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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2018

Open Access 01-12-2018 | Research article

A systematic review of adherence to oral pre-exposure prophylaxis for HIV – how can we improve uptake and adherence?

Authors: David Sidebottom, Anna Mia Ekström, Susanne Strömdahl

Published in: BMC Infectious Diseases | Issue 1/2018

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Abstract

Introduction

Oral pre-exposure prophylaxis (PrEP) is an effective strategy to reduce the risk of HIV transmission in high risk individuals. However, the effectiveness of oral pre-exposure prophylaxis is highly dependent on user adherence, which some previous trials have struggled to optimise particularly in low and middle income settings. This systematic review aims to ascertain the reasons for non-adherence to pre-exposure prophylaxis to guide future implementation.

Methods

We performed structured literature searches of online databases and conference archives between August 8, 2016 and September 16, 2017. In total, 18 prospective randomized control trials and implementation studies investigating oral pre-exposure prophylaxis were reviewed. A structured form was used for data extraction and findings summarized regarding efficacy, effectiveness, adherence and possible reasons for non-adherence.

Results

Adherence varied between differing populations both geographically and socioeconomically. Common reasons for non-adherence reported over multiple studies were; social factors such as stigma, low risk perception, low decision making power, an unacceptable dosing regimen, side effects, and the logistics of daily life. Oral pre-exposure prophylaxis with included antiviral regimens was not associated with a high risk of antiviral resistance development in the reviewed studies.

