Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.
Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
AIDS Behav. 2023 Feb;27(2):719-732. doi: 10.1007/s10461-022-03805-3. Epub 2022 Aug 19.
Measurement of adherence to oral pre-exposure prophylaxis (PrEP) in real-time has been challenging. We developed DOT Diary, a smartphone application that combines automated directly observed therapy with a PrEP adherence visualization toolkit, and tested its ability to measure PrEP adherence and to increase adherence among a diverse cohort of young men who have sex with men (MSM). We enrolled 100 MSM in San Francisco and Atlanta and randomly assigned them 2:1 to DOT Diary versus standard of care. Concordance between DOT Diary measurement and drug levels in dried blood spots was substantial, with 91.0% and 85.3% concordance between DOT Diary and emtricitabine-triphosphate and tenofovir-diphosphate, respectively. There was no significant difference in the proportion of participants with detectable PrEP drug levels at 24 weeks between study arms. These results suggest DOT Diary is substantially better than self-reported measures of adherence, but additional interventions are needed to improve PrEP adherence over time.
实时测量口服暴露前预防（PrEP）的依从性一直具有挑战性。我们开发了 DOT Diary，这是一款智能手机应用程序，将自动直接观察治疗与 PrEP 依从性可视化工具包相结合，并测试了其测量 PrEP 依从性以及提高与不同性取向的男男性接触者（MSM）多样化队列的依从性的能力。我们在旧金山和亚特兰大招募了 100 名 MSM，并将他们随机分为 DOT Diary 组和标准护理组，比例为 2:1。DOT Diary 测量结果与干血斑中的药物水平之间具有很高的一致性，DOT Diary 与恩曲他滨三磷酸盐和替诺福韦二磷酸盐的一致性分别为 91.0%和 85.3%。在 24 周时，研究组之间具有可检测 PrEP 药物水平的参与者比例没有显著差异。这些结果表明，DOT Diary 比自我报告的依从性测量方法要好得多，但需要额外的干预措施来随着时间的推移提高 PrEP 的依从性。
