Center for Global Health, Massachusetts General Hospital, Boston, MA.
Department of Medicine, Harvard Medical School, Boston, MA.
J Acquir Immune Defic Syndr. 2022 Mar 1;89(3):251-260. doi: 10.1097/QAI.0000000000002876.
To present detailed analyses of long-term pre-exposure prophylaxis (PrEP) use and associated behaviors and perceptions among young Kenyan women.
Prospective, observational cohort.
The Monitoring PrEP among Young Adult women Study involved 18 to 24-year-old women at high HIV risk initiating PrEP in Kisumu and Thika, Kenya. Visits for PrEP counseling and dispensing, HIV testing, and socio-behavioral data collection occurred at Month 1 and quarterly for 2 years. PrEP adherence was measured with pharmacy refill and real-time electronic monitoring, plus tenofovir diphosphate levels in 15% of participants. HIV risk behavior and perception were assessed by self-report in weekly short message service surveys from Months 6-24. Predictors of adherence were assessed with multivariable logistic regression analysis.
Three hundred forty-eight women (median age 21, VOICE risk score 7) were followed for 617 person-years. Pharmacy refills steadily declined from 100% (Month 0-1) to 54% (Months 22-24). Average electronically monitored adherence similarly declined from 65% (Month 0-1) to 15% (Months 22-24). Electronically monitored adherence had moderately high concordance with tenofovir diphosphate levels (67%). High average adherence (5+ doses/week) was seen at 385/1898 (20%) participant-visits and associated with low baseline VOICE risk score, >1 current sexual partner, ≤1-hour travel time to clinic, and the Kisumu site. short message service-reported behavior and risk perception were not associated with adherence. Four women acquired HIV (incidence 0.7/100 person-years).
PrEP adherence was modest and declined over time. HIV risk was inconsistently associated with adherence; clinic access and site-level factors were also relevant. Relatively low HIV incidence suggests participants may have achieved protection through multiple strategies.
详细分析肯尼亚年轻女性长期使用暴露前预防（PrEP）以及相关行为和认知。
前瞻性观察队列研究。
“监测年轻成年女性 PrEP 使用情况研究”纳入了在肯尼亚基苏木和锡卡 18-24 岁高艾滋病毒风险的女性，她们开始使用 PrEP。在第 1 个月和之后的每季度进行 PrEP 咨询和配药、艾滋病毒检测以及社会行为数据收集。通过药房补药和实时电子监测以及 15%参与者中替诺福韦二磷酸酯水平来衡量 PrEP 依从性。在第 6-24 个月通过每周短消息服务调查评估艾滋病毒风险行为和认知。使用多变量逻辑回归分析评估依从性的预测因素。
348 名女性（中位年龄 21 岁，VOICE 风险评分 7）随访了 617 人年。药房补药率从 100%（第 0-1 个月）稳步下降至 54%（第 22-24 个月）。电子监测的平均依从性也从 65%（第 0-1 个月）下降至 15%（第 22-24 个月）。电子监测的依从性与替诺福韦二磷酸酯水平（67%）具有中度一致性。在 1898 次参与者就诊中的 385 次（20%）就诊中观察到高平均依从性（每周≥5 剂），这与基线 VOICE 风险评分低、当前性伴侣≥1 个、就诊时间≤1 小时和基苏木地点有关。短消息服务报告的行为和风险认知与依从性无关。4 名女性感染了艾滋病毒（发病率为 0.7/100 人年）。
PrEP 依从性适中且随时间下降。艾滋病毒风险与依从性不一致相关；就诊机会和地点因素也很重要。相对较低的艾滋病毒发病率表明参与者可能通过多种策略获得了保护。
