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Performance of Multiple Adherence Measures for pre-exposure Prophylaxis (PrEP) Among Young Women in Kenya

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Abstract

Understanding PrEP adherence is key in the formulation of HIV prevention strategies; however, measurement of adherence can be challenging. We compared multiple adherence measures in a two-year study of young Kenyan women at high risk of HIV acquisition. Among 289 participants, concordance between electronic adherence monitoring (EAM) and tenofovir diphosphate (TFV-DP) in dried blood spots ranged from 57 to 72% depending on selected thresholds. Using area under the receiver operating curve, discrimination of quantifiable TFV-DP was high at 0.85 with EAM and low at 0.49–0.54 for multiple self-reported measures. Correlation between EAM and self-reported measures was low (r < 0.11) although correlation within self-reported measures was moderate (r > 0.69). These findings indicate that both TFV-DP and EAM are useful PrEP adherence tools. Adherence would benefit from better availability of less expensive versions of both measurement tools. Additionally, further research on TFV-DP thresholds is needed to inform interpretation and use in understanding PrEP adherence in this population.

Resumen

Comprender la adherencia a la PrEP es importante en la formulación de estrategias de prevención del VIH; sin embargo, la medición de la adherencia puede ser difícil. Comparamos múltiples medidas de adherencia en un estudio de dos años de mujeres jóvenes kenianas con alto riesgo de contraer el VIH. Entre 289 participantes, la concordancia entre la monitorización electrónica de la adherencia (EAM) y el tenofovir difosfato (TFV-DP) en las manchas de sangre seca varió del 57% al 72% dependiendo de los umbrales seleccionados. Utilizando el área bajo la curva operativa del receptor, la discriminación de TFV-DP cuantificable fue alta en 0.85 con EAM y baja en 0.49–0.54 para múltiples medidas autoinformadas. La correlación entre la EAM y las medidas autoinformadas fue baja (r < 0,11), aunque la correlación entre de las medidas autoinformadas fue moderada (r > 0,69). Estos resultados indican que tanto TFV-DP como EAM son herramientas útiles de adherencia a la PrEP. La adherencia se beneficiaría de una mejor disponibilidad de versiones menos costosas de ambas herramientas de medición. Además, se necesita más investigación sobre los umbrales TFV-DP para informar la interpretación y el uso en la comprensión de la adherencia a la PrEP en esta población.

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Acknowledgements

We would like to thank the study participants and the MPYA Study team below:

Investigators: Jessica E. Haberer, Jared M. Baeten, Elizabeth Bukusi, Nelly Mugo, Ruanne Barnabas, Harsha Thirumurthy, Ingrid Katz.

Kisumu study team: Kevin Kamolloh, Josephine Odoyo, Linda Aswani, Lawrence Juma, Elizabeth Koyo, Bernard Rono, Stanley Cheruiot, Vallery Ogello, Loice Okumu, Violet Kwach, Alfred Obiero, Stella Njuguna, Millicent Faith Akinyi, Lilian Adipo, Sylvia Akinyi.

Thika study team: Catherine Kiptiness, Nicholas Thuo, Stephen Gakuo Maina, Irene Njeru, Peter Mogere, Sarah Mbaire, Murugi Micheni, Lynda Oluoch, John Njoroge, Snaidah Ongachi, Jacinta Nyokabi.

Program manager: Lindsey Garrison.

Statisticians/analysts: Maria Pyra, Kathleen K. Thomas, Nicholas Musinguzi, Susie Valenzuela.

Clinical oversight: Susan Morrison.

Funding

This study was funded by the National Institute of Mental Health (R01MH109309); study medication was provided by Gilead (United States). Neither organization influenced the trial conduct, analysis, or presentation of the results.

Author information

Authors and Affiliations

  1. Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda

    Nicholas Musinguzi

  2. Center for Clinical Research (CCR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

    Kenneth Ngure & Nelly R. Mugo

  3. Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya

    Kenneth Ngure

  4. Department of Obstetrics and Gynecology, University of Washington, Seattle, USA

    Elizabeth A. Bukusi

  5. Department of Global Health, University of Washington, Seattle, USA

    Elizabeth A. Bukusi, Nelly R. Mugo & Jared M. Baeten

  6. Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

    Elizabeth A. Bukusi

  7. Department of Epidemiology, University of Washington, Seattle, USA

    Jared M. Baeten

  8. Department of Medicine, University of Washington, Seattle, USA

    Jared M. Baeten

  9. Colorado Antiviral Pharmacology Laboratory, Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, USA

    Peter L. Anderson

  10. Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Jessica E. Haberer

  11. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Jessica E. Haberer

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  1. Nicholas Musinguzi
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Contributions

NM and JEH conceived and designed the analysis; NM performed the analysis; NM wrote the initial draft of the manuscript with significant input from JEH; KN, EAB, NRM, PLA, and JMB provided critical review of the manuscript.

Corresponding author

Correspondence to Nicholas Musinguzi.

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Ethics Statement

The study was approved by the Kenya Medical Research Institute (Nairobi, Kenya), MassGeneral Brigham (Boston, MA, USA), and the University of Washington (Seattle, WA, USA).

Consent to Participate

All participants gave written informed consent.

Consent for publication

Consent for publication was not requested since there was no relevant information collected as to necessitate this consent.

Conflict of interest

JEH reports personal fees from Merck, outside the submitted work. JMB is an employee of Gilead Sciences, outside the submitted work. All other authors declare no conflict of interest related to this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

EAB reports personal fees from Merck, outside the submitted work.

PLA reports personal fees from Gilead, Merck, ViiV and research support from Gilead paid to his institution all outside the submitted work.

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Musinguzi, N., Ngure, K., Bukusi, E.A. et al. Performance of Multiple Adherence Measures for pre-exposure Prophylaxis (PrEP) Among Young Women in Kenya. AIDS Behav 27, 3961–3969 (2023). https://doi.org/10.1007/s10461-023-04111-2

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