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. 2023 Feb 24;18(2):e0281728.
doi: 10.1371/journal.pone.0281728. eCollection 2023.

Development of a tool to assess HIV prevention readiness of adolescent girls and young women in HPTN 082 study

Geetha Beauchamp  1   2 , Sybil Hosek  3 , Deborah J Donnell  1   2 , Kwun C G Chan  1   4 , Brian P Flaherty  5 , Peter L Anderson  6 , Bonnie J Dye  7 , Nyaradzo Mgodi  8 , Linda-Gail Bekker  9 , Sinead Delany-Moretlwe  10 , Connie Celum  11 ; HPTN 082 study team
Affiliations

Development of a tool to assess HIV prevention readiness of adolescent girls and young women in HPTN 082 study

Geetha Beauchamp et al. PLoS One. .

Abstract

Background: African adolescent girls and young women (AGYW) represent a large proportion of new HIV infections, a priority population for pre-exposure prophylaxis (PrEP), but adherence remains a challenge. A reliable, valid readiness tool would help identify AGYW motivated to take PrEP who need adherence support.

Methods: In the HPTN 082 open-label PrEP study (2016-2019), South African and Zimbabwean women ages 16-25 were administered an HIV prevention readiness measure (HPRM). The 25 items in the HPRM included medication beliefs, connection with care, disclosure of PrEP use, social support, and housing stability using a 5-point Likert scale. Exploratory factor analysis (EFA) using polychoric correlations, scale reliability, and predictive validity were performed on data from 315 participants who responded to all items. We assessed the predictive value of HPRM scores with PrEP adherence, defined as tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots, as a continuous measure and dichotomized as high PrEP adherence (≥700 fmol/punch).

Results: EFA yielded 23 items with three subscales: self-efficacy (16 items), PrEP disclosure (4 items), and social support (3 items). Cronbach's α ranged from 0.71 to 0.92 for the overall scale and the subscales. The average overall scale and the subscales were predictive of 3-month PrEP adherence for TFV-DP concentrations: for each unit increase of the HPRM score, TFV-DP concentration increased by 103 fmol/punch (95% CI: 16, 189, p = 0.02); the highest HPRM score equated with 608 fmol/punch on average. For the self-efficacy subscale, TFV-DP increased by 90 fmol/punch (95% CI: 7, 172, p = 0.03); PrEP disclosure, 68 fmol/punch (95% CI: 19, 117 p = 0.01); and social support, 58fmol/punch (95% CI: 2, 113, p = 0.04). Higher PrEP disclosure suggests high adherence (OR 1.36, 95% CI: 1.00, 1.86, p = 0.05) and predicted persistent high adherence at both months three and six (OR: 1.50, 95% CI: 1.03, 2.21, p = 0.04).

Conclusions: The HPRM scale overall and the subscales individually demonstrated good internal consistency among African young women. PrEP disclosure subscale exhibiting significant association with persistent high PrEP adherence is an important finding for PrEP adherence support programs. Future work will assess replicability and expand self-efficacy and social-support subscales after item revision.

Trial registration: ClinicalTrials.gov NCT02732730.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: PLA reports grants from Gilead; and consulting fees from Gilead, Merck, and ViiV Healthcare. CC reports grants to her institution from the NIH and the Bill & Melinda Gates Foundation; consulting fees from Merck and Gilead as a scientific advisor; payments for expert testimony and support for attending meetings from Gilead; and donated drugs from Gilead. CC also participates on data safety monitoring boards and advisory boards for the HIV Prevention Trials Network and the London School of Hygiene & Tropical Medicine (London, UK).

Figures

Fig 1
Fig 1. Mapping of HIV prevention readiness measure to situated-Information, Motivation and Behavioral framework (sIMB).
See this image and copyright information in PMC

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