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Review
. 2024 Mar;24(3):169-175.
doi: 10.1080/14737159.2024.2312122. Epub 2024 Feb 14.

Point-of-care urine tenofovir monitoring of adherence to drive interventions for HIV treatment and prevention

Matthew Spinelli  1 , Monica Gandhi  1
Affiliations
Review

Point-of-care urine tenofovir monitoring of adherence to drive interventions for HIV treatment and prevention

Matthew Spinelli et al. Expert Rev Mol Diagn. 2024 Mar.

Abstract

Introduction: Although effective antiretroviral and pre-exposure prophylaxis/PrEP regimens are available globally, adherence challenges persist. Objective measures of adherence can both measure adherence accurately and can be used to drive interventions. The first point-of-care pharmacologic adherence measure, urine tenofovir testing using a lateral flow assay, is now available.

Areas covered: This review examines the ability of pharmacologic metrics of adherence to predict HIV and PrEP clinical outcomes and the past use of pharmacologic metrics of adherence as tools to drive adherence interventions. The success of preliminary studies using point-of-care adherence metrics to guide interventions is then discussed.

Expert opinion: Large randomized clinical trials are now needed to test the impact of point-of-care adherence interventions on HIV and PrEP clinical outcomes, given promising results of the pilot studies summarized here. Hybrid implementation-effectiveness studies will be needed to examine optimal approaches to incorporating point-of-care testing into routine clinical care delivery, including in guiding resistance testing, adherence counseling, and delivery of other evidence-based adherence interventions. Given the ability of point-of-care tenofovir testing to be implemented in settings where viral load testing is not available, and at more frequent intervals due to its low cost, urine-based tenofovir assays have the potential to be highly scalable in diverse clinical settings.

Keywords: Adherence; HIV virologic suppression; Interventions; Point-of-care; PrEP; Urine testing.

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Conflict of interest statement

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1:
Figure 1:
Time Frames Examined by Pharmacologic Metrics of Adherence
Figure 2:
Figure 2:
Packaged urine tenofovir lateral flow assay (LFA) for urine
Figure 3:
Figure 3:
Urine assay-informed counseling for women on PrEp in Kenya led to higher proportions of positive urine TFV assays 3, 6, 9 and 12 months than standard-of-car
See this image and copyright information in PMC

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