Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA.
Population Council, New York, NY, USA.
AIDS Behav. 2018 Apr;22(4):1174-1183. doi: 10.1007/s10461-017-1958-4.
Young men who have sex with men (YMSM) face a disproportionately high burden of HIV. Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition, but adherence to PrEP among YMSM may be inadequate. Medication adherence may be assessed via biomarkers, which are expensive and invasive, or via self-report through Audio Computer Assisted Self-Interview (ACASI), which may result in over-reporting of adherence. In this paper we assess the potential of a new method of self-report, the Interactive Questionnaire System (iQS), in validly estimating true adherence rates. PrEP adherence among 167 YMSM aged 15-23 was measured via dried blood spot (DBS), ACASI, and iQS twice over a 24-week study period. Both ACASI- and iQS-reported data revealed that over 40% of individuals self-reporting adequate PrEP adherence had DBS-estimated drug levels indicating inadequate adherence. Adjusted logistic repeated measures random intercept regression analyses indicated that younger YMSM had higher odds of over-reporting adherence than older YMSM-each 1 year increase in age was associated with 0.79 times the odds of over-reporting adherence (95% CI 0.63, 0.98; p value = 0.031), and being African American was associated with 3.22 times greater odds of over-reporting than non-African Americans (95% CI 1.51, 6.90; p-value = 0.0003). These results suggest that ACASI and iQS methods of self-report significantly overestimate true PrEP adherence rates among YMSM, and that the odds of over-reporting adherence may be affected by both age and race.
男男性行为者（MSM）面临着不成比例的高艾滋病毒负担。口服暴露前预防（PrEP）在预防艾滋病毒感染方面非常有效，但 MSM 对 PrEP 的依从性可能不足。药物依从性可以通过生物标志物来评估，生物标志物既昂贵又具侵入性，也可以通过音频计算机辅助自我访谈（ACASI）的自我报告来评估，而自我报告可能会导致对依从性的高估。在本文中，我们评估了一种新的自我报告方法——交互式问卷系统（iQS）在准确估计真实依从率方面的潜力。在一项为期 24 周的研究中，通过干血斑（DBS）、ACASI 和 iQS 两次测量了 167 名年龄在 15-23 岁的 MSM 的 PrEP 依从性。ACASI 和 iQS 报告的数据均显示，超过 40%的自我报告有足够 PrEP 依从性的个体的 DBS 估计药物水平表明依从性不足。调整后的逻辑重复测量随机截距回归分析表明，年轻的 MSM 比年长的 MSM 更有可能高估依从性——每增加 1 岁，高估依从性的几率就会增加 0.79 倍（95%CI 0.63, 0.98；p 值=0.031），非裔美国人比非裔美国人高估依从性的几率高出 3.22 倍（95%CI 1.51, 6.90；p 值=0.0003）。这些结果表明，ACASI 和 iQS 自我报告方法显著高估了 MSM 中真实 PrEP 依从率，并且高估依从性的几率可能受到年龄和种族的影响。
