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Utility of Different Adherence Measures for PrEP: Patterns and Incremental Value.

Andrew Abaasa1, Craig Hendrix2, Monica Gandhi3

  • 1MRC/UVRI Uganda Research Unit on AIDS, P.O Box 49, Entebbe, Uganda. Andrew.Abaasa@mrcuganda.org.

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|November 2, 2017
PubMed
Summary
This summary is machine-generated.

Measuring adherence to pre-exposure prophylaxis (PrEP) is difficult. Combining hair and plasma drug levels best predicts electronic monitoring adherence, outperforming self-report alone.

Keywords:
HairPlasmaPrEP drug-taking patterns of adherence electronic monitoring

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Area of Science:

  • Pharmacokinetics
  • HIV Prevention Research
  • Clinical Trials

Background:

  • Accurate measurement of pre-exposure prophylaxis (PrEP) adherence is critical for its effectiveness in HIV prevention.
  • Previous adherence assessment methods have limitations in reliability and accuracy.

Purpose of the Study:

  • To evaluate and compare different methods for measuring PrEP adherence.
  • To determine the incremental value of combining various adherence measures.

Main Methods:

  • A randomized phase II trial comparing daily tenofovir disoproxil fumarate/emtricitabine to placebo.
  • Adherence measured by electronic monitoring (EM), self-report (SR), plasma drug concentrations, and hair drug concentrations over 4 months.
  • Analysis of discrimination using area under receiver operating curves (AROC) for each measure and combinations.

Main Results:

  • Hair drug concentration was the single best pharmacokinetic (PK) measure for predicting EM-assessed adherence (AROC 0.85).
  • Self-report (SR) showed poor discrimination (AROC 0.53).
  • Combining hair with plasma or hair with self-report improved discrimination significantly (AROC > 0.9).

Conclusions:

  • Self-reported adherence alone has limited utility for assessing PrEP adherence.
  • Hair drug levels are a valuable long-term marker for PrEP adherence.
  • Combining short-term (plasma) and long-term (hair) drug concentration metrics offers a robust approach to assessing adherence patterns.