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Katz AWK, Balán IC, Reddy K, Etima J, Weber K, Tauya T, Atujuna M, Scheckter R, Ngure K, Soto-Torres L, Mgodi N, Palanee-Phillips T, Baeten JM, van der Straten A. Women's experience receiving drug feedback and adherence counseling in MTN-025/HOPE - an HIV Prevention open-label trial of the Dapivirine Vaginal Ring. AIDS Behav 2022; 26:3607-3619. [PMID: 35536519 PMCID: PMC9561023 DOI: 10.1007/s10461-022-03663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
In the Phase IIIB MTN-025/HOPE open label extension trial, participants were offered the dapivirine vaginal ring as HIV prophylaxis, and those who accepted the ring received semi real-time individual adherence feedback, based on residual drug level (RDL) from returned rings, during Motivational Interviewing-based counseling. Counseling messages, based on the best knowledge at the time, framed RDL results in terms of ring use and HIV protection, from no use /no protection (0 RDL) to high use /high protection (3 RDL). At six HOPE sites, in-depth-Interviews (IDIs) about RDL were conducted with 64 participants who had received at least one RDL result. We found mixed interpretations of what the RDL meant and strong emotional reactions with a focus on the external validation of the level itself. Counseling was critical to help participants process their reactions to the RDL and make decisions accordingly (i.e., persistence, adherence improvement, and/or switching to another HIV prevention method). Providing drug adherence feedback was complex to implement yet proved useful as a component of a multi-pronged adherence support strategy.
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Affiliation(s)
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States
- Present affiliation Florida State University College of Medicine, Tallahassee, FL, USA
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa
| | - Juliane Etima
- Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Thelma Tauya
- College of Health Sciences Clinical Trials Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Millicent Atujuna
- Desmond Tutu AIDS Foundation, University of Cape Town, Cape Town, South Africa
| | | | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Nyaradzo Mgodi
- College of Health Sciences Clinical Trials Unit, University of Zimbabwe, Harare, Zimbabwe
| | | | - Jared M Baeten
- University of Washington, Seattle, WA, USA
- Present affiliation Gilead Sciences, Foster City, CA, USA
| | - Ariane van der Straten
- Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA, USA
- Present affiliation ASTRA Consulting, Kensington, CA, USA
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2
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McGowan IM, Kunjara Na Ayudhya RP, Brand RM, Marzinke MA, Hendrix CW, Johnson S, Piper J, Holtz TH, Curlin ME, Chitwarakorn A, Raengsakulrach B, Doncel G, Schwartz JL, Rooney JF, Cranston RD. An Open-Label Pharmacokinetic and Pharmacodynamic Assessment of Tenofovir Gel and Oral Emtricitabine/Tenofovir Disoproxil Fumarate. AIDS Res Hum Retroviruses 2022; 38:279-287. [PMID: 34541872 DOI: 10.1089/aid.2021.0115] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Microbicide Trials Network-017 study was undertaken to characterize the safety, acceptability, pharmacokinetic (PK), and pharmacodynamic profile of the reduced-glycerin (RG) 1% tenofovir (RG-TFV) gel compared to oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). The study was a Phase 2, three-period, randomized sequence, open-label, expanded safety and acceptability crossover study. In each 8-week study period, HIV-1-uninfected participants were randomized to RG-TFV rectal gel daily or RG-TFV rectal gel before and after receptive anal intercourse (RAI) (or at least twice weekly in the event of no RAI), or daily oral FTC/TDF. A mucosal substudy was conducted at sites in the United States and Thailand. Samples were collected to evaluate PK and ex vivo biopsy challenge with HIV-1. A total of 195 men who have sex with men and transgender women were enrolled in the parent study and 37 in the mucosal substudy. As previously reported, both products were found to be safe and acceptable. Systemic TFV concentrations were significantly higher following oral exposure and daily rectal administration compared to RAI-associated product use (p < .001). All three routes of pre-exposure prophylaxis (PrEP) administration resulted in the inhibition of explant infection (p < .05), and there was a significant inverse correlation between explant HIV-1 p24 and tissue concentrations of TFV and FTC (p < .0001). Despite significant differences in systemic and mucosal drug concentrations, all three PrEP regimens were able to protect rectal explants from ex vivo HIV infection. These data suggest that there is a rationale for co-development of oral and topical antiretroviral PrEP for HIV prevention. Clinical Trial Registration number: NCT01687218.
