TY - JOUR
T1 - High levels of prevention-effective adherence to HIV PrEP
T2 - an analysis of substudy data from the EPIC-NSW trial
AU - Bavinton, Benjamin R.
AU - Vaccher, Stefanie
AU - Jin, Fengyi
AU - Prestage, Garrett P.
AU - Holt, Martin
AU - Zablotska-Manos, Iryna B.
AU - Guy, Rebecca
AU - Amin, Janaki
AU - Templeton, David J.
AU - Yeung, Barbara
AU - Hammoud, Mohamed A.
AU - Lewis, David
AU - Baker, David
AU - Dharan, Nila
AU - McNulty, Anna M.
AU - Grulich, Andrew E.
AU - Expanded PrEP Implementation in Communities in New South Wales (EPIC-NSW) research group
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background: Preexposure prophylaxis (PrEP) prevents HIV infection but relies on good adherence at times of risk, termed "prevention-effective adherence." Most studies assess adherence without reference to sexual behaviur, making it challenging to determine if poor adherence coincides with HIV risk. Setting: We examined data from a behavioral substudy of a large-scale PrEP implementation trial in New South Wales, Australia. Methods: Trial participants completed optional brief quarterly surveys, reporting the number of pills taken and sexual behavior with male partners for each day of the "last full week" before each survey. Condomless sex (CLS) was defined as "higher risk" for HIV when with HIV-positive men with detectable/unknown viral loads or unknown HIV status men. Adequate PrEP protection was defined as ≥4 pills for participants assigned male sex at birth and ≥6 pills for participants assigned female sex at birth (including transgender men). Results: Of 9596 participants dispensed PrEP, 4401 completed baseline and ≥1 follow-up survey. Participants reported on 12,399 "last full weeks": 7485 weeks (60.4%) involved CLS and 2521 weeks (33.7% of CLS-weeks) involved higher risk CLS. There were 103 weeks in which participants did not have adequate PrEP protection and had higher risk CLS: 4.1% of higher-risk CLS weeks (n = 103/2521), 1.4% of all CLS weeks (n = 103/7485), and 0.8% of all observed weeks (n = 103/12,399). Conclusions: In a large PrEP trial, prevention-effective adherence to PrEP was very high at 99%. Our findings illustrate the importance of measuring pill-taking and sexual behavior in the same period so that prevention-effective adherence can be better estimated.
AB - Background: Preexposure prophylaxis (PrEP) prevents HIV infection but relies on good adherence at times of risk, termed "prevention-effective adherence." Most studies assess adherence without reference to sexual behaviur, making it challenging to determine if poor adherence coincides with HIV risk. Setting: We examined data from a behavioral substudy of a large-scale PrEP implementation trial in New South Wales, Australia. Methods: Trial participants completed optional brief quarterly surveys, reporting the number of pills taken and sexual behavior with male partners for each day of the "last full week" before each survey. Condomless sex (CLS) was defined as "higher risk" for HIV when with HIV-positive men with detectable/unknown viral loads or unknown HIV status men. Adequate PrEP protection was defined as ≥4 pills for participants assigned male sex at birth and ≥6 pills for participants assigned female sex at birth (including transgender men). Results: Of 9596 participants dispensed PrEP, 4401 completed baseline and ≥1 follow-up survey. Participants reported on 12,399 "last full weeks": 7485 weeks (60.4%) involved CLS and 2521 weeks (33.7% of CLS-weeks) involved higher risk CLS. There were 103 weeks in which participants did not have adequate PrEP protection and had higher risk CLS: 4.1% of higher-risk CLS weeks (n = 103/2521), 1.4% of all CLS weeks (n = 103/7485), and 0.8% of all observed weeks (n = 103/12,399). Conclusions: In a large PrEP trial, prevention-effective adherence to PrEP was very high at 99%. Our findings illustrate the importance of measuring pill-taking and sexual behavior in the same period so that prevention-effective adherence can be better estimated.
KW - HIV
KW - preexposure
KW - prophylaxis
KW - prevention-effective adherence
KW - men who have sex with men
KW - sexual behavior
UR - http://www.scopus.com/inward/record.url?scp=85108659446&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000002691
DO - 10.1097/QAI.0000000000002691
M3 - Article
C2 - 33852503
AN - SCOPUS:85108659446
SN - 1525-4135
VL - 87
SP - 1040
EP - 1047
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 4
ER -