Incentives conditioned on tenofovir levels to support PrEP adherence among young South African women: a randomized trial.
Incentives conditioned on tenofovir levels to support PrEP adherence among young South African women: a randomized trial.
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DOI：
10.1002/jia2.25636
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发表时间：
2020-11
影响因子：
6
通讯作者：
Bekker LG
中科院分区：
文献类型：
--
作者：
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
非洲少女和年轻女性 (AGYW) 的艾滋病毒发病率仍然很高，她们可以从暴露前预防 (PrEP) 中受益。需要在非洲 AGY 中评估提高 PrEP 依从性和持久性的策略，包括以高依从性为条件的激励措施。 3P 预防研究是一项为期 12 个月的前瞻性队列，由 200 名 16 岁至 25 岁的女性组成，2017 年至 2018 年在南非开始 PrEP。参与者在第 1、2 和 3 个月收到了有关药物水平的回顾性反馈；一半的受试者在第 2、3 和 4 个月随机接受 200 兰特购物券（13 美元），条件是干血斑中细胞内替诺福韦二磷酸 (TFV-DP) 水平较高（第 1 个月≥500 fmol/孔，第 2 和第 3 个月≥700 fmol/孔）。主要分析是意向性治疗，根据男男性行为者的 100% 疗效，比较随机分组在第 3 个月时高 PrEP 依从性（≥700 fmol/次）的比例。 200 名女性的中位年龄为 19 岁（四分位距 [IQR] 17, 21）； 86% 有主要性伴侣。第 3 个月时，激励组的平均 TFV-DP 水平为 822 fmol/拳 (SD 522)，对照组为 689 fmol/拳 (SD 546) (p = 0.11)。激励组 85 名女性中有 45 名 (56%) 和对照组 85 名女性中有 35 名 (41%) TFV-DP 水平≥700 fmol/次（RR 1.35；95% CI 0.98, 1.86；p = 0.067），第 12 个月时激励组和对照组分别下降至 8% 和 5%（无显着差异）臂）。 44% 的人没有间断地重新补充 PrEP，14% 的人在覆盖范围内有 ≥3 周的差距，随后重新启动 PrEP，54% 的人在第 9 个月的最后一次配药就诊时接受。启动 PrEP 后没有观察到新的 HIV 感染。在南非 AGYW 启动 PrEP 的患者中，药物水平表明，在第 3 个月，几乎一半的女性有较高的 PrEP 依从性，激励组中依从性较高的比例较高，无统计学意义。超过一半的人坚持执行 12 个月的 PrEP 计划，尽管高依从性在第 3 个月后有所下降。需要支持 PrEP 依从性和持久性的策略以及长效 PrEP 制剂。
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. 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. 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. 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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影响因子：
3.7
作者：
Carballo-Diéguez A;Balán IC;Brown W 3rd;Giguere R;Dolezal C;Leu CS;Marzinke MA;Hendrix CW;Piper JM;Richardson BA;Grossman C;Johnson S;Gomez K;Horn S;Kunjara Na Ayudhya RP;Patterson K;Jacobson C;Bekker LG;Chariyalertsak S;Chitwarakorn A;Gonzales P;Holtz TH;Liu A;Mayer KH;Zorrilla C;Lama J;McGowan I;Cranston RD
通讯作者：
Cranston RD
DOI：
10.1097/qai.0000000000001045
发表时间：
2016-10-01
影响因子：
3.6
作者：
Thirumurthy, Harsha;Masters, Samuel H.;Agot, Kawango
通讯作者：
Agot, Kawango
影响因子：
168.9
作者：
Baeten, Jared M.;Donnell, Deborah;Stringer, Jeffrey
通讯作者：
Stringer, Jeffrey
影响因子：
2.2
作者：
Romer, Daniel
通讯作者：
Romer, Daniel
影响因子：
16.1
作者：
Molina, Jean-Michel;Charreau, Isabelle;Meyer, Laurence
通讯作者：
Meyer, Laurence