Global Health Research Center of Central Asia, Columbia University, New York, NY 10027, USA.
J Acquir Immune Defic Syndr. 2012 Dec 1;61(4):490-8. doi: 10.1097/QAI.0b013e31826f9962.
For pre-exposure prophylaxis (PrEP) and microbicides to effectively prevent HIV, optimal treatment adherence is required. Adherence to these strategies, however, has not been sufficiently studied. This investigation systematically reviews oral PrEP and microbicide trials across 4 domains of adherence: (1) definition and measures used, (2) risks for nonadherence, (3) promotion strategies, and (4) effects on outcomes. Nineteen (n = 19) trials, with 47,157 participants, published between 1987 and 2012 were identified. Reported mean adherence to microbicides was 79% and to oral PrEP 87%. Common risks for microbicide nonadherence were decreased motivation over time, sex with primary (noncommercial/casual) partners, and insufficient supply. Oral PrEP nonadherence risks were older age and medication side effects. Psychoeducation and outreach to participants and communities were frequently used promotion strategies. Most trials failed to systematically identify barriers and monitor and promote adherence, although adherence moderated outcomes. Recommendations for attending to adherence in future trials are provided.
为了使暴露前预防（PrEP）和杀微生物剂能够有效地预防 HIV，需要最佳的治疗依从性。然而，这些策略的依从性尚未得到充分研究。本研究系统地综述了口腔 PrEP 和杀微生物剂试验在以下 4 个依从性领域的情况：（1）定义和使用的措施；（2）不依从的风险；（3）促进策略；（4）对结果的影响。19 项试验（n=19），涉及 47157 名参与者，发表于 1987 年至 2012 年期间。报道的杀微生物剂平均依从率为 79%，口腔 PrEP 为 87%。杀微生物剂不依从的常见风险是随着时间的推移动机降低、与主要（非商业/偶然）伴侣发生性行为以及供应不足。口服 PrEP 不依从的风险是年龄较大和药物副作用。心理教育以及针对参与者和社区的外展活动是常用的促进策略。大多数试验未能系统地确定障碍，也未能监测和促进依从性，尽管依从性影响了结果。提供了关于在未来试验中关注依从性的建议。
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