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Affiliation(s)
- Ian M. McGowan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Orion Biotechnology, Ottawa, Ontario, Canada
| | | | - Rhonda M. Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark A. Marzinke
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Craig W. Hendrix
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jeanna Piper
- National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Timothy H. Holtz
- Division of HIV/AIDS Prevention, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Thailand Ministry of Public Health, United States Centers for Disease Control and Prevention Collaboration, Bangkok, Thailand
- Office of AIDS Research, NIH, Bethesda, Maryland, USA
| | - Marcel E. Curlin
- Division of HIV/AIDS Prevention, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Thailand Ministry of Public Health, United States Centers for Disease Control and Prevention Collaboration, Bangkok, Thailand
| | - Anupong Chitwarakorn
- Thailand Ministry of Public Health, United States Centers for Disease Control and Prevention Collaboration, Bangkok, Thailand
| | - Boonyos Raengsakulrach
- Thailand Ministry of Public Health, United States Centers for Disease Control and Prevention Collaboration, Bangkok, Thailand
| | - Gustavo Doncel
- CONRAD/Eastern Virginia Medical School, Arlington, Virginia, USA
| | - Jill L. Schwartz
- CONRAD/Eastern Virginia Medical School, Arlington, Virginia, USA
| | | | - Ross D. Cranston
- Department of Medicine, University of Barcelona, Barcelona, Spain
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3
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Bardon AR, Dorward J, Sookrajh Y, Sayed F, Quame-Amaglo J, Pillay C, Feutz E, Ngobese H, Simoni JM, Sharma M, Cressey TR, Gandhi M, Lessells R, Moodley P, Naicker N, Naidoo K, Thomas K, Celum C, Abdool Karim S, Garrett N, Drain PK. Simplifying TREAtment and Monitoring for HIV (STREAM HIV): protocol for a randomised controlled trial of point-of-care urine tenofovir and viral load testing to improve HIV outcomes. BMJ Open 2021; 11:e050116. [PMID: 34610939 PMCID: PMC8493905 DOI: 10.1136/bmjopen-2021-050116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Substantial improvements in viral suppression among people living with HIV (PLHIV) are needed to end the HIV epidemic, requiring extensive scale-up of low-cost HIV monitoring services. Point-of-care (POC) tests for monitoring antiretroviral therapy (ART) adherence and viral load (VL) may be efficient and effective tools for real-time clinical decision making. We aim to evaluate the effects of a combined intervention of POC ART adherence and VL testing compared with standard-of-care on ART adherence, viral suppression and retention at 6 and 18 months post-ART initiation among PLHIV. METHODS AND ANALYSIS Simplifying TREAtment and Monitoring for HIV (STREAM HIV) is a two-arm, open-label, randomised controlled superiority trial of POC urine tenofovir (POC TFV) and VL monitoring in PLHIV. We aim to enrol 540 PLHIV initiating a first-line ART regimen at a public HIV clinic in South Africa. Participants will be randomised 1:1 to the intervention or control arm. Intervention arm participants will receive monthly POC TFV testing for the first 5 months and POC VL testing at months 6 and 12. Intervention arm participants will also receive reflex POC TFV testing if viraemic and reflex HIV drug resistance testing for those with viraemia and detectable TFV. Control arm participants will receive standard-of-care, including laboratory-based VL testing at months 6 and 12. Primary outcomes include ART adherence (TFV-diphosphate concentration) at 6 months and viral suppression and retention at 18 months. Secondary outcomes include viral suppression and retention at 6 months, TFV-diphosphate concentration at 18 months, cost and cost-effectiveness of the intervention and acceptability of the intervention among PLHIV and healthcare workers. ETHICS AND DISSEMINATION STREAM HIV has received ethical approval from the University of Washington Institutional Review Board (STUDY00007544), University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC/00000833/2019) and Division of AIDS Regulatory Support Center (38509). Findings will be disseminated at international conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04341779.
