Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa.

IF 3.4 2区医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-07-15 Epub Date: 2024-05-27 DOI:10.1097/QAD.0000000000003925

Lynn T Matthews, Manjeetha Jaggernath, Yolandie Kriel, Patricia M Smith, Jessica E Haberer, Jared M Baeten, Craig W Hendrix, Norma C Ware, Pravi Moodley, Melendhran Pillay, Kara Bennett, John Bassler, Christina Psaros, Kathleen E Hurwitz, David R Bangsberg, Jennifer A Smit

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Abstract

Objective: We developed the Healthy Families-PrEP intervention to support HIV-prevention during periconception and pregnancy. We evaluated preexposure prophylaxis (PrEP) use with three objective measures.

Design: This single-arm intervention study enrolled women in KwaZulu-Natal, South Africa, who were HIV-uninfected, not pregnant, in a relationship with a partner with HIV or unknown-serostatus, and with pregnancy plans. PrEP was offered as part of a comprehensive HIV prevention intervention. Participants were followed for 12 months.

Methods: We evaluated periconception PrEP uptake and adherence using quarterly plasma tenofovir concentrations. We modeled factors associated with PrEP uptake and high plasma tenofovir (past day dosing). Patterns of use were analyzed using electronic pillcap data. Dried blood spots to measure intracellular tenofovir product (past 2 months dosing) were analyzed for a subset of women.

Results: Three hundred thirty women with median age 24 (IQR: 22-27) years enrolled. Partner HIV-serostatus was unknown by 96% ( N = 316); 60% (195) initiated PrEP. High plasma tenofovir concentrations were seen in 35, 25, 22, and 20% of samples at 3, 6, 9, and 12 months, respectively. Similar adherence was measured by pillcap and dried blood spots. In adjusted models, lower income, alcohol use, and higher HIV stigma were associated with high plasma tenofovir. Eleven HIV-seroconversions were observed (incidence rate: 4.04/100 person-years [95% confidence interval: 2.24-7.30]). None had detectable plasma tenofovir.

Conclusion: The Healthy Families-PrEP intervention supported women in PrEP use. We observed high interest in periconception PrEP and over one-third adhered to PrEP in the first quarter; one-fifth were adherent over a year. High HIV incidence highlights the importance of strategies to reduce HIV incidence among periconception women.

Clinical trial number: NCT03194308.

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南非妇女在围孕期口服 PrEP 的吸收、坚持和持久性：一项干预研究。

目的：我们制定了 "健康家庭-PrEP "干预措施，以支持围孕期和妊娠期的艾滋病预防工作。我们通过三项客观指标对暴露前预防（PrEP）的使用情况进行了评估：这项单臂干预研究在南非夸祖鲁-纳塔尔省招募了未感染 HIV、未怀孕、与伴侣有 HIV 感染或性伴侣身份不明以及有怀孕计划的女性。PrEP 作为艾滋病综合预防干预措施的一部分提供。我们对参与者进行了为期 12 个月的随访：我们利用每季度的血浆替诺福韦浓度评估了受孕前 PrEP 的摄入量和坚持率。我们对与 PrEP 摄入和高血浆替诺福韦（过去一天的用药量）相关的因素进行了建模。我们使用电子药帽数据分析了使用模式。我们还分析了一部分女性的干血斑，以测量细胞内替诺福韦的含量（过去2#$##x0200A;个月的用药量）：共有 330 名妇女参加了研究，中位年龄为 24 岁（IQR：22#$#ndash;27）。96%（N#$##x0200A;#$#equals;#$#x0200A;316）的人不知道伴侣的艾滋病毒血清状况；60%（195）的人开始使用 PrEP。在 3、6、9 和 12#$#x0200A;个月时，分别有 35、25、22 和 20% 的样本发现血浆中替诺福韦浓度较高。通过药帽和干血斑测量的依从性相似。在调整模型中，较低的收入、饮酒和较高的艾滋病耻辱感与较高的血浆替诺福韦相关。观察到 11 例 HIV 血清转换（发生率：4.04/100 人-年）：4.04/100人年[95%置信区间：2.24#$#ndash;7.30]）。没有人检测到血浆中含有替诺福韦：健康家庭-PrEP 干预支持妇女使用 PrEP。我们观察到，妇女对孕期 PrEP 的兴趣很高，超过三分之一的妇女在第一季度坚持使用 PrEP；五分之一的妇女坚持使用一年以上。艾滋病的高发病率凸显了降低围孕期妇女艾滋病发病率策略的重要性：临床试验编号：NCT03194308。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.