随访 24 个月时，通过细胞内替诺福韦二磷酸浓度测量的男男性行为者每日接受 PrEP 依从性的决定因素。
Determinants of adherence to daily PrEP measured as intracellular tenofovir diphosphate concentrations over 24 months of follow-up among men who have sex with men.
机构信息
Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands.
出版信息
Sex Transm Infect. 2023 Aug;99(5):303-310. doi: 10.1136/sextrans-2022-055499. Epub 2022 Sep 5.
OBJECTIVES
Adherence is key to the effectiveness of oral pre-exposure prophylaxis (PrEP) to prevent HIV. Therefore, we aimed to explore factors associated with adherence to daily PrEP (dPrEP).
METHODS
Men who have sex with men (MSM) using dPrEP (emtricitabine/tenofovir disoproxil) within the Amsterdam PrEP demonstration project at the Public Health Service of Amsterdam, provided dried blood spots (DBS) 12 and 24 months after PrEP initiation. From DBS, we determined intracellular tenofovir diphosphate (TFV-DP) concentrations to assess adherence; TFV-DP ≥700 fmol/punch was considered adequate. We assessed associations of sociodemographic, clinical and behavioural characteristics with TFV-DP concentrations using multivariable linear regression.
RESULTS
Of 263 participants who attended 12-month or 24-month study visits while on dPrEP, 257 (97.7%) provided DBS at one or both visits (492 DBS in total). Median TFV-DP concentration was 1299 (IQR 1021-1627) fmol/punch (12 months: 1332 (1087-1687); 24 months: 1248 (929-1590]). Higher TFV-DP concentrations were associated with: older age (p=0.0008), condomless anal sex with a casual partner in 6 months preceding PrEP initiation (+166 fmol/punch; 95% CI 36.5 to 296) and using a mobile application providing visualised feedback on PrEP use and sexual behaviour (+146 fmol/punch; 95% CI 28.1 to 263). Lower TFV-DP concentrations were associated with longer duration of PrEP use (24 vs 12 months; -91.5 fmol/punch; 95% CI -155 to -28.1). Time-updated number of sex partners, diagnosed STIs and chemsex were not associated with TFV-DP concentrations.
CONCLUSIONS
Overall, TFV-DP concentrations were high among MSM using dPrEP, indicating excellent adherence. Especially older participants, those who reported condomless anal sex with a casual partner prior to PrEP initiation and those who used an app with visualised feedback showed higher levels of adherence. As TFV-DP concentrations had decreased slightly at 2 years of PrEP use when compared with 1 year, we emphasise the importance of adherence counselling to those who continue using PrEP.
TRIAL REGISTRATION NUMBER
NL5413.
目的
口服暴露前预防（PrEP）的有效性取决于用药依从性。因此，我们旨在探讨与每日 PrEP（dPrEP）依从性相关的因素。
方法
阿姆斯特丹公共卫生服务中心的阿姆斯特丹 PrEP 示范项目中，男男性行为者（MSM）使用恩曲他滨/替诺福韦二吡呋酯（emtricitabine/tenofovir disoproxil）进行 dPrEP，在 PrEP 开始后 12 个月和 24 个月时提供干血斑（DBS）。从 DBS 中，我们测定了细胞内替诺福韦二磷酸（TFV-DP）浓度，以评估依从性；TFV-DP≥700 fmol/刺血点被认为是足够的。我们使用多变量线性回归评估了社会人口统计学、临床和行为特征与 TFV-DP 浓度之间的关联。
结果
在 263 名在 dPrEP 期间参加了 12 个月或 24 个月研究访问的参与者中，有 257 名（97.7%）在一次或两次访问时提供了 DBS（总共 492 个 DBS）。中位 TFV-DP 浓度为 1299（IQR 1021-1627）fmol/刺血点（12 个月：1332（1087-1687）；24 个月：1248（929-1590））。较高的 TFV-DP 浓度与以下因素相关：年龄较大（p=0.0008）、PrEP 开始前 6 个月与偶然伴侣发生无保护肛交（+166 fmol/刺血点；95%CI 36.5 至 296）和使用提供 PrEP 使用和性行为可视化反馈的移动应用程序（+146 fmol/刺血点；95%CI 28.1 至 263）。TFV-DP 浓度较低与 PrEP 使用时间较长（24 个月与 12 个月；-91.5 fmol/刺血点；95%CI -155 至 -28.1）相关。时间更新的性伴侣数、诊断性传播感染和化学性性行为与 TFV-DP 浓度无关。
结论
总体而言，使用 dPrEP 的 MSM 的 TFV-DP 浓度较高，表明依从性良好。特别是年龄较大的参与者、在 PrEP 开始前报告与偶然伴侣发生无保护肛交的参与者以及使用具有可视化反馈的应用程序的参与者，其依从性水平更高。与使用 1 年相比，在使用 2 年 PrEP 时，TFV-DP 浓度略有下降，因此我们强调对继续使用 PrEP 的患者进行依从性咨询的重要性。
试验注册号
NL5413。
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