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Affiliation(s)
- Ashley R Bardon
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | | | - Fathima Sayed
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | | | - Cheryl Pillay
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Hope Ngobese
- eThekwini Municipality Health Unit, Durban, KwaZulu-Natal, South Africa
| | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Tim R Cressey
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Richard Lessells
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- Infectious Diseases Department, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Pravi Moodley
- National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
- Discipline of Virology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- MRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research, Durban, KwaZulu-Natal, South Africa
- Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Katherine Thomas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Salim Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Paul K Drain
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Kutner BA, Giguere R, Lentz C, Kajura-Manyindo C, Dolezal C, Butheliezi S, Gwande M, Nampiira S, Ndlovu T, Mvinjelwa P, Mwenda W, Balán IC. Sharing Objective Measures of Adherence to a Vaginal Microbicide Promotes Candor About Actual Use and Bolsters Motivation to Prevent HIV. AIDS Behav 2021; 25:721-731. [PMID: 32920652 PMCID: PMC7887002 DOI: 10.1007/s10461-020-03026-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
Discrepancies between self-reported and actual adherence to biomedical HIV interventions is common and in clinical trials can compromise the integrity of findings. One solution is to monitor adherence biomarkers, but it is not well understood how to navigate biomarker feedback with participants. We surveyed 42 counselors and interviewed a subset of 22 to characterize their perspectives about communicating with participants about residual drug levels, an objective marker of adherence, within MTN-025/HOPE, a Phase 3b clinical trial of a vaginal ring to prevent HIV. When biomarkers indicated low drug levels that mismatched high adherence by self-report, counselors encountered barriers to acceptance and comprehension among participants. However, discrepancies between low self-report and higher drug levels generally stimulated candor. Women recollected times they had not used the product and disclosed problems that counselors thought might otherwise have remained forgotten or concealed. Navigating conversations toward HIV prevention was easier at mid-range drug levels and when women indicated motivation to prevent HIV. Ratings of residual drug level offered a somewhat objective measure of adherence and protection that counselors perceived as meaningful to participants and as a valuable catalyst for broaching conversation about HIV prevention. However, communication about drug levels required that counselors navigate emotional barriers, respond skillfully to questions about accuracy, and pivot conversations non-judgmentally away from numerical results and toward the priority of HIV prevention. Findings suggest a role for biomarker feedback in future clinical trials as well as other clinical contexts where biomarkers may be monitored, to motivate disclosure of actual adherence and movement toward HIV prevention.Clinical Trial Number NCT02858037.
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Affiliation(s)
- Bryan Andrew Kutner
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | | | - Miriam Gwande
- University of Zimbabwe College of Health Sciences Clinical Trials Research Center, Harare, Zimbabwe
| | - Susan Nampiira
- Makerere University - Johns Hopkins University Research Collaboration Clinical Research Site, Kampala, Uganda
| | - Thakasile Ndlovu
- South African Medical Research Council Clinical Trials Unit, Durban, South Africa
| | | | - Wezi Mwenda
- College of Medicine Clinical Research Site, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
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5
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Balán IC, Giguere R, Lentz C, Kutner BA, Kajura-Manyindo C, Byogero R, Asiimwe FB, Makala Y, Jambaya J, Khanyile N, Chetty D, Soto-Torres L, Mayo A, Mgodi NM, Palanee-Phillips T, Baeten JM. Client-Centered Adherence Counseling with Adherence Measurement Feedback to Support Use of the Dapivirine Ring in MTN-025 (The HOPE Study). AIDS Behav 2021; 25:447-458. [PMID: 32833192 DOI: 10.1007/s10461-020-03011-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fostering adherence and open communication about adherence challenges is key to harnessing the potential of biomedical HIV prevention products. We describe the counseling intervention and objective adherence measure feedback process implemented to support adherence to the dapivirine vaginal ring among participants in four sub-Saharan countries and present findings on the counselors' likeability and acceptability of the intervention. Most counselors (N = 42; 86%) liked Options counseling "very much" and during in-depth interviews (N = 22), reported that the intervention reshaped their adherence counselling approach by emphasizing understanding participants' experiences using the ring, which facilitated open discussion of adherence challenges. Counselors found that reframing residual drug level (RDL) discussions from the "adherence" to "protection" perspective encouraged adherence among consistent users and facilitated decisions to switch to a different HIV prevention approach among infrequent users. Among counselors, 24% said participants "liked it very much" while 26% said that participants "liked it a little" possibly due to two main complaints: perceived repetitiousness of sessions and variability in the RDL assay, which at times resulted in unexpected low RDLs.