Conclusion

Our findings indicate that oral pre-exposure prophylaxis should be delivered within a holistic intervention, acknowledging the other needs of the targeted demographic in order to maximise acceptability. Socioeconomic factors and poor governmental policy remain major barriers to widespread implementation of pre-exposure prophylaxis.
Literature
1.
UNAIDS. Global AIDS Update 2016. Geneva: UNAIDS; 2016.
2.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRef
3.
Joint United Nations Programme on HIV/AIDS. Prevention Gap Report. Geneva: Joint United Nations Programme on HIV/AIDS; 2016.
4.
Carroll A. State sponsored homophobia 2016: a world survey of sexual orientation laws: criminalisation, protection and recognition. 11th ed. Geneva: International Lesbian, Gay, Bisexual, Trans and Intersex Association; 2016.
5.
Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.CrossRef
6.
Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.CrossRef
7.
Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.CrossRef
8.
Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, Henderson FL, Pathak SR, Soud FA, Chillag KL, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.CrossRef
9.
McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, Sullivan AK, Clarke A, Reeves I, Schembri G, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53–60.CrossRef
10.
Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, Tremblay C, Le Gall JM, Cua E, Pasquet A, et al. On-demand Preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46.CrossRef
11.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. 2nd ed. France: World Health Organization; 2016.
12.
Centers for Disease Control and Prevention. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2014 Clinical Practice Guideline. Atlanta: Centers for Disease Control and Prevention; 2014.
13.
Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, Malahleha M, Owino F, Manongi R, Onyango J, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.CrossRef
14.
Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, Palanee T, Nakabiito C, van der Straten A, Noguchi L, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–18.CrossRef
15.
Grant RM, Anderson PL, McMahan V, Liu A, Amico KR, Mehrotra M, Hosek S, Mosquera C, Casapia M, Montoya O, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.CrossRef
16.
Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, Mayer KH, Mimiaga M, Patel R, Chan PA. Defining the HIV pre-exposure prophylaxis care continuum. AIDS. 2017;31(5):731–4.CrossRef
17.
Haberer JE, Baeten JM, Campbell J, Wangisi J, Katabira E, Ronald A, Tumwesigye E, Psaros C, Safren SA, Ware NC, et al. Adherence to antiretroviral prophylaxis for HIV prevention: a substudy cohort within a clinical trial of serodiscordant couples in East Africa. PLoS Med. 2013;10(9):e1001511.CrossRef
18.
Baeten JM, Donnell D, Mugo NR, Ndase P, Thomas KK, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, et al. Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial. Lancet Infect Dis. 2014;14(11):1055–64.CrossRef
19.
(CASP) CASP. Randomised Controlled Trials Checklist. Oxford: Critical Appraisal Skills Programme; 2013.
20.
Patterson KB, Prince HA, Kraft E, Jenkins AJ, Shaheen NJ, Rooney JF, Cohen MS, Kashuba AD. Penetration of tenofovir and emtricitabine in mucosal tissues: implications for prevention of HIV-1 transmission. Sci Transl Med. 2011;3(112):112re114.CrossRef
21.
Anderson PL, Liu AY, Castillo-Mancilla JR, Gardner EM, Seifert SM, McHugh C, Wagner T, Campbell K, Morrow M, Ibrahim M, et al. Intracellular Tenofovir-diphosphate and Emtricitabine-triphosphate in dried blood spots following directly observed therapy. Antimicrob Agents Chemother. 2018;62(1):e01710–17.
22.
Molina JM, Charreau I, Spire B, Cotte L, Chas J, Capitant C, Tremblay C, Rojas-Castro D, Cua E, Pasquet A, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402–10.CrossRef
23.
Liu AY, Cohen SE, Vittinghoff E, Anderson PL, Doblecki-Lewis S, Bacon O, Chege W, Postle BS, Matheson T, Amico KR, et al. Preexposure prophylaxis for HIV infection integrated with municipal- and community-based sexual health services. JAMA Intern Med. 2016;176(1):75–84.CrossRef
24.
Marcus JL, Hurley LB, Hare CB, Nguyen DP, Phengrasamy T, Silverberg MJ, Stoltey JE, Volk JE. Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and Discontinuation. J Acquir Immune Defic Syndr. 2016;73(5):540–6.CrossRef
25.
