Understanding Pre-Exposure Prophylaxis Adherence in Young Women in Kenya.
Understanding Pre-Exposure Prophylaxis Adherence in Young Women in Kenya.
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DOI：
10.1097/qai.0000000000002876
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
Baeten JM
中科院分区：
文献类型：
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作者：
Haberer JE;Mugo N;Bukusi EA;Ngure K;Kiptinness C;Oware K;Garrison LE;Musinguzi N;Pyra M;Valenzuela S;Thomas KK;Anderson PL;Thirumurthy H;Baeten JM
Supplemental Digital Content is Available in the Text. To present detailed analyses of long-term pre-exposure prophylaxis (PrEP) use and associated behaviors and perceptions among young Kenyan women. Prospective, observational cohort. The Monitoring PrEP among Young Adult women Study involved 18 to 24-year-old women at high HIV risk initiating PrEP in Kisumu and Thika, Kenya. Visits for PrEP counseling and dispensing, HIV testing, and socio-behavioral data collection occurred at Month 1 and quarterly for 2 years. PrEP adherence was measured with pharmacy refill and real-time electronic monitoring, plus tenofovir diphosphate levels in 15% of participants. HIV risk behavior and perception were assessed by self-report in weekly short message service surveys from Months 6–24. Predictors of adherence were assessed with multivariable logistic regression analysis. Three hundred forty-eight women (median age 21, VOICE risk score 7) were followed for 617 person-years. Pharmacy refills steadily declined from 100% (Month 0–1) to 54% (Months 22–24). Average electronically monitored adherence similarly declined from 65% (Month 0–1) to 15% (Months 22–24). Electronically monitored adherence had moderately high concordance with tenofovir diphosphate levels (67%). High average adherence (5+ doses/week) was seen at 385/1898 (20%) participant-visits and associated with low baseline VOICE risk score, >1 current sexual partner, ≤1-hour travel time to clinic, and the Kisumu site. short message service-reported behavior and risk perception were not associated with adherence. Four women acquired HIV (incidence 0.7/100 person-years). PrEP adherence was modest and declined over time. HIV risk was inconsistently associated with adherence; clinic access and site-level factors were also relevant. Relatively low HIV incidence suggests participants may have achieved protection through multiple strategies.
