1
|
Matthews LT, Jaggernath M, Kriel Y, Smith PM, Haberer JE, Baeten JM, Hendrix CW, Ware NC, Moodley P, Pillay M, Bennett K, Bassler J, Psaros C, Hurwitz KE, Bangsberg DR, Smit JA. Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa. AIDS 2024; 38:1342-1354. [PMID: 38752557 PMCID: PMC11211057 DOI: 10.1097/qad.0000000000003925] [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] [Received: 01/18/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE We developed the Healthy Families-PrEP intervention to support HIV-prevention during periconception and pregnancy. We evaluated preexposure prophylaxis (PrEP) use with three objective measures. DESIGN This single-arm intervention study enrolled women in KwaZulu-Natal, South Africa, who were HIV-uninfected, not pregnant, in a relationship with a partner with HIV or unknown-serostatus, and with pregnancy plans. PrEP was offered as part of a comprehensive HIV prevention intervention. Participants were followed for 12 months. METHODS We evaluated periconception PrEP uptake and adherence using quarterly plasma tenofovir concentrations. We modeled factors associated with PrEP uptake and high plasma tenofovir (past day dosing). Patterns of use were analyzed using electronic pillcap data. Dried blood spots to measure intracellular tenofovir product (past 2 months dosing) were analyzed for a subset of women. RESULTS Three hundred thirty women with median age 24 (IQR: 22-27) years enrolled. Partner HIV-serostatus was unknown by 96% ( N = 316); 60% (195) initiated PrEP. High plasma tenofovir concentrations were seen in 35, 25, 22, and 20% of samples at 3, 6, 9, and 12 months, respectively. Similar adherence was measured by pillcap and dried blood spots. In adjusted models, lower income, alcohol use, and higher HIV stigma were associated with high plasma tenofovir. Eleven HIV-seroconversions were observed (incidence rate: 4.04/100 person-years [95% confidence interval: 2.24-7.30]). None had detectable plasma tenofovir. CONCLUSION The Healthy Families-PrEP intervention supported women in PrEP use. We observed high interest in periconception PrEP and over one-third adhered to PrEP in the first quarter; one-fifth were adherent over a year. High HIV incidence highlights the importance of strategies to reduce HIV incidence among periconception women. CLINICAL TRIAL NUMBER NCT03194308.
Collapse
Affiliation(s)
- Lynn T. Matthews
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Manjeetha Jaggernath
- Maternal Adolescent and Child Health Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Yolandie Kriel
- Maternal Adolescent and Child Health Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Patricia M. Smith
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica E. Haberer
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jared M. Baeten
- Department of Global Health
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Craig W. Hendrix
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Norma C. Ware
- Department of Global Health & Social Medicine, Harvard Medical School
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pravi Moodley
- University of KwaZulu-Natal, School of Laboratory Medicine and Medical Sciences, National Health Laboratory Service
| | - Melendhran Pillay
- Department of Virology, National Health Laboratory Service, Durban, South Africa
| | | | - John Bassler
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina Psaros
- Department of Psychiatry, Behavioural Medicine Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Jennifer A. Smit
- Maternal Adolescent and Child Health Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| |
Collapse
|
2
|
Musinguzi N, Ngure K, Bukusi EA, Mugo NR, Baeten JM, Anderson PL, Haberer JE. Performance of Multiple Adherence Measures for pre-exposure Prophylaxis (PrEP) Among Young Women in Kenya. AIDS Behav 2023; 27:3961-3969. [PMID: 37351684 DOI: 10.1007/s10461-023-04111-2] [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: 06/03/2023] [Indexed: 06/24/2023]
Abstract
Understanding PrEP adherence is key in the formulation of HIV prevention strategies; however, measurement of adherence can be challenging. We compared multiple adherence measures in a two-year study of young Kenyan women at high risk of HIV acquisition. Among 289 participants, concordance between electronic adherence monitoring (EAM) and tenofovir diphosphate (TFV-DP) in dried blood spots ranged from 57 to 72% depending on selected thresholds. Using area under the receiver operating curve, discrimination of quantifiable TFV-DP was high at 0.85 with EAM and low at 0.49-0.54 for multiple self-reported measures. Correlation between EAM and self-reported measures was low (r < 0.11) although correlation within self-reported measures was moderate (r > 0.69). These findings indicate that both TFV-DP and EAM are useful PrEP adherence tools. Adherence would benefit from better availability of less expensive versions of both measurement tools. Additionally, further research on TFV-DP thresholds is needed to inform interpretation and use in understanding PrEP adherence in this population.
