暴露前预防：近期结合实时依从性反馈和性伴人类免疫缺陷病毒自我检测的依从性情况：一项针对产后妇女的试点试验
Pre-exposure Prophylaxis Recent Adherence With Real-Time Adherence Feedback and Partner Human Immunodeficiency Virus Self-Testing: A Pilot Trial Among Postpartum Women.
作者信息
Joseph Davey Dvora Leah, Dovel Kathryn, Mvududu Rufaro, Nyemba Dorothy, Mashele Nyiko, Bekker Linda-Gail, Gorbach Pamina M, Coates Thomas J, Myer Landon
机构信息
Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
出版信息
Open Forum Infect Dis. 2021 Dec 23;9(2):ofab609. doi: 10.1093/ofid/ofab609. eCollection 2022 Feb.
BACKGROUND
Pre-exposure prophylaxis (PrEP) is safe and effective in postpartum women. Human immunodeficiency virus self-testing (HIVST) for male partners combined with biofeedback counseling through real-time adherence measures may improve PrEP use among postpartum women.
METHODS
Between August 2020 and April 2021, we randomized postpartum women who initiated PrEP in pregnancy 1:1 to the intervention group (HIVST + biofeedback counseling after urine tenofovir test) or to standard of care ([SOC] facility-based human immunodeficiency virus [HIV] tests and routine counseling without biofeedback). The outcomes of interest were PrEP adherence in the past 48-72 hours via urine tenofovir tests and partner HIV testing, measured 1-month after randomization. Secondary outcomes included the proportion of partners who tested for HIV and the discrepancy between self-reported PrEP adherence and urine tenofovir result.
RESULTS
We enrolled 106 women (median age = 26 years). At enrollment, 72% of women reported missing <2 doses in the past 7 days; 36% of women had tenofovir present in her urine. One month after enrollment, 62% (n = 33) of women in the intervention arm had tenofovir present in their urine compared to 34% (n = 18) in SOC (risk ratio [RR] = 1.83; 95% confidence interval [CI] = 1.19-2.82; = .001). Two thirds of women in the intervention arm reported that her partner tested for HIV (66%; n = 35), compared to 17% (n = 9) in SOC (RR = 3.89; 95% CI = 2.08-7.27; < .001). Self-reported PrEP adherence (took PrEP >5 of last week) with no tenofovir in urine test was lower in the intervention group (17% vs 46%; RR = 0.33; 95% CI = 0.17-0.67; = .03). No social or clinical adverse events were reported in the intervention arm.
CONCLUSIONS
The HIVST for partners and biofeedback counseling increased levels of recent PrEP adherence, pointing to the importance of these interventions to support PrEP use in this population.
背景
暴露前预防（PrEP）在产后女性中是安全有效的。为男性伴侣进行人类免疫缺陷病毒自我检测（HIVST）并通过实时依从性措施进行生物反馈咨询，可能会提高产后女性的PrEP使用率。
方法
在2020年8月至2021年4月期间，我们将孕期开始PrEP的产后女性按1:1随机分为干预组（尿替诺福韦检测后进行HIVST + 生物反馈咨询）或标准护理组（[SOC] 基于机构的人类免疫缺陷病毒 [HIV] 检测和无生物反馈的常规咨询）。感兴趣的结局是通过尿替诺福韦检测评估的过去48 - 72小时内的PrEP依从性以及伴侣HIV检测情况，在随机分组1个月后进行测量。次要结局包括进行HIV检测的伴侣比例以及自我报告的PrEP依从性与尿替诺福韦检测结果之间的差异。
结果
我们纳入了106名女性（中位年龄 = 26岁）。入组时，72%的女性报告在过去7天内漏服少于2剂；36%的女性尿液中含有替诺福韦。入组1个月后，干预组62%（n = 33）的女性尿液中含有替诺福韦，而标准护理组为34%（n = 18）（风险比 [RR] = 1.83；95%置信区间 [CI] = 1.19 - 2.82；P = 0.001）。干预组三分之二的女性报告其伴侣进行了HIV检测（66%；n = 35），而标准护理组为17%（n = 9）（RR = 3.89；95% CI = 2.08 - 7.27；P < 0.001）。干预组中自我报告PrEP依从性（上周服用PrEP超过5次）但尿检测中无替诺福韦的比例较低（17%对46%；RR = 0.33；95% CI = 0.17 - 0.67；P = 0.03）。干预组未报告社会或临床不良事件。
结论
为伴侣进行HIVST和生物反馈咨询提高了近期PrEP的依从水平，表明这些干预措施对支持该人群使用PrEP的重要性。
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