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AIDS Behav. 2016 Jul;20(7):1527-34. doi: 10.1007/s10461-016-1415-9.

The Effect of Depressive Symptoms on Adherence to Daily Oral PrEP in Men who have Sex with Men and Transgender Women: A Marginal Structural Model Analysis of The iPrEx OLE Study.

Author information

1
Grant Lab, J David Gladstone Institutes, GIVI, 5th Floor 1650 Owens St, San Francisco, CA, 94158, USA. megha.mehrotra@gladstone.ucsf.edu.
2
University of California, San Francisco, CA, USA. megha.mehrotra@gladstone.ucsf.edu.
3
University of California, San Francisco, CA, USA.
4
Grant Lab, J David Gladstone Institutes, GIVI, 5th Floor 1650 Owens St, San Francisco, CA, 94158, USA.
5
School of Public Health, University of Michigan, Ann Arbor, MI, USA.
6
Stroger Hospital of Cook County, Chicago, IL, USA.
7
Fenway Community Health, Boston, MA, USA.
8
FIOCRUZ, Rio de Janeiro, Brazil.
9
Desmond Tutu Health Foundation, Cape Town, South Africa.
10
University of Sao Paulo Medical School, Sao Paulo, Brazil.
11
Projeto Praca Onze, Hospital Escola Sao Francisco de Assis, Universidade Federal do Rio de Janiero, Rio de Janeiro, Brazil.

Abstract

We assessed the role of depressive symptoms on adherence to daily oral FTC/TDF for HIV PrEP in cisgender men who have sex with men (MSM) and transgender women who have sex with men (TGW) using data from the iPrEx OLE study. A marginal structural logistic regression model was used to estimate the effect of time-varying CES-D scores on having protective levels of drug concentration, adjusting for confounding by sexual practices over time, prior adherence, and baseline demographic characteristics. We found a non-monotonic relationship between CES-D score and odds of protective FTC/TDF levels in MSM. We found evidence that the effect of depression on adherence varied between MSM and TGW, and that depressive symptoms did not contribute greatly to decreased adherence on a population scale. We recommend that depressive symptoms not preclude the prescription of PrEP, and that MSM and TGW be studied separately.

KEYWORDS:

Adherence; Depression; HIV prevention; Marginal structural model; Men who have sex with men; PrEP; Preexposure prophylaxis; Transgender women; iPrEx OLE

PMID:
27125241
PMCID:
PMC4912836
DOI:
10.1007/s10461-016-1415-9
[Indexed for MEDLINE]
Free PMC Article

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