Alignment of adherence and risk for HIV acquisition in a demonstration project of pre-exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention-effective adherence.
Alignment of adherence and risk for HIV acquisition in a demonstration project of pre-exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention-effective adherence.
复制标题
在肯尼亚和乌干达的艾滋病毒血清伴侣中预防前预防的示威计划中，遵守性和艾滋病毒获取风险的比对：预防有效依从性的前瞻性分析。
DOI：
10.7448/ias.20.1.21842
复制
发表时间：
2017-07-25
影响因子：
6
通讯作者：
Baeten JM
中科院分区：
文献类型：
--
作者：
Haberer JE;Kidoguchi L;Heffron R;Mugo N;Bukusi E;Katabira E;Asiimwe S;Thomas KK;Celum C;Baeten JM
简介：坚持使用暴露前预防(PrEP)以防止艾滋病毒感染是必不可少的，但PrEP的使用不一定是终生的。当PREP的使用与风险期--一个称为预防--有效坚持的概念相一致时，它是最有效的。这篇论文的目的是描述肯尼亚和乌干达HIV血清不一致夫妇中综合PrEP和抗逆转录病毒疗法(ART)的开放标签交付项目(伙伴示范项目)中预防有效的坚持和遵守的预测因素。方法：我们向未感染艾滋病毒的参与者提供≥，直到感染艾滋病毒的伴侣接受抗逆转录病毒治疗6个月(这种策略被称为“PrEP作为通往抗逆转录病毒治疗的桥梁”)。以两种方式估计足以预防艾滋病毒的遵守程度：≥4剂量/周和≥6剂量/周(根据电子监测)。如果这对夫妇在接受抗逆转录病毒治疗前报告100%使用避孕套，感染艾滋病毒的风险被认为是高的；如果他们报告发生了性行为，但100%使用避孕套和/或接受抗逆转录病毒治疗六个月，那么感染艾滋病毒的风险很低；如果没有性行为，感染艾滋病毒的风险很低。我们通过将PrEP的使用与艾滋病毒风险交叉列表来评估预防有效的依从性，并使用多变量回归模型评估≥4和≥6每周剂量的预测因素。结果：共有985名未感染艾滋病毒的参与者启动了PrEP；67%的人是男性，中位年龄为29岁，67%的人在登记前一个月报告了无避孕套的性行为。平均每周服用≥4剂和≥6剂的参与者分别占81%和67%。在75-88%的艾滋病毒高风险参与者就诊中，实现了足以预防艾滋病毒感染的坚持。达到足够的依从性的最强预测因素是报告与携带艾滋病毒的研究伙伴发生性关系；其他有统计学意义的预测因素包括不担心每天的PrEP、怀孕或怀孕意图、年龄25岁的女性、年长的男性伴侣以及对关系成功的渴望。没有达到足够的依从性的预测因素是不再是一对夫妇，推迟PrEP启动，>；6个月的随访，艾滋病病毒携带者和酗酒问题的伴侣使用>；6个月。结论：在血清不一致的夫妇中，超过四分之三的未感染艾滋病毒的伴侣的参与者访问实现了预防-有效地遵守PrEP。在有艾滋病毒风险的几个月中观察到更多的依从性，而达到足够依从性的最强预测因素是性行为。
Introduction: Adherence is essential for pre-exposure prophylaxis (PrEP) to protect against HIV acquisition, but PrEP use need not be life-long. PrEP is most efficient when its use is aligned with periods of risk – a concept termed prevention-effective adherence. The objective of this paper is to describe prevention-effective adherence and predictors of adherence within an open-label delivery project of integrated PrEP and antiretroviral therapy (ART) among HIV serodiscordant couples in Kenya and Uganda (the Partners Demonstration Project). Methods: We offered PrEP to HIV-uninfected participants until the partner living with HIV had taken ART for ≥6 months (a strategy known as “PrEP as a bridge to ART”). The level of adherence sufficient to protect against HIV was estimated in two ways: ≥4 and ≥6 doses/week (per electronic monitoring). Risk for HIV acquisition was considered high if the couple reported sex with <100% condom use before six months of ART, low if they reported sex but had 100% condom use and/or six months of ART and very low if no sex was reported. We assessed prevention-effective adherence by cross-tabulating PrEP use with HIV risk and used multivariable regression models to assess predictors of ≥4 and ≥6 doses/week. Results: A total of 985 HIV-uninfected participants initiated PrEP; 67% were male, median age was twenty-nine years, and 67% reported condomless sex in the month before enrolment. An average of ≥4 doses and ≥6 doses/week were taken in 81% and 67% of participant-visits, respectively. Adherence sufficient to protect against HIV acquisition was achieved in 75–88% of participant-visits with high HIV risk. The strongest predictor of achieving sufficient adherence was reporting sex with the study partner who was living with HIV; other statistically significant predictors included no concerns about daily PrEP, pregnancy or pregnancy intention, females aged >25 years, older male partners and desire for relationship success. Predictors of not achieving sufficient adherence were no longer being a couple, delayed PrEP initiation, >6 months of follow-up, ART use >6 months by the partner living with HIV and problem alcohol use. Conclusions: Over three-quarters of participant-visits by HIV-uninfected partners in serodiscordant couples achieved prevention-effective adherence with PrEP. Greater adherence was observed during months with HIV risk and the strongest predictor of achieving sufficient adherence was sexual activity.