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Randomized Controlled Trial
. 2024 Mar 7;19(3):e0299168.
doi: 10.1371/journal.pone.0299168. eCollection 2024.

Acceptability and feasibility of long-term, real-time electronic adherence monitoring of HIV pre-exposure prophylaxis (PrEP) use among young women in Kenya: A mixed methods study

Vallery A Ogello  1 , Bernard Kipkoech Rono  2 , Kenneth Ngure  3   4 , Eric Sedah  2 , Nicholas B Thuo  1 , Nicholas Musinguzi  5 , Jared M Baeten  4   6 , Elizabeth A Bukusi  2   4 , Nelly R Mugo  1   4 , Jessica E Haberer  7   8
Affiliations
Randomized Controlled Trial

Acceptability and feasibility of long-term, real-time electronic adherence monitoring of HIV pre-exposure prophylaxis (PrEP) use among young women in Kenya: A mixed methods study

Vallery A Ogello et al. PLoS One. .

Abstract

Real-time electronic adherence monitoring involves "smart" pill boxes that record and monitor openings as a proxy for pill taking and may be useful in understanding and supporting PrEP use; however, acceptability and/or feasibility for PrEP users is uncertain. We sought to understand the experiences of using a real-time electronic adherence monitor for PrEP delivery among young women in Kisumu and Thika, Kenya. We used the Wisepill device to monitor PrEP use among 18-24-year-old women for two years. Half of the participants were randomized to also receive SMS adherence reminders (daily or as needed for missed doses). We assessed acceptability quantitatively and qualitatively according to the four constructs of Unified Theory of Acceptance and Use of Technology (UTAUT): performance expectancy, effort expectancy, social influence, and facilitating conditions. We assessed feasibility by monitor functionality during periods of PrEP use. We analyzed quantitative data descriptively and compared by site and over time; qualitative data were analyzed inductively and deductively. The median age was 21 years (IQR 19-22), median education was 12 years (IQR 10-13), 182 (53%) had disclosed PrEP use, and 55 (16%) reported recent intimate partner violence. Most participants reported high levels of usefulness and high interest in using the monitor with few problems or worries reported throughout follow-up. Feasibility was high overall with some differences by site (96% functional monitor days in Kisumu vs 88% in Thika). Few monitors were reported lost (N = 29; 8%) or dysfunctional (N = 11; 3%). In qualitative interviews, electronic monitoring was perceived as useful because it supported privacy, confidentiality, easy storage, and PrEP adherence. Effort was generally considered low. Participants expressed some concern for stigma from monitor and/or PrEP use. Facilitating conditions involved the monitor size, color, and battery life. Overall, real-time electronic adherence monitoring was a highly acceptable and feasible approach to understand PrEP adherence among young women in a sub-Saharan African setting.

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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;JMB is currently an employee of Gilead Sciences, outside of the present work. JEH reports consultation fees from Merck and stock ownership in Natera. KN has received research funds from Merck (MSD) and speaker fees from Gilead. EAB reports scientific advisory engagement fees and research support from Merck(MSD). The other authors declare no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Wisepill device (116mm lengthx52mm widthx15mm depth).
Fig 2
Fig 2. The Unified Theory Acceptance and Use of Technology (UTAUT) model.
See this image and copyright information in PMC

References

    1. Baeten J. M. et al.., “Integrated Delivery of Antiretroviral Treatment and Pre-exposure Prophylaxis to HIV-1 –Serodiscordant Couples: A Prospective Implementation Study in Kenya and Uganda,” pp. 1–17, 2016, doi: 10.1371/journal.pmed.1002099 - DOI - PMC - PubMed
    1. CDC, “PrEP Effectiveness | PrEP | HIV Basics | HIV/AIDS | CDC.” 2020, [Online]. https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html.
    1. Beesham I. et al.., “Exploring the Use of Oral Pre-exposure Prophylaxis (PrEP) Among Women from Durban, South Africa as Part of the HIV Prevention Package in a Clinical Trial,” AIDS Behav., vol. 25, no. 4, pp. 1112–1119, 2021, doi: 10.1007/s10461-020-03072-0 - DOI - PMC - PubMed
    1. de Dieu Tapsoba J. et al.., “Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya.,” AIDS Care, vol. 33, no. 6, pp. 712–720, Jun 2021, doi: 10.1080/09540121.2020.1822505 - DOI - PMC - PubMed
    1. Celum C. et al.., “PrEP uptake, persistence, adherence, and effect of retrospective drug level feedback on PrEP adherence among young women in southern Africa: Results from HPTN 082, a randomized controlled trial,” PLoS Medicine, vol. 18, no. 6. 2021, doi: 10.1371/journal.pmed.1003670 - DOI - PMC - PubMed

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