Low daily oral PrEP adherence and low validity of self-report in a randomized trial among PWID in Ukraine.
In: The International journal on drug policy, Jg. 123 (2024), S. 104284
Online
academicJournal
Background: The efficacy of daily oral pre-exposure prophylaxis (PrEP) in preventing HIV transmission among people who inject drugs (PWID) was demonstrated over a decade ago. However, only a few studies among PWID have since measured PrEP adherence using laboratory markers.
Methods: In this trial, we randomized recently injecting PWID in Kyiv, Ukraine, to receive daily oral TDF/FTC with or without SMS reminders. Enrollment and PrEP initiation took place at an HIV clinic. Subsequent visits at months 1, 3, and 6 were conducted at a community harm reduction center and included a structured interview, adherence counseling, PrEP dispensing, and dried blood spot collection. PrEP adherence was assessed using standard self-reported measures and TDF/FTC biomarkers.
Results: A total of 199 PWID (99 SMS, 100 No-SMS) were enrolled, of whom 24 % were women, with a median age of 37. At month 6, 79.4 % (158/199) of participants were retained, with 84 % (133/158) reporting opioid injection and 20 % (31/158) reporting stimulant injection in the past 30 days. 77 % (122/158) reported taking >95 % of PrEP doses in the past month, and 87 % reported taking the last dose within 2 days. Tenofovir diphosphate was detected in 17 % (28/158) of participants, and emtricitabine triphosphate was detected in 25 % (40/158). Only 3 % (5/158) had metabolite levels indicative of consistent PrEP uptake at 4+ doses per week. There was no association between the SMS intervention and TDF/FTC metabolite detection.
Conclusion: Adherence to daily oral PrEP among actively injecting PWID, without daily supervision or incentives, was extremely low, despite supportive counseling and SMS reminders. We also observed a high rate of discordance between self-report and classification by a validated biomarker of adherence. Given the scarcity of evidence and emerging data suggesting low oral PrEP adherence among PWID, additional implementation studies with TDF/FTC biomarkers are needed to study whether a sufficient level of adherence to daily PrEP is attainable among PWID, especially as long-acting injectable PrEP offers a promising alternative.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023. Published by Elsevier B.V.)
| Titel: |
Low daily oral PrEP adherence and low validity of self-report in a randomized trial among PWID in Ukraine.
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| Autor/in / Beteiligte Person: | Dumchev, K ; Kornilova, M ; Makarenko, O ; Antoniak, S ; Liulchuk, M ; Cottrell, ML ; Varetska, O ; Morozova, O |
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| Zeitschrift: | The International journal on drug policy, Jg. 123 (2024), S. 104284 |
| Veröffentlichung: | 1998- : Amsterdam ; New York : Elsevier ; <i>Original Publication</i>: Liverpool, England : International Journal on Drug Policy,, 2024 |
| Medientyp: | academicJournal |
| ISSN: | 1873-4758 (electronic) |
| DOI: | 10.1016/j.drugpo.2023.104284 |
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