Adherence to Daily Oral TDF/FTC for PrEP in Community Health Center Populations: The Sustainable Health Center Implementation PrEP Pilot (SHIPP) Study
Adherence to Daily Oral TDF/FTC for PrEP in Community Health Center Populations: The Sustainable Health Center Implementation PrEP Pilot (SHIPP) Study
复制标题
社区健康中心人群坚持每日口服 TDF/FTC 进行 PrEP：可持续健康中心实施 PrEP 试点 (SHIPP) 研究
作者：
D. Smith;M. Rawlings;N. Glick;L. Mena;M. Coleman;M. Houlberg;S. McCallister;J. Wiener
口服暴露前预防（PrEP）的预防效果高度依赖于药物依从性，但没有经过验证的长期PrEP依从性措施可供照顾不同人群的初级保健临床医生使用。我们比较了两种自我报告方法（过去7天内漏服的剂量和过去一周每天服药的剂量）和使用PrEP前12个月每季度访问的干血斑（DBS）样本中替诺福韦浓度的结果。美国五个社区卫生中心的1420名男性和女性参加了一项药物依从性亚研究。对于3、6、9和12个月，自我报告与DBS水平一致的人在前一周服用所有7种剂量的百分比分别为71%（51%）、70%（47%）、71%（46%）和69%（44%）。相反，报告在前一周服用0-1剂量的参与者的百分比与DBS药物水平在3,6,9和12个月的不依从性水平为6%(9%),5%(10%),8%（9%）和9%（15%）。与白人受试者相比，黑人受试者（RR 1.60, CI 1.09-2.34）或“其他”种族受试者（RR 1.62, CI 0.99-2.65）的低依从性（估计前一周0-1次剂量）的估计风险更高；与男男性行为者相比，变性女性（RR 2.31, CI 1.33-4.02）；或在提供PrEP经验较少的研究地点注册。对于在过去3个月内性伴侣数量较多以及拥有学士学位或更高学位的参与者，DBS依从性较低的估计风险较低。需要开展更多的工作，为临床医生提供措施，以评估正在使用PrEP的美国不同人群的药物依从性，以支持其有效使用，减少个人和社区一级的艾滋病毒感染。
The prevention effectiveness of oral preexposure prophylaxis (PrEP) is highly dependent on medication adherence but no validated longer term PrEP adherence measures are readily available for use by primary care clinicians caring for diverse populations. We compared two self-report measures (number of doses missed in past 7 days and day-by-day past week pill taking) to results of tenofovir concentrations in dried blood spot (DBS) samples at quarterly visits over the first 12 months of PrEP use. 1420 men and women in five US community health centers enrolled in a medication adherence substudy. For 3, 6, 9 and 12 months, the respective percentages of persons with self-report vs DBS levels consistent having taken all 7 doses in the week prior were 71% (51%), 70% (47%), 71% (46%) and 69% (44%). Conversely, the percentage of participants reporting taking 0–1 doses in the week prior by self-report vs DBS drug levels at 3, 6, 9 and 12 months consistent with this level of nonadherence of 6% (9%), 5% (10%), 8% (9%), and 9% (15%). The estimated risk of low adherence (estimated 0–1 doses in the week prior) was higher for participants of Black (RR 1.60, CI 1.09–2.34) or “Other” race (RR 1.62, CI 0.99–2.65) compared with participants of White race; being a transgender female (RR 2.31, CI 1.33–4.02) compared to men who have sex with men; or enrollment at a study site with less experience in the provision of PrEP. The estimated risk of low adherence by DBS was lower for participants with a higher number of sex partners in the past 3 months and those having a bachelor’s degree or higher. More work is needed to provide clinicians with measures to assess medication adherence in diverse US populations being prescribed PrEP to support its effective use in reducing HIV acquisition in individuals and at the community level.
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影响因子：
6.4
作者：
Gandhi, Monica;Glidden, David V.;Grant, Robert M.
通讯作者：
Grant, Robert M.
影响因子：
39
作者：
Liu, Albert Y.;Cohen, Stephanie E.;Vittinghoff, Eric;Anderson, Peter L.;Doblecki-Lewis, Susanne;Bacon, Oliver;Chege, Wairimu;Postle, Brian S.;Matheson, Tim;Amico, K. Rivet;Liegler, Teri;Rawlings, M. Keith;Trainor, Nikole;Blue, Robert Wilder;Estrada, Yannine;Coleman, Megan E.;Cardenas, Gabriel;Feaster, Daniel J.;Grant, Robert;Philip, Susan S.;Elion, Richard;Buchbinder, Susan;Kolber, Michael A.
通讯作者：
Kolber, Michael A.
影响因子：
1.5
作者：
Castillo-Mancilla, Jose R.;Zheng, Jia-Hua;Anderson, Peter L.
通讯作者：
Anderson, Peter L.
DOI：
10.1016/s1473-3099(14)70847-3
发表时间：
2014-09
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Grant RM;Anderson PL;McMahan V;Liu A;Amico KR;Mehrotra M;Hosek S;Mosquera C;Casapia M;Montoya O;Buchbinder S;Veloso VG;Mayer K;Chariyalertsak S;Bekker LG;Kallas EG;Schechter M;Guanira J;Bushman L;Burns DN;Rooney JF;Glidden DV;iPrEx study team
通讯作者：
iPrEx study team