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. 2018 Apr;22(4):1165-1173.
doi: 10.1007/s10461-017-1951-y.

Utility of Different Adherence Measures for PrEP: Patterns and Incremental Value

Andrew Abaasa  1 , Craig Hendrix  2 , Monica Gandhi  3 , Peter Anderson  4 , Anatoli Kamali  5 , Freddie Kibengo  6 , Eduard J Sanders  7 , Gaudensia Mutua  8 , Namandjé N Bumpus  2 , Frances Priddy  5 , Jessica E Haberer  9
Affiliations

Utility of Different Adherence Measures for PrEP: Patterns and Incremental Value

Andrew Abaasa et al. AIDS Behav. 2018 Apr.

Abstract

Measuring PrEP adherence remains challenging. In 2009-2010, the International AIDS Vaccine Initiative randomized phase II trial participants to daily tenofovir disoproxil fumarate/emtricitabine or placebo in Uganda and Kenya. Adherence was measured by electronic monitoring (EM), self-report (SR), and drug concentrations in plasma and hair. Each adherence measure was categorised as low, moderate, or high and also considered continuously; the incremental value of combining measures was determined. Forty-five participants were followed over 4 months. Discrimination for EM adherence by area under receiver operating curves (AROC) was poor for SR (0.53) and best for hair (AROC 0.85). When combining hair with plasma or hair with self-report, discrimination was improved (AROC > 0.9). Self-reported adherence was of low utility by itself. Hair level was the single best PK measure to predict EM-assessed adherence; the other measurements had lower discrimination values. Combining short-term (plasma) and long-term (hair) metrics could be useful to assess patterns of drug-taking in the context of PrEP.

Keywords: Hair; Plasma; PrEP drug-taking patterns of adherence electronic monitoring.

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Conflict of interest statement

Conflict of interest

All authors declare that they have no conflict of interest.

Informed Consent

All trial participants provided written informed consent before enrolment. At each site, the trials were approved by the respective ethical committees including the Uganda Virus Research Institute Research and Ethics Committee, Uganda National Council for Science and Technology and the National Drug Authority, Kenyatta National Hospital Ethics Review Committee and the Kenya Medical Research Institute Ethics Review Committee.

Figures

Fig. 1
Fig. 1
Study profile on randomization and follow up of participants at both Uganda and Kenya sites
Fig. 2
Fig. 2
Maximal discrimination between high and moderate or low EM adherence based on a single alternate adherence measure or combinations of adherence measures
See this image and copyright information in PMC

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