Perception of HIV risk and adherence to a daily, investigational pill for HIV prevention in FEM-PrEP.
BACKGROUND
FEM-PrEP was unable to demonstrate the effectiveness of oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) as pre-exposure prophylaxis for HIV prevention because of low adherence. We hypothesized that one reason for the poor adherence was low perceived HIV risk.


METHODS
At enrollment and at quarterly follow-up visits, we assessed participants' perceived HIV risk for the subsequent 4 weeks. We used logistic regression to assess factors associated with some (small, moderate, or high) perceived HIV risk. We also used logistic regression with robust variance estimation to assess the association between risk perceptions (none versus some) reported at enrollment and at weeks 12, 24, and 36 and good adherence based on drug concentrations of plasma tenofovir and intracellular tenofovir diphosphate in specimens collected 4 weeks later (at weeks 4, 16, 28, and 40) among 150 randomly selected participants assigned FTC/TDF.


RESULTS
Multiple factors were statistically associated with having some perceived risk, including having sex without a condom, having multiple partners, and not knowing if a partner has HIV. We observed a significant association between having some risk perception and good adherence (odds ratio: 2.0; 95% confidence interval: 1.1 to 3.5; P = 0.016).


CONCLUSIONS
Data suggest that participants are likely knowledgeable about factors that increase their HIV risk. Perceived risk seemed to have influenced some participants' decisions to adhere to the study pill within the context of a placebo-controlled clinical trial. Future research can explore the role of risk perception in the uptake of and adherence to pre-exposure prophylaxis, now that FTC/TDF has been shown efficacious.
*Social and Behavioral Health Sciences, FHI 360, Durham, NC; †Quantitative Sciences, FHI 360, Durham, NC; ‡Impact Research and Development Organization, Kisumu, Kenya; §Setshaba Research Centre, Soshanguve, South Africa; ‖Josha Research, Bloemfontein, South Africa; and ¶Clinical Sciences, FHI 360, Durham, NC (Dr Van Damme is now with The Bill & Melinda Gates Foundation, Seattle, WA).
Amy
A
Corneli
Meng
M
Wang
Kawango
K
Agot
Khatija
K
Ahmed
Johan
J
Lombaard
Lut
L
Van Damme
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001774:Blood Chemical Analysis; D018890:Chemoprevention / Q000379:methods*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D000068679:Emtricitabine; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence; D063065:Organophosphonates / Q000627:therapeutic use; D012309:Risk-Taking; D000068698:Tenofovir; D055815:Young Adult
D044966:Anti-Retroviral Agents; D063065:Organophosphonates; D003841:Deoxycytidine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine