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
Observational Study
. 2019 Oct;23(10):2719-2729.
doi: 10.1007/s10461-019-02502-y.

Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color

Sarah Wood  1   2   3 , Robert Gross  4 , Judy A Shea  4 , José A Bauermeister  5 , Joshua Franklin  6   4 , Danielle Petsis  6   7 , Meghan Swyryn  8 , Linden Lalley-Chareczko  8 , Helen C Koenig  4   8 , Nadia Dowshen  6   4   7
Affiliations
Observational Study

Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color

Sarah Wood et al. AIDS Behav. 2019 Oct.

Abstract
in English, Spanish

We aimed to discover barriers and facilitators of HIV pre-exposure prophylaxis (PrEP) adherence in young men and transgender women of color who have sex with men (YMSM/TW). Short-term and sustained adherence were measured by urine tenofovir concentration and pharmacy refills, respectively. Optimal adherence was defined as having both urine tenofovir concentration consistent with dose ingestion within 48 h and pharmacy refills consistent with ≥ 4 doses per week use. Participants completed semi-structured interviews exploring adherence barriers and facilitators. Participants (n = 31) were primarily African-American (68%), mean age 22 years (SD: 1.8), and 48% had optimal adherence. Adherence barriers included stigma, health systems inaccessibility, side effects, competing stressors, and low HIV risk perception. Facilitators included social support, health system accessibility, reminders/routines, high HIV risk perception, and personal agency. Our findings identify targets for intervention to improve PrEP adherence in these populations, including augmenting health activation and improving accuracy of HIV risk perception.

Nuestro objetivo fue descubrir los obstáculos y facilitadores de la adherencia al profilaxis de pre-exposición al VIH (PrEP) en hombres jóvenes y mujeres transgénero que tienen sexo con hombres (YMSM/TW) y quienes son minorías étnicas. La adherencia, a corto plazo y sostenida, se midió mediante la concentración de tenofovir en la orina y las prescripciones completadas en la farmacia. La adherencia óptima se definió basado en una concentración de tenofovir en la orina consistente con el uso de PrEP en las ultimas 48 horas y prescripciones completadas en la farmacia consistentes con ≥4 dosis por semana. Los participantes completaron entrevistas semiestructuradas que exploraron los obstáculos y facilitadores de la adherencia. Los participantes (n = 31) fueron principalmente afroamericanos (68%), con una edad media de 22 años (SD: 1.8) y 48% obtuvieron adherencia óptima. Participantes discutieron varios obstáculos, incluyendo el estigma, acceso limitado a los sistemas de salud, los efectos secundarios asociados a PrEP, competencia con otras prioridades, y la baja percepción del riesgo de VIH. Los facilitadores incluyeron apoyo social, acceso al sistema de salud, recordatorios/rutinas, alta percepción de riesgo de VIH y agencia personal. Nuestros hallazgos identifican oportunidades para mejorar la adherencia a la PrEP en estas poblaciones a través de intervenciones, incluyendo la activación de salud y cambios en la percepción del riesgo al VIH en estas comunidades.

Keywords: Adherence; HIV prevention; Pre-exposure prophylaxis; Social support.

PubMed Disclaimer

References

    1. Marcus JL, Buisker T, Horvath T, Amico KR, Fuchs JD, Buchbinder SP, et al. Helping our patients take HIV pre-exposure prophylaxis (PrEP): a systematic review of adherence interventions. HIV Med. 2014;15(7):385–95. - PMC - PubMed
    1. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53–60. - PMC - PubMed
    1. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34. - PubMed
    1. Karim SS, Kashuba AD, Werner L, Karim QA. Drug concentrations after topical and oral antiretroviral pre-exposure prophylaxis: implications for HIV prevention in women. Lancet. 2011;378(9787):279–81. - PMC - PubMed
    1. Amico KR. The key role of adherence for the effectiveness of antiretroviral-based prevention: state of the science and implications for the Asia-Pacific region. Sex Health. 2014;11(2):155–65. - PubMed

Publication types

MeSH terms