Incentives conditioned on tenofovir levels to support PrEP adherence among young South African women: a randomized trial

Celum, Connie; Gill, Katherine; Morton, Jennifer; Stein, Gabrielle; Myers, Laura J.; Thomas, Katherine K.; McConnell, Margaret; Straten, Ariane van der; Baeten, Jared M.; Duyver, Menna; Mendel, Eve; Naidoo, Keshani; Dallimore, Jacqui; Wiesner, Lubbe; Bekker, Linda‐Gail

doi:10.1002/jia2.25636

Cited by 56 publications

(80 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We observed high drop-offs in PrEP adherence by Week 52: only 348 (81.5%) participants had DBS samples and PrEP was detected in 31% samples at this visit. However, these results are consistent with other PrEP projects among AGYW that have reported declining PrEP adherence over time [12,[65][66][67]. There are several potential mechanisms to explain our findings on the significant negative relationship between depressive symptoms and PrEP use.…”

Section: Group-based Trajectory Modelsupporting

confidence: 92%

Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre‐exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction African adolescent girls and young women (AGYW) eligible for HIV pre‐exposure prophylaxis (PrEP) experience high levels of depressive symptoms. Depression can reduce PrEP adherence among adults, although analyses have considered depression as a time‐varying exposure rather than modelling distinct patterns of symptoms. The association between depressive symptoms and PrEP adherence has not been explored for AGYW. To address these gaps, we sought to understand depressive symptom trajectories among African AGYW initiating PrEP and the impact of time‐varying depressive symptoms and symptom trajectories on PrEP adherence. Methods HPTN 082 was an open‐label PrEP study among AGYW (ages 16 to 24) in Zimbabwe and South Africa from 2016 to 2018. Depressive symptoms were measured at enrolment and Weeks 13, 26 and 52, using the 10‐item Center for Epidemiologic Studies scale; a score ≥10 is indicative of elevated depressive symptoms. PrEP adherence was defined as any detectable tenofovir diphosphate (TFV‐DP) levels. Group‐based trajectory modelling was used to model longitudinal patterns of depressive symptoms. We assessed psychosocial and behavioural predictors of depressive symptom trajectory membership (e.g. PrEP stigma, intimate partner violence [IPV], sexual behaviour). We modelled associations between (1) group trajectory membership and PrEP adherence at Week 52 and (2) time‐varying depressive symptoms and PrEP adherence through follow‐up. Results At enrolment, 179 (41.9%) participants had elevated depressive symptoms. Group‐based trajectory models revealed persistent elevated depressive symptoms in 48.5%, declining symptoms in 9.4% and no consistent or mild depressive symptoms in 43.3%. AGYW who engaged in transactional sex, reported IPV, or had traumatic stress symptoms were more likely to be assigned to the persistent elevated symptom group compared with the consistent no/mild symptom group (Wald test p‐value all <0.01). Participants assigned to the persistent elevated depressive symptom trajectory had a significantly lower risk of detectable TFV‐DP at Week 52 than those in the no/mild symptom trajectory (adjusted prevalence ratio = 0.89; 95% CI: 0.80 to 0.98). Elevated depressive symptoms were significantly inversely associated with PrEP use throughout follow‐up (adjusted relative risk = 0.73; 95% CI = 0.53 to 0.99). Conclusions Persistent depressive symptoms were common among African AGYW seeking PrEP. Integration of depressive symptom screening and treatment into PrEP programmes may improve PrEP effectiveness among African women.

show abstract

Section: Group-based Trajectory Modelsupporting

confidence: 92%

Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre‐exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The 3Ps for Prevention study, or 3P, was a pilot prospective intervention study evaluating PrEP acceptability and adherence among HIV-uninfected AGYW taking open-label daily oral PrEP [ 12 ]. 3P was conducted at a youth-friendly clinic in a peri-urban settlement located outside Cape Town, South Africa from 2017–18.…”

Section: Methodsmentioning

confidence: 99%

“…At enrollment, AGYW were randomized to receive (or not receive) a small incentive conditional on high adherence on the basis of tenofovir diphosphate (TFV-DP) concentrations in dried blood spots (DBS). Additional detail on the study is described elsewhere [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Given the disparities in HIV incidence faced by AGYW in generalized HIV epidemic settings, the relative sparsity of adolescents in PrEP research, and low adherence as an emerging barrier to PrEP effectiveness in this age group, research is needed to inform PrEP implementation efforts among AGYW with a focus on maximizing adherence. We analyzed qualitative data from the 3Ps for Prevention study [ 12 ] to explore South African AGYW’s perceptions about the role of disclosure and social support in their adherence to oral PrEP. The aims of this research were firstly, to describe experiences of AGYW disclosing their PrEP use and secondly, to better understand the perceived effect of disclosure on PrEP use behavior.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Experiences of oral pre-exposure prophylaxis (PrEP) use disclosure among South African adolescent girls and young women and its perceived impact on adherence

