Understanding Pre-Exposure Prophylaxis Adherence in Young Women in Kenya

Jessica E Haberer, Nelly Mugo, Elizabeth Ann Bukusi, Kenneth Ngure, Catherine Kiptinness, Kevin Oware, Lindsey E Garrison, Nicholas Musinguzi, Maria Pyra, Susie Valenzuela, Katherine K Thomas, Peter L Anderson, Harsha Thirumurthy, Jared M Baeten, Jessica E Haberer, Nelly Mugo, Elizabeth Ann Bukusi, Kenneth Ngure, Catherine Kiptinness, Kevin Oware, Lindsey E Garrison, Nicholas Musinguzi, Maria Pyra, Susie Valenzuela, Katherine K Thomas, Peter L Anderson, Harsha Thirumurthy, Jared M Baeten

Abstract

Objective: To present detailed analyses of long-term pre-exposure prophylaxis (PrEP) use and associated behaviors and perceptions among young Kenyan women.

Design: Prospective, observational cohort.

Methods: The Monitoring PrEP among Young Adult women Study involved 18 to 24-year-old women at high HIV risk initiating PrEP in Kisumu and Thika, Kenya. Visits for PrEP counseling and dispensing, HIV testing, and socio-behavioral data collection occurred at Month 1 and quarterly for 2 years. PrEP adherence was measured with pharmacy refill and real-time electronic monitoring, plus tenofovir diphosphate levels in 15% of participants. HIV risk behavior and perception were assessed by self-report in weekly short message service surveys from Months 6-24. Predictors of adherence were assessed with multivariable logistic regression analysis.

Results: Three hundred forty-eight women (median age 21, VOICE risk score 7) were followed for 617 person-years. Pharmacy refills steadily declined from 100% (Month 0-1) to 54% (Months 22-24). Average electronically monitored adherence similarly declined from 65% (Month 0-1) to 15% (Months 22-24). Electronically monitored adherence had moderately high concordance with tenofovir diphosphate levels (67%). High average adherence (5+ doses/week) was seen at 385/1898 (20%) participant-visits and associated with low baseline VOICE risk score, >1 current sexual partner, ≤1-hour travel time to clinic, and the Kisumu site. short message service-reported behavior and risk perception were not associated with adherence. Four women acquired HIV (incidence 0.7/100 person-years).

Conclusions: PrEP adherence was modest and declined over time. HIV risk was inconsistently associated with adherence; clinic access and site-level factors were also relevant. Relatively low HIV incidence suggests participants may have achieved protection through multiple strategies.

Trial registration: ClinicalTrials.gov NCT02915367.

Conflict of interest statement

J.E.H. reports personal fees from Merck, outside the submitted work. K.N. reports personal fees from Gilead Sciences and Merck. P.L.A. reports personal fees and grants from Gilead Sciences. J.M.B. reports personal fees from Gilead Sciences, Janssen, and Merck, outside the submitted work. The remaining authors have no conflicts of interest to disclose.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

FIGURE 1.
FIGURE 1.
PrEP adherence over time. Each column indicates the number of participants picking up PrEP at each study visit (ie, pharmacy refill adherence) from months 0 through 21. Electronically monitored adherence over the period covered by each pharmacy refill is shown as the average number of doses per week. The green color indicates high adherence (5+ doses/week).

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Source: PubMed

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