Comparison of Measures of Adherence to Human Immunodeficiency Virus Preexposure Prophylaxis Among Adolescent and Young Men Who Have Sex With Men in the United States
Comparison of Measures of Adherence to Human Immunodeficiency Virus Preexposure Prophylaxis Among Adolescent and Young Men Who Have Sex With Men in the United States
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DOI：
10.1093/cid/cix755
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发表时间：
2018-01-15
影响因子：
11.8
通讯作者：
Gandhi, Monica
中科院分区：
文献类型：
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作者：
Koss, Catherine A.;Hosek, Sybil G.;Gandhi, Monica
背景。年轻男男性接触者 (MSM) 受人类免疫缺陷病毒 (HIV) 的影响尤为严重。暴露前预防 (PrEP) 可以减少青少年感染艾滋病毒，但依从性不佳会影响有效性。青少年中 PrEP 依从性的最佳指标尚未确定。方法。青少年试验网络 110/113 研究向不同的 MSM 人群（年龄 15-22 岁）提供每日口服 PrEP，服用富马酸替诺福韦 (TFV) 二吡呋酯/恩曲他滨，为期 48 周。评估自我报告的依从性，并从头发和干血斑 (DBS) 样本中测量 PrEP 药物浓度； 23% 的参与者收到了 Wisepill 电子监控设备。估计每周服用的 PrEP 平均剂量，并评估措施之间的一致性。结果。在 243 名参与者中，在 1186/1238 (96%) 人次访问中收集了头发样本。头发中的 TFV 水平和 DBS 中的 TFV-二磷酸水平在与每周服用 >= 4 和 7 剂 PrEP 剂量一致的阈值附近的一致性很高（76% 和 80%）。头发和 DBS 浓度与自我报告和 Wisepill 指标的相关性较差。到第 12 周，估计 40%-60% 的参与者（按头发和 DBS）、85%（自我报告）每周服用 >= 4 剂 PrEP（与 MSM 中的保护相关的阈值）。对于除自我报告之外的所有措施，依从性随着时间的推移而下降，到第 48 周时，一半的参与者每周服用 < 2 剂剂量。结论。在接受 PrEP 的青少年中，依从性随着时间的推移而减弱。自我报告高估了依从性，并且 Wisepill 的使用受到限制。毛发采集非常容易被接受，并且提供了与 DBS 类似的解释。在未来的青少年 PrEP 研究中纳入任一指标都可以识别次优的依从性并触发干预措施。
Background. Young men-who-have-sex-with-men (MSM) are disproportionately impacted by human immunodeficiency virus (HIV). Preexposure prophylaxis (PrEP) could reduce HIV acquisition among youth, but suboptimal adherence threatens effectiveness. Optimal metrics of PrEP adherence among adolescents have remain undefined.Methods. The Adolescent Trials Network 110/113 studies provided daily oral PrEP with tenofovir (TFV) disoproxil fumarate/emtricitabine over 48 weeks to a diverse population of MSM (aged 15-22 years). Self-reported adherence was assessed and PrEP drug concentrations measured from hair and dried blood spot (DBS) samples; 23% of participants received Wisepill electronic monitoring devices. The average number of PrEP doses per week taken was estimated, and concordance between measures assessed.Results. Among 243 participants, hair samples were collected at 1186/1238 (96%) person-visits. The concordance of TFV levels in hair and TFV-diphosphate in DBS around thresholds consistent with taking >= 4 and 7 PrEP doses/week was high (76% and 80%). Hair and DBS concentrations correlated poorly with self-report and Wisepill metrics. Through week 12, 40%-60% of participants (by hair and DBS), 85% (self-report) were estimated to have taken >= 4 PrEP doses/week (a threshold associated with protection among MSM). For all measures except self-report, adherence declined over time, with half of participants taking < 2 doses/week by week 48.Conclusions. Among youth on PrEP, adherence waned over time. Self-report overestimated adherence, and use of Wisepill was limited. Hair collection was highly acceptable and provided similar interpretations to DBS. Incorporation of either metric in future PrEP studies among youth could identify suboptimal adherence and trigger interventions.