Instituto Nacional de Infectologia Evandro Chagas, 37903Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Int J STD AIDS. 2021 Nov;32(13):1231-1241. doi: 10.1177/09564624211031787. Epub 2021 Jul 26.
Understanding the factors associated with pre-exposure prophylaxis (PrEP) adherence may help in the development of strategies to support, motivate and sustain PrEP use. This study estimated self-reported adherence, described perceived barriers and facilitators and investigated factors associated with adherence to daily oral PrEP among men who have sex with man (MSM) and transgender women after 1 year of PrEP use in Brazil. PrEP Brasil was a prospective, multicentre, open-label demonstration study with MSM and transgender women at high risk for HIV infection. We used logistic regression to evaluate factors associated with complete adherence (not forgetting to take any pills in the past 30 days) at week 48. Of 338 participants included in this analysis, 60% reported complete adherence to daily oral PrEP at week 48. Perceived barriers and facilitators to daily oral PrEP were reported by 38.2% and 98.5%, respectively. The most reported barrier and facilitator were 'I forgot to take my pills' (19.2%) and 'Associate PrEP with a daily activity/task' (58.6%), respectively. In final multivariable analysis, living in Rio de Janeiro (aOR: 0.38; 95% CI: 0.20-0.73), being transgender women (aOR: 0.22; 95% CI: 0.07-0.73), reporting stimulant use (a OR: 0.40; 95% CI: 0.20-0.80) and having any perceived barriers to daily oral PrEP (aOR: 0.12; 95% CI: 0.07-0.23) were associated with decreased odds of complete adherence. Our findings provide information for developing the best practices to promote PrEP adherence in the Brazilian context.
了解与暴露前预防 (PrEP) 依从性相关的因素可能有助于制定支持、激励和维持 PrEP 使用的策略。本研究估计了使用 PrEP 1 年后男男性行为者 (MSM) 和跨性别女性自我报告的依从性,描述了他们对 PrEP 的感知障碍和促进因素,并调查了与每日口服 PrEP 依从性相关的因素。PrEP Brasil 是一项前瞻性、多中心、开放性标签的演示研究,研究对象为感染 HIV 风险较高的 MSM 和跨性别女性。我们使用逻辑回归评估了在第 48 周时与完全依从性(在过去 30 天内未忘记服用任何药丸)相关的因素。在本分析中,纳入的 338 名参与者中,60%报告在第 48 周时完全依从每日口服 PrEP。分别有 38.2%和 98.5%的参与者报告了每日口服 PrEP 的感知障碍和促进因素。报告最多的障碍和促进因素分别是“我忘记服用我的药丸”(19.2%)和“将 PrEP 与日常活动/任务联系起来”(58.6%)。在最终的多变量分析中,居住在里约热内卢(aOR:0.38;95%CI:0.20-0.73)、跨性别女性(aOR:0.22;95%CI:0.07-0.73)、报告使用兴奋剂(aOR:0.40;95%CI:0.20-0.80)和存在任何与每日口服 PrEP 依从性相关的感知障碍(aOR:0.12;95%CI:0.07-0.23)与完全依从性的几率降低相关。我们的研究结果为制定在巴西背景下促进 PrEP 依从性的最佳实践提供了信息。
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