Collapse
Affiliation(s)
- Nicholas Musinguzi
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Kenneth Ngure
- Center for Clinical Research (CCR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Elizabeth A Bukusi
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Nelly R Mugo
- Center for Clinical Research (CCR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Peter L Anderson
- Colorado Antiviral Pharmacology Laboratory, Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, USA
| | - Jessica E Haberer
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Zia Y, Nambala L, Stalter RM, Muwonge TR, Ssebuliba T, Nakyanzi A, Nampewo O, Boyer J, Morrison S, Nsubuga R, Bagaya M, Nyanzi R, Matovu F, Yin M, Wyatt C, Mujugira A, Heffron R. Depression and PrEP uptake, interruption, and adherence among young women in Uganda. AIDS Care 2023; 35:1365-1374. [PMID: 36892945 DOI: 10.1080/09540121.2023.2177250] [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] [Received: 08/19/2022] [Accepted: 01/13/2023] [Indexed: 03/10/2023]
Abstract
Depression is a common cause of morbidity globally and can impact adherence to medications, posing challenges to medication-based HIV prevention. The objectives of this work are to describe the frequency of depression symptoms in a cohort of 499 young women in Kampala, Uganda and to determine the association of depression symptoms with use of HIV pre-exposure prophylaxis (PrEP). Mild or greater depression, assessed by the patient health questionnaire (PHQ-9), was experienced by 34% of participants at enrollment. Participants with mild depression symptoms tended to uptake PrEP, request PrEP refills, and adhere to PrEP with similar frequency to women with no/minimal signs of depression. These findings highlight opportunities to leverage existing HIV prevention programs to identify women who may benefit from mental health services and may not otherwise be screened.Trial registration: ClinicalTrials.gov identifier: NCT03464266..
Collapse
Affiliation(s)
- Yasaman Zia
- Departments of Epidemiology, University of Washington, Seattle, WA, USA
- Global Health, University of Washington, Seattle, WA, USA
| | - Lydia Nambala
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Sacramento City College, Sacramento, CA, USA
| | - Randy M Stalter
- Departments of Epidemiology, University of Washington, Seattle, WA, USA
- Global Health, University of Washington, Seattle, WA, USA
| | - Timothy R Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Timothy Ssebuliba
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Nakyanzi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Olivia Nampewo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jade Boyer
- Global Health, University of Washington, Seattle, WA, USA
| | - Susan Morrison
- Global Health, University of Washington, Seattle, WA, USA
| | - Rogers Nsubuga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Monica Bagaya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Nyanzi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Flavia Matovu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Michael Yin
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Mujugira
- Global Health, University of Washington, Seattle, WA, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Renee Heffron
- Departments of Epidemiology, University of Washington, Seattle, WA, USA
- Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
4
|
van den Elshout MA, Hoornenborg E, Coyer L, Anderson PL, Davidovich U, de Vries HJ, Prins M, Schim van der Loeff MF. Determinants of adherence to daily PrEP measured as intracellular tenofovir diphosphate concentrations over 24 months of follow-up among men who have sex with men. Sex Transm Infect 2023; 99:303-310. [PMID: 37258273 PMCID: PMC10359585 DOI: 10.1136/sextrans-2022-055499] [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] [Received: 04/12/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Adherence is key to the effectiveness of oral pre-exposure prophylaxis (PrEP) to prevent HIV. Therefore, we aimed to explore factors associated with adherence to daily PrEP (dPrEP). METHODS Men who have sex with men (MSM) using dPrEP (emtricitabine/tenofovir disoproxil) within the Amsterdam PrEP demonstration project at the Public Health Service of Amsterdam, provided dried blood spots (DBS) 12 and 24 months after PrEP initiation. From DBS, we determined intracellular tenofovir diphosphate (TFV-DP) concentrations to assess adherence; TFV-DP ≥700 fmol/punch was considered