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Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Bryan A Kutner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Clare Kajura-Manyindo
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
- Department of Counseling, Montclair State University, Montclair, NJ, USA
- Department of Social Sciences, Essex County College, Newark, NJ, USA
| | - Rose Byogero
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Florence Biira Asiimwe
- Makerere University - Johns Hopkins University Research Collaboration CRS, Kampala, Uganda
| | - Yvonne Makala
- University of North Carolina Lilongwe Clinical Research Site, Lilongwe, Malawi
| | - Jane Jambaya
- University of Zimbabwe College of Health Sciences Zengeza Clinical Trials Unit, Harare, Zimbabwe
| | - Nombuso Khanyile
- South African Medical Research Council Tongaat Clinical Trials Unit, Durban, South Africa
| | - Diane Chetty
- CAPRISA Clinical Trials Unit for AIDS/Tuberculosis Prevention and Treatment, Durban, South Africa
| | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | | | - Nyaradzo M Mgodi
- University of Zimbabwe - University of California San Francisco Collaborative Research Program, Harare, Zimbabwe
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Jared M Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
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6
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Bardon AR, Simoni JM, Layman LM, Stekler JD, Drain PK. Perspectives on the utility and interest in a point-of-care urine tenofovir test for adherence to HIV pre-exposure prophylaxis and antiretroviral therapy: an exploratory qualitative assessment among U.S. clients and providers. AIDS Res Ther 2020; 17:50. [PMID: 32762713 PMCID: PMC7412814 DOI: 10.1186/s12981-020-00308-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background Real-time, objective measures of adherence to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are needed to better assess adherence levels and to expedite clinical response for those with suboptimal adherence. Point-of-care tenofovir (POC-TFV) testing has been proposed as a solution to facilitate real-time antiretroviral adherence monitoring, but little is known about how health care providers, people living with HIV (PLWH) receiving ART, and people receiving PrEP will perceive POC-TFV testing. Methods We conducted an exploratory qualitative study to assess perspectives on the utility and interest in POC-TFV testing from potential end users. We conducted three focus group discussions (FGDs) among 17 PLWH receiving ART and four individuals receiving PrEP, as well as eight in-depth interviews (IDIs) with health care providers in the Seattle area and presented participants with a hypothetical urine-based POC-TFV test. FGDs and IDIs were audio recorded, transcribed, coded, and analyzed to describe emerging themes. Results Overall, study participants demonstrated divergent opinions about the POC-TFV test. Among study participants, PLWH were most ambivalent about POC-TFV testing, first demonstrating reluctance to TFV-level monitoring and shifting positions during the FGDs. However, all PLWH participants were receptive to POC-TFV testing if requested by their provider. PrEP participants were generally supportive of POC-TFV testing for routine adherence monitoring and emphasized potential value in self-administered testing. Providers’ perceptions were equally divided – half suggested POC-TFV testing would be valuable, particularly for people receiving PrEP, while half indicated the test would have little benefit for most individuals receiving ART or PrEP in the U.S. All providers agreed that POC-TFV test results could be beneficial for assessing discrepancies in viral load results and self-reported adherence among PLWH. The study also revealed that a low-cost, non-urine-based POC-TFV test with a long-term limit of detection would be preferred over the hypothetical urine-based test. Conclusions Our findings indicate POC-TFV testing may be beneficial for routine, clinic-based adherence monitoring, particularly for individuals receiving PrEP or for PLWH with persistent viremia or following recent ART initiation. These findings should also be used to formulate a target product profile for a POC-TFV test and to guide further developments in tools for objective antiretroviral adherence monitoring.
