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AIDS Care. 2019 Mar;31(3):379-387. doi: 10.1080/09540121.2018.1533223. Epub 2018 Oct 14.

Trajectory of use over time of an oral tablet and a rectal gel for HIV prevention among transgender women and men who have sex with men.

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a HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , NY , USA.
b School of Nursing , University of Pennsylvania , Philadelphia , PA , USA.
c Center for AIDS Prevention Studies, Department of Medicine , University of California San Francisco , San Francisco , CA , USA.
d Department of Biostatistics , University of Washington , Seattle , WA , USA.
e Division of AIDS , National Institute of Allergy and Infectious Diseases , Rockville , MD , USA.
f Asociación Civil Impacta Salud y Educación , Lima , Peru.
g Department of Medicine , University of Pittsburgh , Pittsburgh , PA , USA.


We examined product adherence among 187 men who have sex with men and transgender women enrolled in a phase II, crossover trial comparing safety and acceptability of an oral tablet and a rectal gel used daily for HIV prevention. Participants reported adherence via daily text messages during 8-week periods. Trajectory analysis identified weekly patterns. Polytomous logistic regression identified characteristics associated with higher probability of trajectory group membership. We identified 3 groups per product: high-adherers (72% daily oral, 70% daily gel); decreasing-adherers (20% daily oral, 22% daily gel); and low-adherers (8% daily oral, 9% daily gel). Daily oral high-adherers (compared with low-adherers) were more likely to self-identify as male (OR = 4.76, 95% CI:1.35-16.67), to have more sexual partners (OR = 1.67, 95% CI:1.04-2.63), and to find the tablet easy to swallow (OR = 2.22, 95% CI:1.08-4.76). Daily gel high-adherers (compared with low-adherers) were more likely to be older (OR = 1.16, 95% CI:1.05-1.28), to find gel application easier at the last few applications (OR = 2.27, 95% CI:1.01-5.00), and to report a change in routine if gel was not used (OR = 5.26, 95% CI:1.23-100.00). Characteristics of participants likely to be high-adherers to product use vary according to product. Evaluation of acceptability prior to phase II/III trials could identify participants likely to maintain high adherence.


PrEP; SMS; adherence; microbicides; trajectory

[Available on 2020-03-01]

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