Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Dec 1;61(4):490-8.
doi: 10.1097/QAI.0b013e31826f9962.

State of the science of adherence in pre-exposure prophylaxis and microbicide trials

Felix M Muchomba  1 , Robin E Gearing, Jane M Simoni, Nabila El-Bassel
Affiliations
Review

State of the science of adherence in pre-exposure prophylaxis and microbicide trials

Felix M Muchomba et al. J Acquir Immune Defic Syndr. .

Abstract

For pre-exposure prophylaxis (PrEP) and microbicides to effectively prevent HIV, optimal treatment adherence is required. Adherence to these strategies, however, has not been sufficiently studied. This investigation systematically reviews oral PrEP and microbicide trials across 4 domains of adherence: (1) definition and measures used, (2) risks for nonadherence, (3) promotion strategies, and (4) effects on outcomes. Nineteen (n = 19) trials, with 47,157 participants, published between 1987 and 2012 were identified. Reported mean adherence to microbicides was 79% and to oral PrEP 87%. Common risks for microbicide nonadherence were decreased motivation over time, sex with primary (noncommercial/casual) partners, and insufficient supply. Oral PrEP nonadherence risks were older age and medication side effects. Psychoeducation and outreach to participants and communities were frequently used promotion strategies. Most trials failed to systematically identify barriers and monitor and promote adherence, although adherence moderated outcomes. Recommendations for attending to adherence in future trials are provided.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Frequency of Risks for Non-adherence and Adherence Intervention Strategies in Oral Pre-Exposure Prophylaxis (PrEP) and Microbicide Randomized Controlled Trials
See this image and copyright information in PMC

References

    1. Cohen MS, Gay C, Kashuba ADM, Blower S, Paxton L. Narrative review: Antiretroviral therapy to prevent the sexual transmission of HIV-1. Annals of Internal Medicine. 2007;146(8):591–601. - PubMed
    1. Garcia-Lerma JG, Paxton L, Kilmarx PH, Heneine W. Oral pre-exposure prophylaxis for HIV prevention. Trends Pharmacol Sci. 2010;31(2):74–81. - PubMed
    1. Padian NS, Buve A, Balkus J, Serwadda D, Cates W., Jr. Biomedical interventions to prevent HIV infection: Evidence, challenges, and way forward. Lancet. 2008;372(9638):585–599. - PubMed
    1. Balzarini J, Van Damme L. Microbicide drug candidates to prevent HIV infection. Lancet. 2007;369(9563):787–797. - PubMed
    1. McGowan I. Microbicides for HIV prevention: Reality or hope? Curr Opin Infect Dis. 2010;23(1):26–31. - PubMed