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7
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Abstract
HIV topical microbicides are products with anti-HIV activity, generally incorporating a direct-acting antiretroviral agent, that when applied to the vagina or rectum have the potential to prevent the sexual acquisition of HIV in women and men. Topical microbicides may meet the prevention needs of individuals and groups for whom oral daily forms of pre-exposure prophylaxis (PrEP) have not been acceptable. Microbicides can provide personal control over HIV prevention and offer the possibility of discreet use, qualities that may be particularly important for receptive partners in sexual relationships such as women and transgender women and men, who together account for the clear majority of new HIV infections worldwide. Although the promise of such a product emerged nearly three decades ago, proof of concept has been demonstrated only within the last decade. A robust pipeline of microbicidal gels, films, inserts, and rings has been evaluated in multiple studies among at-risk women and men, and refinement of products for ease of use, reversibility, and high safety is the priority for the field.
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Affiliation(s)
- Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington 98104, USA;
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA;
| | - Sharon L Hillier
- Department of Obstetrics, Gynecology, and Reproductive Sciences and Department of Microbiology and Molecular Genetics, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania 15213, USA;
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8
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Ojeda VD, Amico KR, Hughes JP, Wilson E, Li M, Holtz TH, Chitwarakorn A, Grant RM, Dye B, Bekker LG, Mannheimer S, Marzinke M, Hendrix CW. Low Disclosure of PrEP Nonadherence and HIV-Risk Behaviors Associated With Poor HIV PrEP Adherence in the HPTN 067/ADAPT Study. J Acquir Immune Defic Syndr 2019; 82:34-40. [PMID: 31169769 PMCID: PMC6698708 DOI: 10.1097/qai.0000000000002103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated the relationship between 2 types of social relationships, ie, (1) external support for use of HIV pre-exposure prophylaxis (PrEP) and related study supplies and (2) participants' disclosure of PrEP use and condom use and HIV PrEP adherence among daily-dosing regimen participants in HIV Prevention Trials Network (HPTN) 067, an open-label trial of oral tenofovir (TFV) disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg. METHODS Using HPTN 067 survey data, we developed scales examining (1) Low Perceived External Support for PrEP: low perceived support by others for PrEP use or perceived negative reactions to the pill case (scoring ranges from 0 to 2) and (2) Participant-Staff Disclosure Challenges Scale, which identifies challenges to sharing nonuse of PrEP or condoms to study staff (scoring ranges from 0 to 4); these scales are the primary independent variables. Adherence, the dependent variable, was determined using log-transformed plasma TFV concentrations. generalized estimating equation (GEE) linear regression was used to assess the association between both scales and adherence. RESULTS Participants (n = 161) included HIV-uninfected women in South Africa, and men who have sex with men and transgender women, in Thailand and the United States. In multivariable analyses, higher scores in the Participant-Staff Disclosure Challenges Scale were significantly associated with lower PrEP adherence [exp(β) = 0.62, 95% CI: (0.46 to 0.84); P = 0.002] as were increased days since the last PrEP dose [exp(β) = 0.73, 95% CI: (0.65 to 0.83); P ≤ 0.001]. CONCLUSIONS Given the association with adherence, study staff-participant interactions and participants' disclosure of PrEP challenges may be worthwhile intervention targets for improving PrEP adherence in confirmatory studies.
