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. 2023 Mar 16;18(3):e0282999.
doi: 10.1371/journal.pone.0282999. eCollection 2023.

Correlates of self-reported and biomarker based adherence to daily oral HIV pre-exposure prophylaxis among a cohort of predominantly men who have sex with men in Nigeria

Olusegun A Adeyemi  1   2 , Rebecca G Nowak  3 , Mark Marzinke  4 , Daniel Morgan  1 , Nadia Sam-Agudu  2 , Jaih Craddock  5 , Min Zhan  6 , Trevor A Crowell  7   8 , Stefan Baral  9 , Nicaise Ndembi  2 , Sylvia Adebajo  10 , Manhattan E Charurat  3 ; TRUST/RV368 Study Group
Affiliations

Correlates of self-reported and biomarker based adherence to daily oral HIV pre-exposure prophylaxis among a cohort of predominantly men who have sex with men in Nigeria

Olusegun A Adeyemi et al. PLoS One. .

Abstract

Introduction: HIV pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV acquisition. However, studies have demonstrated discordance between self-reported measures and biomedical benchmarks of PrEP adherence. We estimated the correlation between self-reported PrEP adherence and PrEP biomarkers and explored factors associated with adherence among men who have sex with men (MSM) in Nigeria.

Methods: TRUST-PrEP, an open-label, prospective study; conducted in Abuja between April 2018 and May 2019. MSM ≥ 18 years with substantial HIV risk were enrolled. Participants reported PrEP adherence in the last month using a 4-point scale from "poor" to "perfect" and serum samples for PrEP biomarkers were collected at months 3 and 9. Serum tenofovir concentration was measured by liquid chromatography-tandem mass spectrometry and considered protective for adherence if ≥ 4.2 ng/ml. Spearman's rank correlation was used to estimate correlation between self-reported adherence and measured tenofovir levels. Generalized estimating equations with a logit link was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between self-reported adherence and laboratory-measured adherence.

Results: A total of 219 MSM with median age 23 (interquartile range 20-27) years had at least one PrEP biomarker assay. Only 66/219 (30%) had at least one record of protective tenofovir concentration. Correlation between tenofovir and self-reported adherence at 3 and 9 months were 0.1 and 0.02 respectively. Furthermore, 17/219 (8%,) and 49/219 (22%) had serum tenofovir of 4.2-35.4 ng/mL and ≥ 35.5 ng/mL, corresponding to at least 4 and 7 days' PrEP use in a week, respectively. PrEP adherence was higher among participants introduced to PrEP in the clinics compared with communities (aOR: 8.35, 95%CI: [3.24, 21.5]) and those with same-sex practices family disclosure (aOR: 3.60 95% CI: [1.73, 7.51]).

Conclusion: Self-reported PrEP adherence poorly correlated with biomarkers. Facilitating clinic-based PrEP introduction and disclosure of same-sex practices to family among MSM may improve PrEP adherence.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Scatter plots of absolute TFV concentration at Month 3.
Fig 2
Fig 2. Scatter plots of absolute TFV concentration at Month 9.
Fig 3
Fig 3. Study flowchart.
Fig 4
Fig 4. Summary of self-reported PrEP adherence measures in past 30 days.
Fig 5
Fig 5. Estimated mean oral PrEP pills used a week before assay at Month 3.
Fig 6
Fig 6. Estimated mean oral PrEP pills used a week before assay at Month 9.
See this image and copyright information in PMC

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