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Clin Infect Dis. 2018 Jan 6;66(2):213-219. doi: 10.1093/cid/cix755.

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.

Author information

1
Department of Medicine, University of California San Francisco.
2
Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois.
3
Department of Epidemiology and Biostatistics, University of California San Francisco.
4
Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora.
5
Bridge HIV, San Francisco Department of Public Health, California.
6
Department of Bioengineering and Therapeutic Sciences, University of California San Francisco.
7
Department of Epidemiology, University of Alabama Birmingham.

Abstract

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), ≤31% (Wisepill), and >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.

KEYWORDS:

HIV prevention; adherence; adolescent; preexposure prophylaxis

PMID:
29020194
PMCID:
PMC5850042
DOI:
10.1093/cid/cix755
[Indexed for MEDLINE]
Free PMC Article

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