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Affiliation(s)
- Victoria D. Ojeda
- Department of Medicine, UCSD School of Medicine, La Jolla,
California, United States
| | - K. Rivet Amico
- Department of Health Behavior and Health Education,
University of Michigan, Ann Arbor, Michigan, United States
| | - James P. Hughes
- Department of Biostatistics, University of Washington,
Seattle, Washington, United States
| | - Ethan Wilson
- Statistical Center for AIDS Research and Prevention, Fred
Hutchinson Cancer Research Center, Seattle, USA
| | - Maoji Li
- Statistical Center for AIDS Research and Prevention, Fred
Hutchinson Cancer Research Center, Seattle, USA
| | - Timothy H. Holtz
- Thailand Ministry of Public Health – U.S. Centers
for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease
Control and Prevention, Atlanta, Georgia, United States
| | | | - Robert M. Grant
- Gladstone Institutes, University of California, San
Francisco, California, United States
| | - Bonnie Dye
- HIV Prevention Trials Network, FHI 360, Durham, North
Carolina, United States
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town,
Cape Town, South Africa
| | - Sharon Mannheimer
- Department of Medicine, Harlem Hospital Center, New
York, New York, United States
- Department of Epidemiology, Columbia University Mailman
School of Public Health, New York, New York, United States
- ICAP, Columbia University Mailman School of Public
Health, New York, New York, United States
| | - Mark Marzinke
- Dept. of Pathology, Johns Hopkins University School of
Medicine, Baltimore, MD USA
- Department of Medicine (Clinical Pharmacology), Johns
Hopkins University, Baltimore, Maryland, USA
| | - Craig W. Hendrix
- Department of Medicine (Clinical Pharmacology), Johns
Hopkins University, Baltimore, Maryland, USA
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Brown W, Sheinfil A, Lopez-Rios J, Giguere R, Dolezal C, Frasca T, Lentz C, Balán IC, Rael C, Cruz Torres C, Crespo R, Febo I, Carballo-Diéguez A. Methods, system errors, and demographic differences in participant errors using daily text message-based short message service computer-assisted self-interview (SMS-CASI) to measure sexual risk behavior in a RCT of HIV self-test use. Mhealth 2019; 5:17. [PMID: 31380409 PMCID: PMC6624350 DOI: 10.21037/mhealth.2019.06.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Assessment of sexual risk behavior is crucial to HIV prevention trials. Currently, there are no biomarkers or objective measures to detect and characterize sexual risk behavior; therefore, we must rely on self-reports. Self-report accuracy may be improved by collecting data in real-time. Our objective was to demonstrate how a text message-based short message service computer-assisted self-interview (SMS-CASI) system can collect daily sexual risk behavior data. METHODS During the course of a 2-arm randomized controlled trial, confidential daily SMS-CASI was used to assess sexual risk behavior over three months for participants using only condoms in the control condition and using condoms and HIV self-tests to test themselves and their non-monogamous sexual partner over six months for participants in the intervention condition (total N=272). Active monitoring of participants responses and data cleaning took place concurrently with trial execution. Descriptive statistics were used to examine frequencies related to system functionality, participant reporting, system errors, communication patterns, and overall feasibility of using the SMS-CASI system for reporting sexual risk behavior. RESULTS The SMS-CASI system processed 272,565 messages. In addition, 87 classifications of metadata were collected, for a total of 22,895,460 different data points. Types of messages included these sent (N=171,749; 63.01%) to participants, received (N=100,646; 36.93%) from participants, and failed (N=168; 0.06%) to be sent. Most errors (N=1,858) were due to system malfunctions (N=535; 28.79%) or participants' mistakes (N=1,289; 69.38%). Participant errors included: wrong password, incomplete surveys, and invalid response. The highest error rates by demographic characteristics were by age among older participants [ages 30-39; 383 errors (29.71%), and 40-69; 545 errors (42.28%)] and by race among Hispanic/Latino participants [487 errors (37.78%)]. CONCLUSIONS The SMS-CASI system was effective at confidentially collecting sexual risk behavior data on a daily basis, potentially contributing to reduced recall and social desirability bias. This study provides methodological examples and data demonstrating how SMS-CASI can be used for sexual health data collection.
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Affiliation(s)
- William Brown
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, CA, USA
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse, USA
| | - Javier Lopez-Rios
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Timothy Frasca
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Iván C. Balán
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Christine Rael
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Catherine Cruz Torres
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Raynier Crespo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Irma Febo
- Department of Pediatrics, University of Puerto Rico Medical Sciences Campus, San Juan, USA
| | - Alex Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, New York, NY, USA
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