Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa.
| Autor: | Matthews LT; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA., Jaggernath M; Maternal Adolescent and Child Health Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa., Kriel Y; Maternal Adolescent and Child Health Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa., Smith PM; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA., Haberer JE; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Baeten JM; Department of Global Health.; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington., Hendrix CW; Department of Medicine (Clinical Pharmacology), Johns Hopkins University, School of Medicine, Baltimore, Maryland., Ware NC; Department of Global Health & Social Medicine, Harvard Medical School.; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Moodley P; University of KwaZulu-Natal, School of Laboratory Medicine and Medical Sciences, National Health Laboratory Service., Pillay M; Department of Virology, National Health Laboratory Service, Durban, South Africa., Bennett K; Target RWE, Durham, North Carolina., Bassler J; Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama., Psaros C; Department of Psychiatry, Behavioural Medicine Program, Massachusetts General Hospital, Boston, Massachusetts, USA., Hurwitz KE; Target RWE, Durham, North Carolina., Bangsberg DR; Vinh University College of Health Sciences, Hanoi, Vietnam., Smit JA; Maternal Adolescent and Child Health Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa. |
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| Jazyk: | angličtina |
| Zdroj: | AIDS (London, England) [AIDS] 2024 Jul 15; Vol. 38 (9), pp. 1342-1354. Date of Electronic Publication: 2024 May 27. |
| DOI: | 10.1097/QAD.0000000000003925 |
| Abstrakt: | Objective: We developed the Healthy Families-PrEP intervention to support HIV-prevention during periconception and pregnancy. We evaluated preexposure prophylaxis (PrEP) use with three objective measures. Design: This single-arm intervention study enrolled women in KwaZulu-Natal, South Africa, who were HIV-uninfected, not pregnant, in a relationship with a partner with HIV or unknown-serostatus, and with pregnancy plans. PrEP was offered as part of a comprehensive HIV prevention intervention. Participants were followed for 12 months. Methods: We evaluated periconception PrEP uptake and adherence using quarterly plasma tenofovir concentrations. We modeled factors associated with PrEP uptake and high plasma tenofovir (past day dosing). Patterns of use were analyzed using electronic pillcap data. Dried blood spots to measure intracellular tenofovir product (past 2 months dosing) were analyzed for a subset of women. Results: Three hundred thirty women with median age 24 (IQR: 22-27) years enrolled. Partner HIV-serostatus was unknown by 96% ( N = 316); 60% (195) initiated PrEP. High plasma tenofovir concentrations were seen in 35, 25, 22, and 20% of samples at 3, 6, 9, and 12 months, respectively. Similar adherence was measured by pillcap and dried blood spots. In adjusted models, lower income, alcohol use, and higher HIV stigma were associated with high plasma tenofovir. Eleven HIV-seroconversions were observed (incidence rate: 4.04/100 person-years [95% confidence interval: 2.24-7.30]). None had detectable plasma tenofovir. Conclusion: The Healthy Families-PrEP intervention supported women in PrEP use. We observed high interest in periconception PrEP and over one-third adhered to PrEP in the first quarter; one-fifth were adherent over a year. High HIV incidence highlights the importance of strategies to reduce HIV incidence among periconception women. Clinical Trial Number: NCT03194308. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.) |
| Databáze: | MEDLINE |
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