adequate. We assessed associations of sociodemographic, clinical and behavioural characteristics with TFV-DP concentrations using multivariable linear regression. RESULTS Of 263 participants who attended 12-month or 24-month study visits while on dPrEP, 257 (97.7%) provided DBS at one or both visits (492 DBS in total). Median TFV-DP concentration was 1299 (IQR 1021-1627) fmol/punch (12 months: 1332 (1087-1687); 24 months: 1248 (929-1590]). Higher TFV-DP concentrations were associated with: older age (p=0.0008), condomless anal sex with a casual partner in 6 months preceding PrEP initiation (+166 fmol/punch; 95% CI 36.5 to 296) and using a mobile application providing visualised feedback on PrEP use and sexual behaviour (+146 fmol/punch; 95% CI 28.1 to 263). Lower TFV-DP concentrations were associated with longer duration of PrEP use (24 vs 12 months; -91.5 fmol/punch; 95% CI -155 to -28.1). Time-updated number of sex partners, diagnosed STIs and chemsex were not associated with TFV-DP concentrations. CONCLUSIONS Overall, TFV-DP concentrations were high among MSM using dPrEP, indicating excellent adherence. Especially older participants, those who reported condomless anal sex with a casual partner prior to PrEP initiation and those who used an app with visualised feedback showed higher levels of adherence. As TFV-DP concentrations had decreased slightly at 2 years of PrEP use when compared with 1 year, we emphasise the importance of adherence counselling to those who continue using PrEP. TRIAL REGISTRATION NUMBER NL5413.
Collapse
Affiliation(s)
- Mark Am van den Elshout
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Liza Coyer
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Udi Davidovich
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam Faculty of Social and Behavioural Sciences, Amsterdam, The Netherlands
| | - Henry Jc de Vries
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | |
Collapse
|
5
|
Weld ED, Parsons TL, Gollings R, McCauley M, Grinsztejn B, Landovitz RJ, Marzinke MA. Development and validation of a liquid chromatographic-tandem mass spectrometric assay for the quantification of cabotegravir and rilpivirine from dried blood spots. J Pharm Biomed Anal 2023; 228:115307. [PMID: 36842333 PMCID: PMC10065945 DOI: 10.1016/j.jpba.2023.115307] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Dried blood spots (DBS) have been utilized as a blood plasma alternative for therapeutic drug monitoring and pharmacologic analysis. There are analytical and physiochemical considerations in bridging drug concentrations from plasma to DBS. Recently, the long-acting antiretroviral cabotegravir (CAB) has been approved for HIV prevention, and a co-packaged regimen of long-acting CAB and rilpivirine (RPV) has been approved for HIV treatment. Measurement of these drugs in blood collected as DBS may offer increased capacity and flexibility in translational applications. METHODS Whole blood was spiked with CAB and RPV and spotted on DBS cards. Following extraction and addition of isotopically labeled internal standards, samples were subjected to liquid chromatographic-tandem mass spectrometric (LC-MS/MS) analysis. The method was validated according to regulatory recommendations, and the assay was evaluated in remnant samples from an HIV prevention trial in which paired DBS and plasma samples were collected. RESULTS DBS CAB and RPV concentrations were linear from 25 to 20,000 ng/mL and 2-2500 ng/mL, respectively. Precision, accuracy, and matrix effect results were acceptable. DBS RPV demonstrated stability under all tested conditions; DBS CAB showed mean biases of - 23.5% when stored at room temperature for 36 days, and - 18.0% at 40 °C and 100% humidity for two days. DBS measurements for CAB and RPV were an average 54.0% and 14.1% lower, respectively, as compared to paired plasma samples. Derived conversion factors of 1.79 and 1.16 were applied to DBS CAB and RPV measurements, respectively, to estimate plasma concentrations. Estimated plasma CAB and RPV concentrations showed mean biases of 2.2% and 0.6%, respectively. In a CAB clinical trial, application of the conversion factor resulted in agreement between estimated plasma CAB concentrations from DBS and plasma CAB concentrations (y = 1.08x - 79.2, r = 0.932; mean bias of -3.2%; 95% CI: -48.2% to 41.9%). CONCLUSIONS We developed and validated a novel LC-MS/MS assay for the quantification of CAB and RPV from DBS, and identified conversion factors to estimate plasma concentrations from spotted blood.
