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PATTERNS AND CORRELATES OF PREP DRUG DETECTION AMONG MSM AND TRANSGENDER WOMEN IN THE GLOBAL IPREX STUDY
Liu, Albert et al. | Date Issued: 2014
Author
Liu, Albert
Glidden, David V.
Anderson, Peter L.
Amico, K. Rivet
McMahan, Vanessa
Mehrotra, Megha
Lama, Javier R.
MacRae, John
Hinojosa, Juan Carlos
Montoya, Orlando
Veloso, Valdiléa G.
Schechter, Mauro
Kallas, Esper G.
Chariyalerstak, Suwat
Bekker, Linda-Gail
Mayer, Kenneth
Buchbinder, Susan
Grant, Robert
Affilliation
Bridge HIV. San Francisco Department of Public Health. San Francisco, CA, USA / Department of Medicine. University of California. San Francisco, San Francisco. CA, USA.
Department of Epidemiology and Biostatistics. University of California San Francisco. San Francisco, CA, USA.
Department of Pharmaceutical Sciences. University of Colorado. Aurora, CO, USA.
Center for Health Intervention and Prevention. University of Connecticut. Storrs, CT, USA.
Gladstone Institutes. University of California San Francisco. San Francisco, CA, USA.
Gladstone Institutes. University of California San Francisco. San Francisco, CA, USA.
Asociación Civil Impacta Salud y Educación. Lima, Peru.
Investigaciones Médicas en Salud. Lince, Peru.
Asociación Civil Selva Amazónica. Iquitos, Peru.
Fundación Ecuatoriana Equidad. Quito, Equador.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Hospital Escola São Francisco de Assis. Projeto Praça Onze. Rio de Janeiro, RJ, Brasil.
Universidade de São Paulo. São Paulo, SP, Brasil.
Research Institute for Health Sciences. Chiang Mai University. Chiang Mai, Thailand / Faculty of Medicine. Chiang Mai University. Chiang Mai, Thailand.
The Desmond Tutu HIV Centre. University of Cape Town. Cape Town, South Africa.
Fenway Community Health. Boston, MA, USA / Brown University. Providence, RI, USA.
Bridge HIV. San Francisco Department of Public Health. San Francisco, CA, USA / Department of Medicine. University of California San Francisco. San Francisco, CA, USA / Department of Epidemiology and Biostatistics. University of California San Francisco. San Francisco, CA, USA.
Department of Medicine. University of California San Francisco. San Francisco, CA, USA / Gladstone Institutes. University of California San Francisco, San Francisco, CA, USA.
Abstract
Background: Adherence to pre-exposure prophylaxis (PrEP) is critical for efficacy. Antiretroviral concentrations are an objective measure of PrEP use and correlate with efficacy. Understanding patterns and correlates of drug detection can identify populations at risk for nonadherence and inform design of PrEP adherence interventions. Methods: Blood antiretroviral concentrations were assessed among active arm participants in iPrEx, a randomized placebo-controlled trial of emtricitabine/tenofovir in men who have sex with men and transgender women in 6 countries. We evaluated rates and correlates of drug detection among a random sample of 470 participants at week 8 and a longitudinal cohort of 303 participants through 72 weeks of follow-up. Results: Overall, 55% of participants (95% confidence interval: 49 to 60) tested at week 8 had drug detected. Drug detection was associated with older age and varied by study site. In longitudinal analysis, 31% never had drug detected, 30% always had drug detected, and 39% had an inconsistent pattern. Overall detection rates declined over time. Drug detection at some or all visits was associated with older age, indices of sexual risk, including condomless receptive anal sex, and responding "don't know" to a question about belief of PrEP efficacy (0-10 scale). Conclusions: Distinct patterns of study product use were identified, with a significant proportion demonstrating no drug detection at any visit. Research literacy may explain greater drug detection among populations having greater research experience, such as older men who have sex with men in the United States. Greater drug detection among those reporting highest risk sexual practices is expected to increase the impact and cost-effectiveness of PrEP.
Keywords
Pre-exposure prophylaxis
Drug detection
Emtricitabine tenofovir
Adherence
Men who have sex with men
 
Citation
LIU, Albert et al. Patterns and Correlates of PrEP Drug Detection among MSM and Transgender Women in the Global iPrEx Study. Journal of Acquired Immune Deficiency Syndromes, v. 67, n. 5, p. 528-537, Dec. 2014.
DOI
10.1097/QAI.0000000000000351
ISSN
1525-4135