HPTN 067/ADAPT：2012-2013 年，性相关暴露前预防用药依从性的相关因素，泰国男男性行为者和跨性别女性。
HPTN 067/ADAPT: Correlates of Sex-Related Pre-exposure Prophylaxis Adherence, Thai Men Who Have Sex With Men, and Transgender Women, 2012-2013.
机构信息
Thailand Ministry of Public Health-U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
出版信息
J Acquir Immune Defic Syndr. 2019 Oct 1;82(2):e18-e26. doi: 10.1097/QAI.0000000000002131.
BACKGROUND
We identified correlates of sex-related pre-exposure prophylaxis (PrEP) adherence in HPTN067/ADAPT, a phase 2, open-label feasibility study of daily and nondaily regimens of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based PrEP, among Thai men who have sex with men (MSM), and transgender women (TGW), Bangkok.
METHODS
Participants were randomly assigned to one of three self-administered dosing regimens for 24 weeks: daily, time-driven, or event-driven. Demographic and behavioral information was obtained at screening. Pill-container opening was recorded with electronic dose monitoring, and self-reported information on PrEP use, sex events, and substance use was obtained during weekly interviews to confirm dose data. Sex-related PrEP adherence was calculated as the proportion of sex events covered by PrEP use (at least one tablet taken within 4 days before sex and at least one tablet taken within 24 hours after sex) to total sex events. We used multivariate modeling with sex event as the unit of analysis to evaluate correlates associated with sex-related PrEP adherence.
RESULTS
Among 178 MSM and TGW, sex-related PrEP adherence was similar in the daily and time-driven arms (P = 0.79), both significantly greater than the event-driven arm (P = 0.02 compared to daily). Sex-related PrEP adherence by those reporting stimulant use (74.2%) was similar to those reporting other nonalcohol drug use (76.3%, P = 0.80), but lower than those reporting no substance use (84.6%, P = 0.04). In a multivariable model, randomization to the event-driven arm, a higher prestudy number of reported sex events, and use of stimulant drugs were associated with significantly lower sex-related PrEP adherence.
CONCLUSION
Adherence was influenced by treatment schedule and adversely affected by nonalcoholic substance use. Regardless of these factors, Thai MSM and TGW maintained high adherence levels to oral PrEP dosing regimens and coverage of sexual exposures.
背景
我们在 HPTN067/ADAPT 中确定了与性别相关的暴露前预防（PrEP）依从性相关的因素，这是一项针对男男性行为者（MSM）和跨性别女性（TGW）的每日和非每日恩曲他滨/替诺福韦酯（FTC/TDF）为基础的 PrEP 的 2 期开放标签可行性研究。该研究在曼谷进行。
方法
参与者被随机分配到三种自我管理的给药方案中的一种，持续 24 周：每日、时间驱动或事件驱动。在筛选时获得了人口统计学和行为信息。电子剂量监测记录了药瓶的开启情况，每周访谈中获得了关于 PrEP 使用、性行为事件和物质使用的自我报告信息，以确认剂量数据。将与性行为相关的 PrEP 依从性定义为性行为事件中使用 PrEP 的比例（在性行为前至少 4 天内服用至少一片药物，在性行为后 24 小时内至少服用一片药物）与总性行为事件的比例。我们使用以性行为事件为单位的多变量建模来评估与性行为相关的 PrEP 依从性相关的因素。
结果
在 178 名 MSM 和 TGW 中，每日和时间驱动组的性行为相关 PrEP 依从性相似（P = 0.79），均显著高于事件驱动组（与每日相比，P = 0.02）。报告使用兴奋剂的参与者（74.2%）的性行为相关 PrEP 依从性与报告使用其他非酒精药物的参与者（76.3%，P = 0.80）相似，但低于报告未使用物质的参与者（84.6%，P = 0.04）。在多变量模型中，随机分配到事件驱动组、研究前报告的性行为事件数量较高以及使用兴奋剂与性行为相关的 PrEP 依从性显著降低相关。
结论
依从性受到治疗方案的影响，并受到非酒精物质使用的不利影响。无论这些因素如何，泰国 MSM 和 TGW 对口服 PrEP 剂量方案和性行为暴露的覆盖保持了较高的依从水平。
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