Collapse
Affiliation(s)
- Ethel D Weld
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teresa L Parsons
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryann Gollings
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raphael J Landovitz
- Center for Clinical AIDS Research and Education, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Mark A Marzinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
6
|
Matthews LT, Atukunda EC, Owembabazi M, Kalyebera KP, Psaros C, Chitneni P, Hendrix CW, Marzinke MA, Anderson PL, Isehunwa OO, Hurwitz KE, Bennett K, Muyindike W, Bangsberg DR, Haberer JE, Marrazzo JM, Bwana MB. High PrEP uptake and objective longitudinal adherence among HIV-exposed women with personal or partner plans for pregnancy in rural Uganda: A cohort study. PLoS Med 2023; 20:e1004088. [PMID: 36795763 PMCID: PMC9983833 DOI: 10.1371/journal.pmed.1004088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/03/2023] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND In Uganda, fertility rates and adult HIV prevalence are high, and many women conceive with partners living with HIV. Pre-exposure prophylaxis (PrEP) reduces HIV acquisition for women and, therefore, infants. We developed the Healthy Families-PrEP intervention to support PrEP use as part of HIV prevention during periconception and pregnancy periods. We conducted a longitudinal cohort study to evaluate oral PrEP use among women participating in the intervention. METHODS AND FINDINGS We enrolled HIV-negative women with plans for pregnancy with a partner living, or thought to be living, with HIV (2017 to 2020) to evaluate PrEP use among women participating in the Healthy Families-PrEP intervention. Quarterly study visits through 9 months included HIV and pregnancy testing and HIV prevention counseling. PrEP was provided in electronic pillboxes, providing the primary adherence measure ("high" adherence when pillbox was opened ≥80% of days). Enrollment questionnaires assessed factors associated with PrEP use. Plasma tenofovir (TFV) and intraerythrocytic TFV-diphosphate (TFV-DP) concentrations were determined quarterly for women who acquired HIV and a randomly selected subset of those who did not; concentrations TFV ≥40 ng/mL and TFV-DP ≥600 fmol/punch were categorized as "high." Women who became pregnant were initially exited from the cohort by design; from March 2019, women with incident pregnancy remained in the study with quarterly follow-up until pregnancy outcome. Primary outcomes included (1) PrEP uptake (proportion who initiated PrEP); and (2) PrEP adherence (proportion of days with pillbox openings during the first 3 months following PrEP initiation). We used univariable and multivariable-adjusted linear regression to evaluate baseline predictors selected based on our conceptual framework of mean adherence over 3 months. We also assessed mean monthly adherence over 9 months of follow-up and during pregnancy. We enrolled 131 women with mean age 28.7 years (95% CI: 27.8 to 29.5). Ninety-seven (74%) reported a partner with HIV and 79 (60%) reported condomless sex. Most women (N = 118; 90%) initiated PrEP. Mean electronic adherence during the 3 months following initiation was 87% (95% CI: 83%, 90%). No covariates were associated with 3-month pill-taking behavior. Concentrations of plasma TFV and TFV-DP were high among 66% and 47%, 56% and 41%, and 45% and 45% at months 3, 6, and 9, respectively. We observed 53 pregnancies among 131 women (1-year cumulative incidence 53% [95% CI: 43%, 62%]) and 1 HIV-seroconversion in a non-pregnant woman. Mean pillcap adherence for PrEP users with