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction There is limited understanding of how social dynamics impact pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW) in generalized HIV-epidemic settings. We examined experiences of oral PrEP use disclosure to various social groups with the goal of identifying supportive relationships that can be leveraged to promote adherence. Methods We used qualitative methods to explore experiences disclosing PrEP use and the perceived impact of disclosure on adherence among 22 South African AGYW (16–25 years) taking daily oral PrEP. Serial in-depth-interviews (IDIs) were conducted 1-, 3-, and 12-months post-PrEP initiation. Respondents also self-reported their disclosures separately for various social groups and adherence was assessed using intracellular tenofovir-diphosphate levels. Results Qualitative respondents had a median age of 20.5 years and reported disclosing their PrEP use to friends (n = 36 total disclosures), partners, siblings, other family members (n = 24 disclosures each), and parents (n = 19 disclosures). IDI data revealed that parents and partners provided the most support to respondents and a lack of support from these groups was most often perceived as negatively affecting PrEP use. AGYW described difficulties explaining PrEP to their mothers, who believed PrEP was HIV treatment or would lead to HIV infection. Disclosure to household members was notably meaningful for AGYW (both positively and negatively). Respondents reported leveraging supportive relationships for pill reminders. For respondents who perceived a household member would be unsupportive, however, non-disclosure was less feasible and PrEP use was often stigmatized. To avoid stigma, several respondents hid or discontinued PrEP. Conclusions While supportive relationships may facilitate PrEP use, disclosure can also lead to stigma. Counselors should support AGYW in disclosing to key people in their social networks and provide AGYW with materials that lend credibility to explanations of PrEP. Community education is necessary to alleviate PrEP-related stigma and facilitate disclosure.

show abstract

“…Our study adds to the literature by showing how ongoing use of incentives can promote repeated behaviors that tend to decline over time. For example, several studies have found large declines in preexposure prophylaxis (PrEP) adherence and clinic engagement over time in sub-Saharan Africa [ 34 – 36 ]. Though our trial took place before widespread PrEP implementation in Uganda, effective strategies to promote retesting, if offered alongside the choice of PrEP and other emerging prevention strategies [ 3 ], could be used to engage those who may not consider themselves at risk for retesting and prevention services.…”

Section: Discussionmentioning

confidence: 99%

Financial incentives and deposit contracts to promote HIV retesting in Uganda: A randomized trial

et al. 2021

View full text Add to dashboard Cite

Background Frequent retesting for HIV among persons at increased risk of HIV infection is critical to early HIV diagnosis of persons and delivery of combination HIV prevention services. There are few evidence-based interventions for promoting frequent retesting for HIV. We sought to determine the effectiveness of financial incentives and deposit contracts in promoting quarterly HIV retesting among adults at increased risk of HIV. Methods and findings In peri-urban Ugandan communities from October to December 2018, we randomized HIV–negative adults with self-reported risk to 1 of 3 strategies to promote HIV retesting: (1) no incentive; (2) cash incentives (US$7) for retesting at 3 and 6 months (total US$14); or (3) deposit contracts: participants could voluntarily deposit US$6 at baseline and at 3 months that would be returned with interest (total US$7) upon retesting at 3 and 6 months (total US$14) or lost if participants failed to retest. The primary outcome was retesting for HIV at both 3 and 6 months. Of 1,482 persons screened for study eligibility following community-based recruitment, 524 participants were randomized to either no incentive (N = 180), incentives (N = 172), or deposit contracts (N = 172): median age was 25 years (IQR: 22 to 30), 44% were women, and median weekly income was US$13.60 (IQR: US$8.16 to US$21.76). Among participants randomized to deposit contracts, 24/172 (14%) made a baseline deposit, and 2/172 (1%) made a 3-month deposit. In intent-to-treat analyses, HIV retesting at both 3 and 6 months was significantly higher in the incentive arm (89/172 [52%]) than either the control arm (33/180 [18%], odds ratio (OR) 4.8, 95% CI: 3.0 to 7.7, p < 0.001) or the deposit contract arm (28/172 [16%], OR 5.5, 95% CI: 3.3 to 9.1, p < 0.001). Among those in the deposit contract arm who made a baseline deposit, 20/24 (83%) retested at 3 months; 11/24 (46%) retested at both 3 and 6 months. Among 282 participants who retested for HIV during the trial, three (1%; 95%CI: 0.2 to 3%) seroconverted: one in the incentive group and two in the control group. Study limitations include measurement of retesting at the clinic where baseline enrollment occurred, only offering clinic-based (rather than community-based) HIV retesting and lack of measurement of retesting after completion of the trial to evaluate sustained retesting behavior. Conclusions Offering financial incentives to high-risk adults in Uganda resulted in significantly higher HIV retesting. Deposit contracts had low uptake and overall did not increase retesting. As part of efforts to increase early diagnosis of HIV among high-risk populations, strategic use of incentives to promote retesting should receive greater consideration by HIV programs. Trial registration clinicaltrials.gov: NCT02890459.

show abstract

Incentives conditioned on tenofovir levels to support PrEP adherence among young South African women: a randomized trial

Cited by 56 publications

References 36 publications

Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre‐exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial

Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre‐exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial

Experiences of oral pre-exposure prophylaxis (PrEP) use disclosure among South African adolescent girls and young women and its perceived impact on adherence

Financial incentives and deposit contracts to promote HIV retesting in Uganda: A randomized trial

Contact Info

Product

Resources

About