The future of HIV pre-exposure prophylaxis adherence: reducing barriers and increasing opportunities

Haberer, Jessica; Mujugira, Andrew; Mayer, Kenneth R.

doi:10.1016/s2352-3018(23)00079-6

Cited by 22 publications

(9 citation statements)

References 84 publications

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“…3 The effectiveness of PrEP hinges on not only uptake but also persistent use of PrEP for clients with ongoing risk of exposure to HIV. 24 Clients in Ukraine had low persistence on PrEP, consistent with the global literature. Across different countries and settings, PrEP persistence was generally short, with 50% or more of users discontinuing within 6–12 months.…”

Section: Discussionsupporting

confidence: 84%

“…There are multiple interventions that might increase both PrEP uptake and PrEP persistence in Ukraine. Because access and stigma are barriers to PrEP uptake in Ukraine, offering PrEP through primary care health facilities that do not focus solely on HIV care, a model that has been successful in other countries, 24 is worth studying. In recent years, Ukraine embarked on an ambitious reform of the healthcare system to make previously hard-to-access specialized care accessible through primary care.…”

Section: Discussionmentioning

confidence: 99%

“…32 This model has been successful in other countries. 24 PrEP uptake and adherence may also be improved through telemedicine approaches, with delivery locations integrated within organizations and venues KPs already frequent. The addition of mobile healthcare clinics offering PrEP has increased PrEP coverage and persistence in other countries, 24 and it may be effective in Ukraine, perhaps among populations that might have poor access to telemedicine.…”

Section: Discussionmentioning

confidence: 99%

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Uptake and persistent use of HIV pre-exposure prophylaxis (PrEP) among key populations: Results from Ukraine’s scaled national PrEP program

Vitruk,

Ihnatiuk,

Kazanzhy

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Ukraine has implemented ambitious HIV-prevention programs since 1999 and began offering pre-exposure prophylaxis (PrEP) in 2017. Little is known about PrEP uptake and persistence in this setting. Setting: We analyzed data from 40 facilities providing PrEP in 11 oblasts (regions) of Ukraine between October 2020-February 2022. Methods: We estimated the time between PrEP visits and conducted Kaplan-Meier analyses to estimate retention on PrEP stratified by sex, age, and key populations (KPs): men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), discordant couples and others vulnerable to HIV acquisition (DC/Other). We used Cox regression to estimate risk of PrEP discontinuation by KP group and sex, adjusting for age. Results: Overall, 2,033 clients initiated PrEP across regions; the majority (51%) were DC/Other, 22% were MSM, 22% were PWID, and 5% were SW. The overall three-month persistence was 52.3% (95% confidence interval [CI]: 49.9-54.8%) and was lowest among MSM (46.7%; 95% CI: 41.9-52.2%) and SW (25.9%; 95% CI: 18.2-36.9%) (p<0.05 for differences by KP group). After adjusting for age, PrEP discontinuation was not statistically significantly different across groups, although female PWID tended to have the lowest discontinuation risk (adjusted hazard ratio [aHR] 0.59; 95% CI: 0.31-1.11 while male SW tended to have the highest risk (aHR 1.87, 95% CI: 0.57-6.11) compared with females in the DC/Other group). Conclusion: Three-month PrEP persistence was low across KP groups, especially in SW. Further research examining the barriers and enablers of persistence by KPs is needed.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Uptake and persistent use of HIV pre-exposure prophylaxis (PrEP) among key populations: Results from Ukraine’s scaled national PrEP program

Vitruk,

Ihnatiuk,

Kazanzhy

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…stigma, intimate partner attitudes) and structural barriers (e.g. financial constraints, lack of access or education) [4–7]. While injectable PrEP may offer effective HIV prevention without certain adherence barriers, data on experiences with PrEP injections are limited.…”

Section: Introductionmentioning

confidence: 99%

HPTN 083‐02: factors influencing adherence to injectable PrEP and retention in an injectable PrEP study

Psaros,

Goodman,

Lee

et al. 2024

J Int AIDS Soc.

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IntroductionHPTN 083 demonstrated the superiority of long‐acting cabotegravir (CAB‐LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre‐exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial.MethodsParticipants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non‐adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis.ResultsParticipants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study‐related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non‐judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection‐related anxiety, which abated with time and when given some measure of control (e.g. pre‐injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules).ConclusionsRespondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non‐judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.

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“…The percentage of participants with sustained adherence was much lower than in previous studies in MSM, underscoring the challenge of daily oral F/TDF for cisgender women. Barriers to PrEP adherence may vary by local context, although low perception of HIV risk, stigma, and poor social support are among the common reasons across settings . Pregnancy was not analyzed in this study, but can also influence adherence.…”

mentioning

confidence: 99%

Shifting the Narrative of Preexposure Prophylaxis Adherence Counseling for Cisgender Women

Sheth,

Momplaisir,

Dumond

2024

JAMA

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The future of HIV pre-exposure prophylaxis adherence: reducing barriers and increasing opportunities

Cited by 22 publications

References 84 publications

Uptake and persistent use of HIV pre-exposure prophylaxis (PrEP) among key populations: Results from Ukraine’s scaled national PrEP program

Uptake and persistent use of HIV pre-exposure prophylaxis (PrEP) among key populations: Results from Ukraine’s scaled national PrEP program

HPTN 083‐02: factors influencing adherence to injectable PrEP and retention in an injectable PrEP study

Shifting the Narrative of Preexposure Prophylaxis Adherence Counseling for Cisgender Women

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