pregnancy follow-up (N = 17) was 98% (95% CI: 97%, 99%). Study design limitations include lack of a control group. CONCLUSIONS Women in Uganda with PrEP indications and planning for pregnancy chose to use PrEP. By electronic pillcap, most were able to sustain high adherence to daily oral PrEP prior to and during pregnancy. Differences in adherence measures highlight challenges with adherence assessment; serial measures of TFV-DP in whole blood suggest 41% to 47% of women took sufficient periconception PrEP to prevent HIV. These data suggest that women planning for and with pregnancy should be prioritized for PrEP implementation, particularly in settings with high fertility rates and generalized HIV epidemics. Future iterations of this work should compare the outcomes to current standard of care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03832530 https://clinicaltrials.gov/ct2/show/NCT03832530?term=lynn+matthews&cond=hiv&cntry=UG&draw=2&rank=1.
Collapse
Affiliation(s)
- Lynn T. Matthews
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | | | | | - Kato Paul Kalyebera
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pooja Chitneni
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases and General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Craig W. Hendrix
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mark A. Marzinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, United States of America
| | - Oluwaseyi O. Isehunwa
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kathleen E. Hurwitz
- NoviSci, Inc., a Target RWE company, Durham, North Carolina, United States of America
| | - Kara Bennett
- Bennett Statistical Consulting Inc., Ballston Lake, New York, United States of America
| | - Winnie Muyindike
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - David R. Bangsberg
- School of Public Health, Oregon Health Sciences University–Portland State University, Portland, Oregon, United States of America
| | - Jessica E. Haberer
- Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Boston, Massachusetts, United States of America
| | - Jeanne M. Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | | |
Collapse
|
7
|
Olanrewaju AO, Sullivan BP, Gim AH, Craig CA, Sevenler D, Bender AT, Drain PK, Posner JD. REverSe TRanscrIptase chain termination (RESTRICT) for selective measurement of nucleotide analogs used in HIV care and prevention. Bioeng Transl Med 2023; 8:e10369. [PMID: 36684094 PMCID: PMC9842053 DOI: 10.1002/btm2.10369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023] Open
Abstract
Sufficient drug concentrations are required for efficacy of antiretroviral drugs used in HIV care and prevention. Measurement of nucleotide analogs, included in most HIV medication regimens, enables monitoring of short- and long-term adherence and the risk of treatment failure. The REverSe TRanscrIptase Chain Termination (RESTRICT) assay rapidly infers the concentration of intracellular nucleotide analogs based on the inhibition of DNA synthesis by HIV reverse transcriptase enzyme. Here, we introduce a probabilistic model for RESTRICT and demonstrate selective measurement of multiple nucleotide analogs using DNA templates designed according to the chemical structure of each drug. We measure clinically relevant concentrations of tenofovir diphosphate, emtricitabine triphosphate, lamivudine triphosphate, and azidothymidine triphosphate with agreement between experiment and theory. RESTRICT represents a new class of activity-based assays for therapeutic drug monitoring in HIV care and could be extended to other diseases treated with nucleotide analogs.
