Comparison of Measures of Adherence to Human Immunodeficiency Virus Preexposure Prophylaxis Among Adolescent and Young Men Who Have Sex With Men in the United States.

TitleComparison of Measures of Adherence to Human Immunodeficiency Virus Preexposure Prophylaxis Among Adolescent and Young Men Who Have Sex With Men in the United States.
Publication TypePublication
Year of Publication2018
AuthorsKoss CA, Hosek SG, Bacchetti P, Anderson PL, Liu AY, Horng H, Benet LZ, Kuncze K, Louie A, Saberi P, Wilson CM, Gandhi M
JournalClin Infect Dis
Volume66
Issue2
Pagination213-219
Date Published2018 01 06
ISSN1537-6591
KeywordsAdolescent, Anti-HIV Agents, Blood Chemical Analysis, Disease Transmission, Infectious, Emtricitabine, Hair, HIV Infections, Homosexuality, Male, Humans, Male, Medication Adherence, Pre-Exposure Prophylaxis, Tenofovir, United States, Young Adult
Abstract

<p><b>Background: </b>Young men-who-have-sex-with-men (MSM) are disproportionately impacted by human immunodeficiency virus (HIV). Preexposure prophylaxis (PrEP) could reduce HIV acquisition among youth, but suboptimal adherence threatens effectiveness. Optimal metrics of PrEP adherence among adolescents have remain undefined.</p><p><b>Methods: </b>The Adolescent Trials Network 110/113 studies provided daily oral PrEP with tenofovir (TFV) disoproxil fumarate/emtricitabine over 48 weeks to a diverse population of MSM (aged 15-22 years). Self-reported adherence was assessed and PrEP drug concentrations measured from hair and dried blood spot (DBS) samples; 23% of participants received Wisepill electronic monitoring devices. The average number of PrEP doses per week taken was estimated, and concordance between measures assessed.</p><p><b>Results: </b>Among 243 participants, hair samples were collected at 1186/1238 (96%) person-visits. The concordance of TFV levels in hair and TFV-diphosphate in DBS around thresholds consistent with taking ≥4 and 7 PrEP doses/week was high (76% and 80%). Hair and DBS concentrations correlated poorly with self-report and Wisepill metrics. Through week 12, 40%-60% of participants (by hair and DBS), ≤31% (Wisepill), and >85% (self-report) were estimated to have taken ≥4 PrEP doses/week (a threshold associated with protection among MSM). For all measures except self-report, adherence declined over time, with half of participants taking <2 doses/week by week 48.</p><p><b>Conclusions: </b>Among youth on PrEP, adherence waned over time. Self-report overestimated adherence, and use of Wisepill was limited. Hair collection was highly acceptable and provided similar interpretations to DBS. Incorporation of either metric in future PrEP studies among youth could identify suboptimal adherence and trigger interventions.</p>

DOI10.1093/cid/cix755
Alternate JournalClin. Infect. Dis.
PubMed ID29020194
PubMed Central IDPMC5850042
Grant ListU01 HD040533 / HD / NICHD NIH HHS / United States
R01 MH095628 / MH / NIMH NIH HHS / United States
K23 MH097649 / MH / NIMH NIH HHS / United States
K12 HD052163 / HD / NICHD NIH HHS / United States
R01 AI098472 / AI / NIAID NIH HHS / United States
U01 HD040474 / HD / NICHD NIH HHS / United States
UL1 TR000004 / TR / NCATS NIH HHS / United States