title: Understanding Adherence to Daily and Intermittent Regimens of Oral HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in Kenya.
abstract: A qualitative assessment of Kenyan men who have sex with men taking daily and intermittent oral HIV pre-exposure prophylaxis (PrEP) found stigma, sex work, mobility, and alcohol impacted adherence. We analyzed quantitative data from the same cohort to explore different definitions of intermittent adherence. Volunteers were randomized to daily emtricitabine/tenofovir or placebo, or intermittent (prescription: Mondays/Fridays/after sex, maximum 1 dose/day) emtricitabine/tenofovir or placebo (2:1:2:1), and followed for 4 months. By electronic monitoring, median adherence for daily dosing was 80 %. Median adherence for intermittent dosing was 71 % per a "relaxed" definition (accounting for off-prescription dosing) and 40 % per a "strict" definition (limited to the prescription). Factors associated with lower adherence included travel, transactional sex, and longer follow-up; higher adherence was associated with daily dosing and an income. The definition of intermittent dosing strongly affects interpretation of adherence. These findings suggest interventions should address challenges of mobility, sex work, and long-term PrEP.
authors.affiliation: Center for Geographic Medicine - Coast, Kenya Medical Research Institute, Kilifi, Kenya, pmugo@kemri-wellcome.org.
authors.forename: Peter Mwangi
authors.initials: PM
authors.lastname: Mugo
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Gaudensia
authors.initials: G
authors.lastname: Mutua
authors.forename: Elisabeth
authors.initials: E
authors.lastname: van der Elst
authors.forename: Omu
authors.initials: O
authors.lastname: Anzala
authors.forename: Burc
authors.initials: B
authors.lastname: Barin
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Frances H
authors.initials: FH
authors.lastname: Priddy
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
mesh_terms: D000284:Administration, Oral; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000068679:Emtricitabine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D012959:Socioeconomic Factors; D000068698:Tenofovir / Q000008:administration & dosage* / Q000627:therapeutic use; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir; D000068679:Emtricitabine