An intervention to support HIV preexposure prophylaxis adherence in HIV-serodiscordant couples in Uganda

Christina Psaros; Jessica E. Haberer; Elly Katabira; Allan Ronald; Elioda Tumwesigye; James D. Campbell; Jonathan Wangisi; Kenneth Mugwanya; Alex Kintu; Michael Enyakoit; Katherine K. Thomas; Deborah Donnell; Meighan Krows; Lara Kidoguchi; Norma Ware; Jared M. Baeten; Connie Celum; David R. Bangsberg; Steve A. Safren

doi:10.1097/QAI.0000000000000212

An intervention to support HIV preexposure prophylaxis adherence in HIV-serodiscordant couples in Uganda

Christina Psaros, Jessica E. Haberer, Elly Katabira, Allan Ronald, Elioda Tumwesigye, James D. Campbell, Jonathan Wangisi, Kenneth Mugwanya, Alex Kintu, Michael Enyakoit, Katherine K. Thomas, Deborah Donnell, Meighan Krows, Lara Kidoguchi, Norma Ware, Jared M. Baeten, Connie Celum, David R. Bangsberg, Steve A. Safren

Research output: Contribution to journal › Article › peer-review

42 Scopus citations

Abstract

BACKGROUND: Daily preexposure prophylaxis (PrEP) is an effective HIV prevention strategy, but adherence is required for maximum benefit. To date, there are no empirically supported PrEP adherence interventions. This article describes the process of developing a PrEP adherence intervention and presents results on its impact on adherence. METHODS: The Partners PrEP Study was a placebo-controlled efficacy trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among uninfected members of HIV-serodiscordant couples. An ancillary adherence study was conducted at 3 study sites in Uganda. Participants with <80% adherence as measured by unannounced pill count received an additional adherence counseling intervention based on Lifesteps, an evidence-based HIV treatment adherence intervention, based on principles of cognitive-behavioral theory. FINDINGS: Of the 1147 HIV-seronegative participants enrolled in the ancillary adherence study, 168 (14.6%) triggered the adherence intervention. Of participants triggering the intervention, 62% were men; median age was 32.5 years. The median number of adherence counseling sessions was 10. Mean adherence during the month before the intervention was 75.7% and increased significantly to 84.1% in the month after the first intervention session (P < 0.001). The most frequently endorsed adherence barriers at session 1 were travel and forgetting. INTERPRETATION: A PrEP adherence intervention was feasible in a clinical trial of PrEP in Uganda and PrEP adherence increased after the intervention. Future research should identify PrEP users with low adherence for enhanced adherence counseling and determine optimal implementation strategies for interventions to maximize PrEP effectiveness.

Original language	English (US)
Pages (from-to)	522-529
Number of pages	8
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	66
Issue number	5
DOIs	https://doi.org/10.1097/QAI.0000000000000212
State	Published - Aug 15 2014
Externally published	Yes

Keywords

Adherence
HIV prevention
Intervention
Preexposure prophylaxis
Serodiscordant couples

ASJC Scopus subject areas

Infectious Diseases
Pharmacology (medical)

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10.1097/QAI.0000000000000212

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Psaros, C., Haberer, J. E., Katabira, E., Ronald, A., Tumwesigye, E., Campbell, J. D., Wangisi, J., Mugwanya, K., Kintu, A., Enyakoit, M., Thomas, K. K., Donnell, D., Krows, M., Kidoguchi, L., Ware, N., Baeten, J. M., Celum, C., Bangsberg, D. R., & Safren, S. A. (2014). An intervention to support HIV preexposure prophylaxis adherence in HIV-serodiscordant couples in Uganda. Journal of Acquired Immune Deficiency Syndromes, 66(5), 522-529. https://doi.org/10.1097/QAI.0000000000000212

Psaros, C, Haberer, JE, Katabira, E, Ronald, A, Tumwesigye, E, Campbell, JD, Wangisi, J, Mugwanya, K, Kintu, A, Enyakoit, M, Thomas, KK, Donnell, D, Krows, M, Kidoguchi, L, Ware, N, Baeten, JM, Celum, C, Bangsberg, DR & Safren, SA 2014, 'An intervention to support HIV preexposure prophylaxis adherence in HIV-serodiscordant couples in Uganda', Journal of Acquired Immune Deficiency Syndromes, vol. 66, no. 5, pp. 522-529. https://doi.org/10.1097/QAI.0000000000000212

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abstract = "BACKGROUND: Daily preexposure prophylaxis (PrEP) is an effective HIV prevention strategy, but adherence is required for maximum benefit. To date, there are no empirically supported PrEP adherence interventions. This article describes the process of developing a PrEP adherence intervention and presents results on its impact on adherence. METHODS: The Partners PrEP Study was a placebo-controlled efficacy trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among uninfected members of HIV-serodiscordant couples. An ancillary adherence study was conducted at 3 study sites in Uganda. Participants with <80% adherence as measured by unannounced pill count received an additional adherence counseling intervention based on Lifesteps, an evidence-based HIV treatment adherence intervention, based on principles of cognitive-behavioral theory. FINDINGS: Of the 1147 HIV-seronegative participants enrolled in the ancillary adherence study, 168 (14.6%) triggered the adherence intervention. Of participants triggering the intervention, 62% were men; median age was 32.5 years. The median number of adherence counseling sessions was 10. Mean adherence during the month before the intervention was 75.7% and increased significantly to 84.1% in the month after the first intervention session (P < 0.001). The most frequently endorsed adherence barriers at session 1 were travel and forgetting. INTERPRETATION: A PrEP adherence intervention was feasible in a clinical trial of PrEP in Uganda and PrEP adherence increased after the intervention. Future research should identify PrEP users with low adherence for enhanced adherence counseling and determine optimal implementation strategies for interventions to maximize PrEP effectiveness.",

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AU - Psaros, Christina

AU - Haberer, Jessica E.

AU - Katabira, Elly

AU - Ronald, Allan

AU - Tumwesigye, Elioda

AU - Campbell, James D.

AU - Wangisi, Jonathan

AU - Mugwanya, Kenneth

AU - Kintu, Alex

AU - Enyakoit, Michael

AU - Thomas, Katherine K.

AU - Donnell, Deborah

AU - Krows, Meighan

AU - Kidoguchi, Lara

AU - Ware, Norma

AU - Baeten, Jared M.

AU - Celum, Connie

AU - Bangsberg, David R.

AU - Safren, Steve A.

PY - 2014/8/15

Y1 - 2014/8/15

N2 - BACKGROUND: Daily preexposure prophylaxis (PrEP) is an effective HIV prevention strategy, but adherence is required for maximum benefit. To date, there are no empirically supported PrEP adherence interventions. This article describes the process of developing a PrEP adherence intervention and presents results on its impact on adherence. METHODS: The Partners PrEP Study was a placebo-controlled efficacy trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among uninfected members of HIV-serodiscordant couples. An ancillary adherence study was conducted at 3 study sites in Uganda. Participants with <80% adherence as measured by unannounced pill count received an additional adherence counseling intervention based on Lifesteps, an evidence-based HIV treatment adherence intervention, based on principles of cognitive-behavioral theory. FINDINGS: Of the 1147 HIV-seronegative participants enrolled in the ancillary adherence study, 168 (14.6%) triggered the adherence intervention. Of participants triggering the intervention, 62% were men; median age was 32.5 years. The median number of adherence counseling sessions was 10. Mean adherence during the month before the intervention was 75.7% and increased significantly to 84.1% in the month after the first intervention session (P < 0.001). The most frequently endorsed adherence barriers at session 1 were travel and forgetting. INTERPRETATION: A PrEP adherence intervention was feasible in a clinical trial of PrEP in Uganda and PrEP adherence increased after the intervention. Future research should identify PrEP users with low adherence for enhanced adherence counseling and determine optimal implementation strategies for interventions to maximize PrEP effectiveness.

AB - BACKGROUND: Daily preexposure prophylaxis (PrEP) is an effective HIV prevention strategy, but adherence is required for maximum benefit. To date, there are no empirically supported PrEP adherence interventions. This article describes the process of developing a PrEP adherence intervention and presents results on its impact on adherence. METHODS: The Partners PrEP Study was a placebo-controlled efficacy trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among uninfected members of HIV-serodiscordant couples. An ancillary adherence study was conducted at 3 study sites in Uganda. Participants with <80% adherence as measured by unannounced pill count received an additional adherence counseling intervention based on Lifesteps, an evidence-based HIV treatment adherence intervention, based on principles of cognitive-behavioral theory. FINDINGS: Of the 1147 HIV-seronegative participants enrolled in the ancillary adherence study, 168 (14.6%) triggered the adherence intervention. Of participants triggering the intervention, 62% were men; median age was 32.5 years. The median number of adherence counseling sessions was 10. Mean adherence during the month before the intervention was 75.7% and increased significantly to 84.1% in the month after the first intervention session (P < 0.001). The most frequently endorsed adherence barriers at session 1 were travel and forgetting. INTERPRETATION: A PrEP adherence intervention was feasible in a clinical trial of PrEP in Uganda and PrEP adherence increased after the intervention. Future research should identify PrEP users with low adherence for enhanced adherence counseling and determine optimal implementation strategies for interventions to maximize PrEP effectiveness.

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KW - HIV prevention

KW - Intervention

KW - Preexposure prophylaxis

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An intervention to support HIV preexposure prophylaxis adherence in HIV-serodiscordant couples in Uganda

Abstract

Keywords

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