Journal
AIDS AND BEHAVIOR
Volume 17, Issue 6, Pages 2143-2155Publisher
SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10461-013-0429-9
Keywords
PrEP; Microbicides; Adherence; Intervention; Counseling; Clinical trials; HIV prevention
Funding
- FIC NIH HHS [D43 TW000231, D43TW00231] Funding Source: Medline
- NIAID NIH HHS [5UM1AI068633, UM1 AI068633, AI51794, U19 AI051794] Funding Source: Medline
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Adherence is a critical component of the success of antiretroviral-based pre-exposure prophylaxis (PrEP) in averting new HIV-infections. Ensuring drug availability at the time of potential HIV exposure relies on self-directed product use. A deeper understanding of how to best support sustained PrEP adherence remains critical to current and future PrEP efforts. This paper provides a succinct synthesis of the adherence support experiences from four pivotal PrEP trials-Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004, FEM-PrEP, Iniciativa Prophylaxis (iPrEx), and Vaginal and Oral Interventions to Control the Epidemic (VOICE). Notwithstanding variability in the design, population/cohort, formulation, drug, dosing strategy, and operationalization of adherence approaches utilized in each trial, the theoretical basis and experiences in implementation and monitoring of the approaches used by these trials provide key lessons for optimizing adherence in future research and programmatic scale-up of PrEP. Recommendations from across these trials include participant-centered approaches, separating measurement of adherence from adherence counseling, incorporating tailored strategies that go beyond education, fostering motivation, and addressing the specific context in which an individual incorporates and negotiates PrEP use.
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