Lahuerta M, Zerbe A, Baggaley R, Falcao J, Ahoua L, DiMattei P, Morales F, Ramiro I, El-Sadr WM. Feasibility, acceptability and adherence with short term HIV pre-exposure prophylaxis in female sexual partners of migrant miners in Mozambique. J Acquir Immune Defic Syndr. 2017;76:343–7.CrossRef
26.
Balavoine S, Noret M, Loze B, Pintado C, Leplatois A, Charbonneau P, Moudachirou K, Djessima-Taba A, Niedbalski L, Siguier M, Aslan A, Ponscarme D, Penot P, Gatey C, Clavel F, Crémieux A-C, Lorho F, Dalle E, Parlier S, Delgado J, Veron R, Fonsart J, Delaugerre C, Rozenbaum W, Molina JM. PrEP uptake, safety and efficacy in a hospital-based clinic in Paris. Paris: 9th AIS conference on HIV science. p. 2017.
27.
Zablotska IV, S Bloch M, Carr A, Foster R, Grulich A, Guy R, McAllister JO, C Poynten M, Templton D. No HIV infections despite high-risk behaviour and STI incidence among gay/bisexual men taking daily pre-exposure prophylaxis (PrEP): the PRELUDE demonstration project. Paris: 9th AIS conference on HIV science. p. 2017.
28.
Vaccher SM, M Grulich AE, Ooi C, Carr A, Haire BG, Sctdhmclz I. Very high adherence to HIV PrEP over one year confirmed by four measures in an open-label demonstration project (PrELUDE) in NSW, Australia. Paris: 9th IAS conference on HIV science. p. 2017.
29.
Gafos MW, E White D, Clarke A, Apea V, Brodnicki E, Mackie NS, A Schembri G, Lacey C, Horne R, Dunn D, McCormack S. Adherence intentions, long-term adherence and HIV acquisition among PrEP users in the PROUD open-label randomised control trial of PrEP in England. Paris: 9th AIS conference on HIV science. p. 2017.
30.
Gill KD, J Gray G, Pidwell T, Kayamba F, Bennie T, Myer L, Johnson LS, H Slack C, Elharrar V, Strode A, Rooney J, Bekker L. Pluspills: an open label, safety and feasibility study of oral pre-exposureprophylaxis (PrEP) in 15-19 year old adolescents in two sites in South Africa. Paris: 9th AIS conference on HIV science. p. 2017.
31.
Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock P, Leethochawalit M, Chiamwongpaet S, Kitisin P, Natrujirote P, Kittimunkong S, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–90.CrossRef
32.
King HL, Keller SB, Giancola MA, Rodriguez DA, Chau JJ, Young JA, Little SJ, Smith DM. Pre-exposure prophylaxis accessibility research and evaluation (PrEPARE study). AIDS Behav. 2014;18(9):1722–5.CrossRef
33.
Kesler MA, Kaul R, Myers T, Liu J, Loutfy M, Remis RS, Gesink D. Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada. AIDS Care. 2016;28(11):1–8.CrossRef
34.
Merchant RC, Corner D, Garza E, Guan W, Mayer KH, Brown L, Chan PA. Preferences for HIV pre-exposure prophylaxis (PrEP) information among men-who-have-sex-with-men (MSM) at community outreach settings. J Gay Lesbian Ment Health. 2016;20(1):21–33.CrossRef
35.
Kibengo FM, Ruzagira E, Katende D, Bwanika AN, Bahemuka U, Haberer JE, Bangsberg DR, Barin B, Rooney JF, Mark D, et al. Safety, adherence and acceptability of intermittent tenofovir/emtricitabine as HIV pre-exposure prophylaxis (PrEP) among HIV-uninfected Ugandan volunteers living in HIV-serodiscordant relationships: a randomized, clinical trial. PLoS One. 2013;8(9):e74314.CrossRef
36.
Bekker L-G, Hughes J, Amico R, Roux S, Hendrix C, Anderson PL, Dye B, Elharrar V, Sirratt MJ, Grant R. HPTN 067/ADAPT Cape Town: a comparison of daily and nondaily PrEP dosing in African women: Conference on retroviruses and opportunistic infections, Seattle. p. 2015.
37.
Frankis J, Young I, Flowers P, McDaid L. Who will use pre-exposure prophylaxis (PrEP) and why?: understanding PrEP awareness and acceptability amongst men who have sex with men in the UK - a mixed methods study. PLoS One. 2016;11(4):e0151385.CrossRef
38.
Mutua G, Sanders E, Mugo P, Anzala O, Haberer JE, Bangsberg D, Barin B, Rooney JF, Mark D, Chetty P, et al. Safety and adherence to intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers. PLoS One. 2012;7(4):e33103.CrossRef
39.
van de Wijgert J, McCormack S. Vaginal dysbiosis and pre-exposure prophylaxis efficacy. Lancet HIV. 2017;4(10):e427–9.CrossRef
40.
Heffron R, McClelland RS, Balkus JE, Celum C, Cohen CR, Mugo N, Bukusi E, Donnell D, Lingappa J, Kiarie J, et al. Efficacy of oral pre-exposure prophylaxis (PrEP) for HIV among women with abnormal vaginal microbiota: a post-hoc analysis of the randomised, placebo-controlled partners PrEP study. Lancet HIV. 2017;4(10):e449–56.CrossRef
41.
