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Clinical Trial
. 2024 May 31;24(1):1461.
doi: 10.1186/s12889-024-18946-4.

The impact of intimate partner violence on PrEP adherence among U.S. Cisgender women at risk for HIV

Katherine M Anderson  1   2 , Jill Blumenthal  3 , Sonia Jain  4 , Xiaoying Sun  4 , K Rivet Amico  5 , Raphael Landovitz  6 , Christine M Zachek  7 , Sheldon Morris  3 , David J Moore  8 , Jamila K Stockman  3
Affiliations
Clinical Trial

The impact of intimate partner violence on PrEP adherence among U.S. Cisgender women at risk for HIV

Katherine M Anderson et al. BMC Public Health. .

Abstract

Background: Cisgender women account for 1 in 5 new HIV infections in the United States, yet remain under-engaged in HIV prevention. Women experiencing violence face risk for HIV due to biological and behavioral mechanisms, and barriers to prevention, such as challenges to Pre-Exposure Prophylaxis for HIV Prevention (PrEP) adherence. In this analysis, we aim to characterize intimate partner violence (IPV) among cisgender heterosexual women enrolled in a PrEP demonstration project and assess the associations with PrEP adherence.

Methods: Adherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) was a 48-week single-arm open-label study of PrEP adherence in HIV-negative cisgender women in Southern California (N = 130) offered daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). From 6/2016 to 10/2018, women completed a survey reporting HIV risk behavior and experiences of any IPV (past 90-days) and IPV sub-types (past-year, lifetime) and biological testing for HIV/STIs at baseline, and concentrations of tenofovir-diphosphate (TFV-DP) in dried blood spots at weeks 4, 12, 24, 36, and 48. Outcomes were TFV-DP concentrations consistent with ≥ 4 or ≥ 6 doses/week at one or multiple visits. Multivariable logistic regression models were conducted to examine associations.

Results: Past-90-day IPV was reported by 34.4% of participants, and past-year and lifetime subtypes reported by 11.5-41.5%, and 21.5-52.3%, respectively. Women who engaged in sex work and Black women were significantly more likely to report IPV than others. Lifetime physical IPV was negatively associated with adherence at ≥ 4 doses/week at ≥ 3 of 5 visits, while other relationships with any IPV and IPV sub-types were variable.

Conclusion: IPV is an indication for PrEP and important indicator of HIV risk; our findings suggest that physical IPV may also negatively impact long-term PrEP adherence.

Clinical trials registration: NCT02584140 (ClinicalTrials.gov), registered 15/10/2015.

Keywords: Adherence; Intimate Partner violence; Pre-exposure Prophylaxis for HIV Prevention; Violence.

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Conflict of interest statement

KMA, SJ, XS, KRA, CZ, DM, and JKS have no competing interests to declare. JB reports research funding from Gilead Sciences outside of the submitted work. RL reports personal fees from Gilead Sciences and personal fees from Merck, outside the submitted work. SM reports research funding form Gilead Sciences and Merck, stock in Bristol Myers Squibb and Pfizer, and is a cofounder of Aspera Biomedicines.

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