Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study.
Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study.
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DOI：
10.1371/journal.pmed.1004097
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发表时间：
2022-09
期刊：
影响因子：
15.8
通讯作者：
中科院分区：
文献类型：
--
作者：
In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) ages 15 to 24 years represent <10% of the population yet account for 1 in 5 new HIV infections. Although oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) can be highly effective, low persistence in PrEP programs and poor adherence have limited its ability to reduce HIV incidence among women. A total of 336 AGYW participating in the PEPFAR-funded DREAMS PrEP program in western Kenya were enrolled into a study of PrEP use conducted between 6/2019 to 1/2020. AGYW, who used daily oral TDF/FTC, completed interviews and provided dried blood spots (DBS) for measurement of tenofovir-diphosphate (TFV-DP) concentrations at enrollment and 3 months later, and 176/302 (58.3%, 95% confidence interval [95% CI 52.3 to 63.8]) met our definition of PrEP persistence: having expressed intention to use PrEP and attended both the second interview and an interim refill visit. Among AGYW with DBS taken at the second interview, only 9/197 (4.6%, [95% CI 1.6 to 7.5]) had protective TFV-DP levels (≥700 fmol/punch) and 163/197 (82.7%, [95% CI 77.5 to 88]) had levels consistent with no recent PrEP use (<10 fmol/punch). Perception of being at moderate-to-high risk for HIV if not taking PrEP was associated with persistence (adjusted odds ratio, 10.17 [95% CI 5.14 to 20.13], p < 0.001) in a model accounting for county of residence and variables that had p-value <0.1 in unadjusted analysis (age, being in school, initiated PrEP 2 to 3 months before the first interview, still active in DREAMS, having children, having multiple sex partners, partner aware of PrEP use, partner very supportive of PrEP use, partner has other partners, AGYW believes that a partner puts her at risk, male condom use, injectable contraceptive use, and implant contraceptive use). Among AGYW who reported continuing PrEP, >90% indicated they were using PrEP to prevent HIV, although almost all had non-protective TFV-DP levels. Limitations included short study duration and inclusion of only DREAMS participants. Many AGYW persisted in the PrEP program without taking PrEP frequently enough to receive benefit. Notably, AGYW who persisted had a higher self-perceived risk of HIV infection. These AGYW may be optimal candidates for long-acting PrEP. Jean de Dieu Tapsoba and colleagues investigate low adherence and non-protective drug levels among adolescent girls and young women in Kenya who continue attendance in a PrEP program. Women in sub-Saharan African bear a disproportionate burden of new HIV infection; adolescent girls and young women (AGYW) account for 1 in 5 new infections. Oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention in men who have sex with men, but has been less successful among young women, in large part due to low adherence. A better understanding of barriers and facilitators to oral PrEP uptake and adherence is critical to designing effective interventions for AGYW. We studied persistence and adherence to oral PrEP among 336 AGYW ages 18 to 24 enrolled in the PEPFAR-funded DREAMS PrEP program and residing in Kisumu and Homa Bay Counties, Kenya. We interviewed girls at 2 time points, capturing self-reported information about PrEP use. We collected dried blood spots (DBS) for measurement of a PrEP metabolite (TFV-DP). A total of 176 AGYW persisted in the PrEP program, that is, they attended the follow-up and PrEP refill visits and stated that they were continuing PrEP. However, most were not adherent. Only 28/176 (16%) had detectable TFV-DP levels at Interview 2, with only 7 (4%) having levels consistent with protection (≥700 fmol/punch). Compared to AGYW who discontinued PrEP altogether, this persistent but non-adherent group (N = 144) was older (twice as likely to be ≥22 years), 4 times more likely to be active in the DREAMS program, 10 times more likely to think they would be at moderate-to-high risk for HIV if not taking PrEP, and 3 times more likely to use injectable contraceptives. While many AGYW intend to use PrEP and come to program visits, they do not take sufficient oral PrEP to provide protection against HIV infection (intention–action gap). A more nuanced understanding of this intention–action gap is needed to develop effective programmatic responses. There is a need to continue to adjust HIV prevention programs to include new tools, such as long-acting PrEP, to more appropriately meet the needs of AGYW, a population at high-risk for HIV.
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影响因子：
8.1
作者：
Ncama, Busisiwe P.;McInerney, Patricia A.;Davis, Sheila M.
通讯作者：
Davis, Sheila M.
影响因子：
15.8
作者：
Birdthistle I;Kwaro D;Shahmanesh M;Baisley K;Khagayi S;Chimbindi N;Kamire V;Mthiyane N;Gourlay A;Dreyer J;Phillips-Howard P;Glynn J;Floyd S
通讯作者：
Floyd S
影响因子：
168.9
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Mayer, Kenneth H.;Molina, Jean-Michel;Thompson, Melanie A.;Anderson, Peter L.;Mounzer, Karam C.;De Wet, Joss J.;DeJesus, Edwin;Jessen, Heiko;Grant, Robert M.;Ruane, Peter J.;Wong, Pamela;Ebrahimi, Ramin;Zhong, Lijie;Mathias, Anita;Callebaut, Christian;Collins, Sean E.;Das, Moupali;McCallister, Scott;Brainard, Diana M.;Brinson, Cynthia;Clarke, Amanda;Coll, Pep;Post, Frank A.;Hare, C. Bradley
通讯作者：
Hare, C. Bradley
影响因子：
16.1
作者：
Molina, Jean-Michel;Charreau, Isabelle;Meyer, Laurence
通讯作者：
Meyer, Laurence
影响因子：
1.5
作者：
Koss, Catherine A.;Bacchetti, Peter;Gandhi, Monica
通讯作者：
Gandhi, Monica