Department of Medicine, UCSD School of Medicine, La Jolla, CA.
Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI.
J Acquir Immune Defic Syndr. 2019 Sep 1;82(1):34-40. doi: 10.1097/QAI.0000000000002103.
We evaluated the relationship between 2 types of social relationships, ie, (1) external support for use of HIV pre-exposure prophylaxis (PrEP) and related study supplies and (2) participants' disclosure of PrEP use and condom use and HIV PrEP adherence among daily-dosing regimen participants in HIV Prevention Trials Network (HPTN) 067, an open-label trial of oral tenofovir (TFV) disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg.
Using HPTN 067 survey data, we developed scales examining (1) Low Perceived External Support for PrEP: low perceived support by others for PrEP use or perceived negative reactions to the pill case (scoring ranges from 0 to 2) and (2) Participant-Staff Disclosure Challenges Scale, which identifies challenges to sharing nonuse of PrEP or condoms to study staff (scoring ranges from 0 to 4); these scales are the primary independent variables. Adherence, the dependent variable, was determined using log-transformed plasma TFV concentrations. generalized estimating equation (GEE) linear regression was used to assess the association between both scales and adherence.
Participants (n = 161) included HIV-uninfected women in South Africa, and men who have sex with men and transgender women, in Thailand and the United States. In multivariable analyses, higher scores in the Participant-Staff Disclosure Challenges Scale were significantly associated with lower PrEP adherence [exp(β) = 0.62, 95% CI: (0.46 to 0.84); P = 0.002] as were increased days since the last PrEP dose [exp(β) = 0.73, 95% CI: (0.65 to 0.83); P ≤ 0.001].
Given the association with adherence, study staff-participant interactions and participants' disclosure of PrEP challenges may be worthwhile intervention targets for improving PrEP adherence in confirmatory studies.
我们评估了 2 种社会关系类型之间的关系，即（1）外部支持使用 HIV 暴露前预防（PrEP）和相关研究用品，以及（2）参与者对 PrEP 使用和 condom 使用的披露，以及在 HIV 预防试验网络（HPTN）067 中每日剂量方案参与者中 HIV PrEP 的依从性，这是一项口服替诺福韦（TFV）双异丙酯富马酸（TDF）300mg/emtricitabine（FTC）200mg 的开放标签试验。
使用 HPTN 067 调查数据，我们开发了评估（1）低感知外部支持 PrEP：他人对 PrEP 使用的感知支持低或对药丸盒的负面反应（评分范围为 0 到 2）和（2）参与者-工作人员披露挑战量表，该量表确定了与工作人员共享不使用 PrEP 或 condom 的挑战（评分范围为 0 到 4）的挑战；这些量表是主要的独立变量。依从性，即因变量，是通过对数转换的血浆 TFV 浓度确定的。广义估计方程（GEE）线性回归用于评估两个量表与依从性之间的关联。
参与者（n=161）包括南非的 HIV 未感染妇女，以及泰国和美国的男男性行为者和跨性别妇女。在多变量分析中，参与者-工作人员披露挑战量表的得分较高与 PrEP 依从性较低显著相关[Exp（β）=0.62，95%置信区间：（0.46 至 0.84）；P=0.002]，而且距上次 PrEP 剂量的天数增加[Exp（β）=0.73，95%置信区间：（0.65 至 0.83）；P≤0.001]。
鉴于与依从性相关，研究人员与参与者的互动以及参与者对 PrEP 挑战的披露可能是提高确认性研究中 PrEP 依从性的有价值的干预目标。