Collapse
Affiliation(s)
- Ayokunle O. Olanrewaju
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWashingtonUSA
- Department of BioengineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Benjamin P. Sullivan
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Alicia H. Gim
- Department of Chemical EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Cosette A. Craig
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Derin Sevenler
- Center for Engineering in Medicine and SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Andrew T. Bender
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Paul K. Drain
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Jonathan D. Posner
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWashingtonUSA
- Department of Chemical EngineeringUniversity of WashingtonSeattleWashingtonUSA
- Department of Family MedicineUniversity of WashingtonSeattleWashingtonUSA
| |
Collapse
|
8
|
Molina JM, Ghosn J, Assoumou L, Delaugerre C, Algarte-Genin M, Pialoux G, Katlama C, Slama L, Liegeon G, Beniguel L, Ohayon M, Mouhim H, Goldwirt L, Spire B, Loze B, Surgers L, Pavie J, Lourenco J, Ben-Mechlia M, Le Mestre S, Rojas-Castro D, Costagliola D. Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study. THE LANCET HIV 2022; 9:e554-e562. [DOI: 10.1016/s2352-3018(22)00133-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
|
9
|
OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1396-1403. [DOI: 10.1093/jac/dkac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/12/2022] [Indexed: 11/12/2022] Open
|
10
|
Brokus C, Kattakuzhy S, Gayle B, Narayanan S, Davis A, Cover A, Eyasu R, Ebah E, Ogbumbadiugha-Weekes O, Hoffmann J, Silk R, Stevens J, Mount J, Gannon C, Nussdorf L, Mathur P, Bijole P, Jones M, Kier R, Sternberg D, Greenblatt A, Weintraub E, Masur H, Kottilil S, Rosenthal E. Suboptimal uptake, retention, and adherence of daily oral PrEP among people with OUD receiving HCV treatment. Open Forum Infect Dis 2021; 9:ofab658. [PMID: 35187191 PMCID: PMC8849288 DOI: 10.1093/ofid/ofab658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Daily oral preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevents human immunodeficiency (HIV) among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use (IDU), PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID. Methods The ANCHOR investigation evaluated a community-based care model collocating hepatitis C virus (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC, and Baltimore, Maryland. PrEP counseling was conducted from HCV treatment day 0 until week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried blood spot TDF analysis. Results One hundred ninety-eight participants were enrolled, of whom 185 (93%) were HIV negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. One hundred sixteen participants (62.7%) met 2014 Centers for Disease Control and Prevention (CDC) PrEP criteria due to IDU (82 [44.3%]), sex (9 [4.9%]), or both practices (25 [13.5%]). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (interquartile range, 28–276 days), with 8 participants retained through week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Conclusions This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.
Collapse
Affiliation(s)
- C Brokus
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - S Kattakuzhy
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - B Gayle
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - S Narayanan
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - A Davis
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - A Cover
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - R Eyasu
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - E Ebah
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - O Ogbumbadiugha-Weekes
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - J Hoffmann
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - R Silk
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - J Stevens
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - J Mount
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - C Gannon
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - L Nussdorf
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
| | - P Mathur
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - P Bijole
- HIPS, org, Washington, DC, United States
| | - M Jones
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - R Kier
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - D Sternberg
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - A Greenblatt
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - E Weintraub
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - H Masur
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - S Kottilil
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - E Rosenthal
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
11
|
Goldwirt L, Bauer R, Liegeon G, Charreau I, Delaugerre C, Cotte L, Pialou G, Cua E, Laghzal A, Buschman L, Anderson P, Mourah S, Meyer L, Molina JM. Estimated pill intake with on-demand PrEP with oral TDF/FTC using TFV-DP concentration in dried blood spots in the ANRS IPERGAY trial. J Antimicrob Chemother 2021; 76:2675-2680. [PMID: 34278433 DOI: 10.1093/jac/dkab253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tenofovir diphosphate (TFV-DP) concentration in dried blood spots (DBSs) is a reliable pharmacokinetics biomarker of adherence to tenofovir disoproxil fumarate (TDF). We aimed to use DBSs to estimate pill intake among participants using on-demand pre-exposure prophylaxis (PrEP) and to identify predictive factors associated with higher TFV-DP concentrations. METHODS DBSs were collected at the last study visit of the open-label phase of the ANRS IPERGAY study, assessing on-demand oral TDF/emtricitabine for PrEP among MSM and transgender female participants. We quantified TFV-DP in DBSs centrally. We assessed correlation between pill count and TFV-DP concentration by Spearman correlation and explored associations between participant demographics, sexual behaviour and PrEP use during sexual intercourse (SI) with TFV-DP concentrations by univariate and multivariate logistic regression models. RESULTS The median age of the 245 participants included in this study was 40 years, with a median body weight of 73 kg. Median (IQR) TFV-DP concentration reached 517 (128-868) fmol/punch, corresponding to an estimated intake of 8-12 tablets per month (2-3 doses per week). Only 39% of participants had a TFV-DP concentration above 700 fmol/punch. TFV-DP concentrations were moderately correlated with pill count (r: 0.59; P < 0.001). In multivariate analysis, only systematic use of PrEP during SI and more frequent episodes of SI in the past 4 weeks were significantly associated with higher TFV-DP levels [OR (95% CI): 11.30 (3.62-35.33) and 1.46 (1.19-1.79), respectively; P < 0.001]. CONCLUSIONS Among participants using on-demand PrEP, estimated pill intake reached 8-12 tablets per month and was correlated with frequency and systematic use of PrEP for SI.
