Interventions to Improve Adherence to Oral Pre-exposure Prophylaxis: A Systematic Review and Network Meta-analysis

Area of Science:

• Public Health
• Infectious Diseases
• Behavioral Science

Background:

• Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection.
• User adherence to PrEP regimens is critical for its effectiveness.
• Optimizing adherence interventions is essential for maximizing PrEP's public health impact.

Purpose of the Study:

• To assess the comparative effectiveness of PrEP adherence interventions versus usual care or other interventions.
• To evaluate different components and combinations of interventions aimed at improving PrEP adherence.
• To provide evidence-based recommendations for designing future adherence strategies.

Main Methods:

• Systematic search of electronic databases for randomized controlled trials (RCTs) from 2010 onwards.
• Inclusion of RCTs involving individuals at risk of HIV randomized to adherence interventions or control groups.
• Network meta-analyses were used to compare interventions, with evidence certainty assessed by CINeMA.

Main Results:

• HIV self-testing with adherence feedback improved adherence compared to usual care (RR: 1.83).
• Multi-component interventions (two or three components) were superior to single-component interventions for adherence.
• HIV self-testing alone and reminders alone were less effective than combined strategies.

Conclusions:

• Interventions incorporating HIV self-testing with adherence feedback are effective.
• Multi-component adherence strategies (2-3 components) are recommended for optimal PrEP adherence.
• Future interventions should focus on combining multiple evidence-based components to enhance adherence.