title: The Effect of Depressive Symptoms on Adherence to Daily Oral PrEP in Men who have Sex with Men and Transgender Women: A Marginal Structural Model Analysis of The iPrEx OLE Study.
abstract: We assessed the role of depressive symptoms on adherence to daily oral FTC/TDF for HIV PrEP in cisgender men who have sex with men (MSM) and transgender women who have sex with men (TGW) using data from the iPrEx OLE study. A marginal structural logistic regression model was used to estimate the effect of time-varying CES-D scores on having protective levels of drug concentration, adjusting for confounding by sexual practices over time, prior adherence, and baseline demographic characteristics. We found a non-monotonic relationship between CES-D score and odds of protective FTC/TDF levels in MSM. We found evidence that the effect of depression on adherence varied between MSM and TGW, and that depressive symptoms did not contribute greatly to decreased adherence on a population scale. We recommend that depressive symptoms not preclude the prescription of PrEP, and that MSM and TGW be studied separately.
authors.affiliation: Grant Lab, J David Gladstone Institutes, GIVI, 5th Floor 1650 Owens St, San Francisco, CA, 94158, USA. megha.mehrotra@gladstone.ucsf.edu.|University of California, San Francisco, CA, USA. megha.mehrotra@gladstone.ucsf.edu.
authors.forename: Megha L
authors.initials: ML
authors.lastname: Mehrotra
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: David V
authors.initials: DV
authors.lastname: Glidden
authors.affiliation: Grant Lab, J David Gladstone Institutes, GIVI, 5th Floor 1650 Owens St, San Francisco, CA, 94158, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: McMahan
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.affiliation: Stroger Hospital of Cook County, Chicago, IL, USA.
authors.forename: Sybil
authors.initials: S
authors.lastname: Hosek
authors.affiliation: Grant Lab, J David Gladstone Institutes, GIVI, 5th Floor 1650 Owens St, San Francisco, CA, 94158, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Defechereux
authors.affiliation: Fenway Community Health, Boston, MA, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Desmond Tutu Health Foundation, Cape Town, South Africa.
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.affiliation: University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Vivian I
authors.initials: VI
authors.lastname: Avelino-Silva
authors.affiliation: Projeto Praca Onze, Hospital Escola Sao Francisco de Assis, Universidade Federal do Rio de Janiero, Rio de Janeiro, Brazil.
authors.forename: Mauro
authors.initials: M
authors.lastname: Schechter
authors.affiliation: Grant Lab, J David Gladstone Institutes, GIVI, 5th Floor 1650 Owens St, San Francisco, CA, 94158, USA.|University of California, San Francisco, CA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Grant
mesh_terms: D000284:Administration, Oral; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D065129:Pre-Exposure Prophylaxis; D012725:Sexual Behavior; D063106:Transgender Persons / Q000523:psychology*
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Depression; HIV prevention; Marginal structural model; Men who have sex with men; PrEP; Preexposure prophylaxis; Transgender women; iPrEx OLE