Collapse
Affiliation(s)
- Lauriane Goldwirt
- Assistance Publique des Hôpitaux de Paris, Saint-Louis Hospital, Department of Pharmacology, Université de Paris Diderot (Paris 7), INSERM UMRS976, France
| | | | - Geoffroy Liegeon
- Assistance Publique des Hôpitaux de Paris, Saint-Louis Hospital, Department of Infectious Diseases, Université de Paris Diderot (Paris 7), INSERM U941, Paris, France
| | | | - Constance Delaugerre
- Assistance Publique des Hôpitaux de Paris, Saint-Louis Hospital, Department of Virology, Université de Paris Diderot (Paris 7), INSERM U944, France
| | - Laurent Cotte
- Hospices Civils de Lyon, Croix-Rousse Hospital, Department of Infectious Diseases, INSERM U1052, Lyon, France
| | - Gilles Pialou
- Assistance Publique des Hôpitaux de Paris, Tenon Hospital, Department of Infectious Diseases, Sorbonne Université, UPMC Université, (Paris 6), France
| | - Eric Cua
- Hôpital de l'Archet, Department of Infectious Diseases, Nice University Hospital, France
| | - Aïcha Laghzal
- Assistance Publique des Hôpitaux de Paris, Saint-Louis Hospital, Department of Pharmacology, Université de Paris Diderot (Paris 7), INSERM UMRS976, France
| | - Lane Buschman
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Peter Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Samia Mourah
- Assistance Publique des Hôpitaux de Paris, Saint-Louis Hospital, Department of Pharmacology, Université de Paris Diderot (Paris 7), INSERM UMRS976, France
| | - Laurence Meyer
- Assistance Publique des Hôpitaux de Paris, Bicêtre Hospital, Université Paris-Saclay, UVSQ, Inserm, Le Kremlin-Bicêtre, France
| | - Jean-Michel Molina
- Assistance Publique des Hôpitaux de Paris, Saint-Louis Hospital, Department of Infectious Diseases, Université de Paris Diderot (Paris 7), INSERM U941, Paris, France
| |
Collapse
|
12
|
Ibrahim ME, Glidden DV, Grant RM, Anderson PL. Letter to the Editor: Revisiting the Pharmacological Forgiveness of HIV Pre-Exposure Prophylaxis. AIDS Res Hum Retroviruses 2021; 37:407-408. [PMID: 33913746 PMCID: PMC8213004 DOI: 10.1089/aid.2021.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mustafa E. Ibrahim
- Department of Pharmaceutical Sciences and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David V. Glidden
- University of California San Francisco, San Francisco, California, USA
| | - Robert M. Grant
- University of California San Francisco, San Francisco, California, USA
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Address correspondence to: Peter L. Anderson, PharmD, Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, V20–C238, Room 4101, 12850 E. Montview Boulevard, Aurora, CO 80045, USA
| |
Collapse
|