Selinger C, Kirtane A, Abouzid O, Langer R, Traverso CG, Bershteyn A. Anticipated adherence, efficacy, and impact of weekly oral preexposure prophylaxis: Conference on retroviruses and opportunistic infections, Seattle. p. 2017.
42.
43.
Att leva med hiv i sverige. In. Järfälla: Folkhälsomyndigheten; 2016.
44.
van der Straten A, Stadler J, Montgomery E, Hartmann M, Magazi B, Mathebula F, Schwartz K, Laborde N, Soto-Torres L. Women's experiences with oral and vaginal pre-exposure prophylaxis: the VOICE-C qualitative study in Johannesburg, South Africa. PLoS One. 2014;9(2):e89118.CrossRef
45.
Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, Kanungi J, Singh S, Haberer J, Priddy F, et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2013;17(6):2162–72.CrossRef
46.
Trust TH. Shh... No talking: LGBT-inclusive Sex and Relationships Education in the UK. London: Terrence Higgins Trust; 2016.
47.
Scotland H. HIV and Education: Guaranteeing lessons for all. Edinburgh, Scotland: HIV Scotland; 2017.
48.
49.
UNAIDS. AIDS by the Numbers. Geneva: UNAIDS; 2016.
50.
Daughtridge GW, Conyngham SC, Ramirez N, Koenig HC. I am men's health: generating adherence to HIV pre-exposure prophylaxis (PrEP) in young men of color who have sex with men. J Int Assoc Provid AIDS Care. 2015;14(2):103–7.CrossRef
51.
Hunter M. The materiality of everyday sex: thinking beyond ‘prostitution’. Afr Stud. 2002;61(1):99–120.CrossRef
52.
Hoenigl M, Graff-Zivin J, Little SJ. Costs per diagnosis of acute HIV infection in community-based screening strategies: a comparative analysis of four screening algorithms. Clin Infect Dis. 2016;62(4):501–11.PubMed
53.
Knox D, Tan D, Harrigan P, Anderson P. HIV-1 infection with multiclass resistance despite preexposure prophylaxis (PrEP). Boston: Conference on retroviruses and opportunistic infections. p. 2016.
54.
Hosek SG, Siberry G, Bell M, Lally M, Kapogiannis B, Green K, Fernandez MI, Rutledge B, Martinez J, Garofalo R, et al. The acceptability and feasibility of an HIV preexposure prophylaxis (PrEP) trial with young men who have sex with men. J Acquir Immune Defic Syndr. 2013;62(4):447–56.CrossRef
55.
Anand T, Kerr SJ, Apornpong T, Nitpolpraset C, Ananworanich J, Phanuphak P, Phanuphak N. Self-perceived’ pre-exposure prophylaxis adherence and its relationship to self-reported ‘actual adherence’ among Thai men who have sex with men and transgender women. Glasgow: HIV Drug Therapy Glasgow; 2016.
56.
Macdonald V, Verster A, Baggaley R. A call for differentiated approaches to delivering HIV services to key populations. J Int AIDS Soc. 2017;20(Suppl 4):21658.CrossRef
57.
Golub SA, Pena S, Hilley A, Pachankis J, Radix A. Brief behavioural intervention increases PrEP drug levels in a real-world setting: Conference on retroviruses and opportunistic infections, Seattle. p. 2017.
58.
Marcus JL, Buisker T, Horvath T, Amico KR, Fuchs JD, Buchbinder SP, Grant RM, Liu AY. Helping our patients take HIV pre-exposure prophylaxis (PrEP): a systematic review of adherence interventions. HIV Med. 2014;15(7):385–95.CrossRef
59.
Khosropour CM, Lester RT, Golden MR, Dombrowski JC. Text messaging is associated with improved retention in a clinic-based PrEP program: Conference on retroviruses and opportunistic infections, Seattle. p. 2017.
60.
Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies. Pew Research Center: Washington; 2016.
61.
The Mobile Economy. Africa 2016. London: GSM Association; 2016.
62.
Evidence brief. Pre-exposure prophylaxis for the prevention of HIV in Europe. In: ECDC evidence brief. Stockholm: European Centre for Disease Prevention and Control. p. 2016.
63.
Cambiano V, Miners A, Dunn D, McCormack S, Ong KJ, Gill ON, Nardone A, Desai M, Field N, Hart G, et al. Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation. Lancet Infect Dis. 2017;18:85–94.CrossRef
64.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRef
65.
Grinsztejn BH, B Moreira R, Kallas E, Madruga J, Leite I, de Boni R, Anderson P, Liu A, Luz P, Veloso V. High level of retention and adherence at week 48 for MSM and TGW enrolled in the PrEP Brasil demonstration study. Paris: 9th IAS conference on HIV science. p. 2017.
Metadata
Title
A systematic review of adherence to oral pre-exposure prophylaxis for HIV – how can we improve uptake and adherence?
Authors
David Sidebottom
Anna Mia Ekström
Susanne Strömdahl
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2018
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-018-3463-4

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