State of the science of adherence in pre-exposure prophylaxis and microbicide trials.
State of the science of adherence in pre-exposure prophylaxis and microbicide trials.
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DOI：
10.1097/qai.0b013e31826f9962
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发表时间：
2012-12-01
期刊：
影响因子：
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通讯作者：
El-Bassel N
中科院分区：
文献类型：
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作者：
Muchomba FM;Gearing RE;Simoni JM;El-Bassel N
对于有效预防 HIV 的暴露前预防 (PrEP) 和杀菌剂，需要最佳的治疗依从性。然而，对这些策略的遵守情况尚未得到充分研究。这项调查系统地回顾了 4 个遵守领域的口服 PrEP 和杀菌剂试验：1) 定义和使用的措施； 2）不遵守的风险； 3）促销策略； 4) 对结果的影响。确定了 1987 年至 2012 年间发表的 19 项试验（n = 19），共有 47157 名参与者。据报道，杀菌剂的平均依从率为 79%，口服 PrEP 的平均依从率为 87%。不遵守杀菌剂的常见风险是随着时间的推移，动机下降、与主要（非商业/临时）伴侣发生性行为以及供应不足。口服 PrEP 不依从的风险是年龄较大和药物副作用。心理教育以及对参与者和社区的宣传是经常采用的推广策略。大多数试验未能系统地识别障碍并监测和促进依从性，尽管依从性会调节结果。提供了在未来试验中注意依从性的建议。
For pre-exposure prophylaxis (PrEP) and microbicides to effectively prevent HIV, optimal treatment adherence is required. Adherence to these strategies, however, has not been sufficiently studied. This investigation systematically reviews oral PrEP and microbicide trials across 4 domains of adherence: 1) definition and measures used; 2) risks for non-adherence; 3) promotion strategies; and 4) effects on outcomes. Nineteen (n = 19) trials, with 47157 participants, published between 1987 and 2012 were identified. Reported mean adherence to microbicides was 79% and to oral PrEP 87%. Common risks for microbicide nonadherence were decreased motivation over time, sex with primary (noncommercial/casual) partners, and insufficient supply. Oral PrEP non-adherence risks were older age and medication side effects. Psychoeducation and outreach to participants and communities were frequently utilized promotion strategies. Most trials failed to systematically identify barriers and monitor and promote adherence, although adherence moderated outcomes. Recommendations for attending to adherence in future trials are provided.