High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort

作者：Brenda Gati Mirembe, Deborah Donnell, Meighan Krows, Zinhle Zwane, Elizabeth A. Bukusi, Ravindre Panchia, Cheryl Louw, Noluthando Mwelase, Pearl Selepe, Melissa Senne, Logashvari Naidoo, Rachel Chihana, Margaret P. Kasaro, Harriet Nuwagaba‐Biribonwoha, Philip Kotze, Katherine Gill, Pippa Macdonald, Alastair van Heerden, Shannon Bosman, Manjeetha Jaggernath, Phillip du Preez, Amy Ward, Remco P. H. Peters, Sinéad Delany‐Moretlwe, Sue Peacock, Rachel Johnson, Jason Caucutt, Susan Morrison, Guohong Wang, Monica Gandhi, Jennifer Velloza, Renee Heffron, Connie Celum, the INSIGHT Study Team · 发表于：Journal of the International AIDS Society · 年份：2024 · DOI：10.1002/jia2.26389 · 被引用次数：8 · 研究领域：HIV/AIDS Research and Interventions、HIV/AIDS drug development and treatment、Adolescent Sexual and Reproductive Health

INTRODUCTION: Adolescent girls and young women (AGYW) account for two-thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre-exposure prophylaxis (PrEP) but low adherence, which might be improved by point-of-care adherence monitoring with tailored counselling. METHODS: From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16-30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia. Participants were offered oral tenofovir-based PrEP at enrolment and followed up at 1, 3 and 6 months. PrEP adherence was assessed by a point-of-care qualitative lateral flow urine tenofovir (TFV) assay indicating PrEP use in the prior 4 days, which accompanied real-time adherence counselling that incorporated urine TFV results when testing was available (70.8% of month 1, 35.3% of month 3 and 83.9% of month 6 visits). We estimated overall adherence, correcting for missing test results, and analysed the association of having received urine TFV results at month 1 or 3 with subsequent urine TFV test positivity, using modified Poisson regression. RESULTS: Of the 3087 AGYW enrolled, the median age was 24 years (interquartile range 21-27), 75.7% were from South Africa, 2878 (93.2%) initiated PrEP at enrolment and 107 (3.5%) after enrolment. Visit retention was 92.0-96.2% for months 1, 3 and 6, and 2518 (90.1%) exited the study with a PrEP refill. Adherence, based on the point-of-care urine teno...