrospun fibers for the prevention of HIV-1 and HSV-2 infections in vitro. Int J Pharm 2017; 531:118-133. [PMID: 28797967 DOI: 10.1016/j.ijpharm.2017.08.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
Sexually transmitted infections affect hundreds of millions of people worldwide. Both human immunodeficiency virus (HIV-1 and -2) and herpes simplex virus-2 (HSV-2) remain incurable, urging the development of new prevention strategies. While current prophylactic technologies are dependent on strict user adherence to achieve efficacy, there is a dearth of delivery vehicles that provide discreet and convenient administration, combined with prolonged-delivery of active agents. To address these needs, we created electrospun fibers (EFs) comprised of FDA-approved polymers, poly(lactic-co-glycolic acid) (PLGA) and poly(DL-lactide-co-ε-caprolactone) (PLCL), to provide sustained-release and in vitro protection against HIV-1 and HSV-2. PLGA and PLCL EFs, incorporating the antiretroviral, tenofovir disoproxil fumarate (TDF), exhibited sustained-release for up to 4 weeks, and provided complete in vitro protection against HSV-2 and HIV-1 for 24h and 1 wk, respectively, based on the doses tested. In vitro cell culture and EpiVaginal tissue tests confirmed the safety of fibers in vaginal and cervical cells, highlighting the potential of PLGA and PLCL EFs as multipurpose next-generation drug delivery vehicles.
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Affiliation(s)
- Kevin M Tyo
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Hung R Vuong
- Department of Biochemistry, School of Medicine, University of Louisville, KY, United States
| | - Danial A Malik
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States
| | - Lee B Sims
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, United States
| | - Houda Alatassi
- Department of Pathology, University of Louisville, Louisville, KY, United States
| | - Jinghua Duan
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Walter H Watson
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Louisville, KY, United States
| | - Jill M Steinbach-Rankins
- Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, United States; Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Department of Microbiology and Immunology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States.
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