Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study
Abstract Introduction Daily oral pre‐exposure prophylaxis (PrEP) can reduce HIV acquisition. However, prevention effectiveness requires daily adherence prior to and during periods of sexual activity. Little is known about pharmacologic measures of PrEP adherence during pregnancy and postpartum and t...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-12-01
|
| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26044 |
| _version_ | 1797976263765262336 |
|---|---|
| author | Dvora Joseph Davey Dorothy C. Nyemba Jose Castillo‐Mancilla Lubbe Wiesner Jennifer Norman Rufaro Mvududu Nyiko Mashele Leigh F. Johnson Linda‐Gail Bekker Pamina Gorbach Thomas J. Coates Landon Myer |
| author_facet | Dvora Joseph Davey Dorothy C. Nyemba Jose Castillo‐Mancilla Lubbe Wiesner Jennifer Norman Rufaro Mvududu Nyiko Mashele Leigh F. Johnson Linda‐Gail Bekker Pamina Gorbach Thomas J. Coates Landon Myer |
| author_sort | Dvora Joseph Davey |
| collection | DOAJ |
| description | Abstract Introduction Daily oral pre‐exposure prophylaxis (PrEP) can reduce HIV acquisition. However, prevention effectiveness requires daily adherence prior to and during periods of sexual activity. Little is known about pharmacologic measures of PrEP adherence during pregnancy and postpartum and the factors related to optimal adherence during periods of sexual activity in this population. Methods Between August 2019 and October 2021, we enrolled pregnant women without HIV at their first antenatal care visit followed‐up through 12 months postpartum. Eligible women ≥16 years old received HIV prevention counselling and were offered oral PrEP (TDF‐FTC). We quantified tenofovir‐diphosphate (TFV‐DP) in dried blood spots in women who reported taking PrEP in the past 30 days (at quarterly follow‐up visits). We used regression models with generalized estimating equations to evaluate correlates of TFV‐DP (any vs. none, and ≥2 vs. <2 doses/week), adjusting for maternal age and pregnancy status. Results and discussion In 382 women who started PrEP in pregnancy, returned for follow‐up and reported PrEP use in the past 30 days, the median age was 27 years (interquartile range [IQR] = 23–32), and the median time on PrEP was 168 days (IQR = 84–252 days). Half of the samples had quantifiable TFV‐DP at any time point (52%), declining from 67% of pregnant women 3 months post‐initiation to 31% of postpartum women by 12 months. Overall, 72% had concentrations corresponding to <2 doses/week; 25% ≥2 doses/week; 3% 7 doses/week. Concentrations were lower in postpartum versus pregnancy (age‐adjusted odds ratio [aOR] = 0.44; 95% confidence interval [CI] = 0.35–0.54). The correlation of self‐reported adherence and TFV‐DP ranged from –0.07 in pregnancy to 0.25 in postpartum women. Variables associated with having quantifiable TFV‐DP included partner living with HIV/unknown serostatus (aOR = 1.50; 95% CI = 1.01–2.22), and reported frequency of sexual activity in the past month (aOR sex >5/month vs. no sex or <5 times/month = 2.11; 95% CI = 1.58–2.82) adjusting for age and pregnancy versus postpartum status. TFV‐DP concentrations declined over follow‐up time (aOR for 6 vs. 3 months = 0.49; 95% CI = 0.36–0.67). Conclusions Objectively measured adherence to PrEP was low overall and did not correlate with self‐reported use. There is an urgent need for objective adherence measures to support clinical decision‐making as well as adherence support interventions as part of PrEP services for pregnant and postpartum women at risk of HIV. |
| first_indexed | 2024-04-11T04:48:13Z |
| format | Article |
| id | doaj.art-cfdf92801e9c4f44b9d8621491135425 |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-04-11T04:48:13Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-cfdf92801e9c4f44b9d86214911354252022-12-27T08:56:30ZengWileyJournal of the International AIDS Society1758-26522022-12-012512n/an/a10.1002/jia2.26044Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort studyDvora Joseph Davey0Dorothy C. Nyemba1Jose Castillo‐Mancilla2Lubbe Wiesner3Jennifer Norman4Rufaro Mvududu5Nyiko Mashele6Leigh F. Johnson7Linda‐Gail Bekker8Pamina Gorbach9Thomas J. Coates10Landon Myer11Division of Infectious Diseases Geffen School of Medicine University of California Los Angeles Los Angeles California USADivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaDivision of Infectious Diseases School of Medicine University of Colorado‐Anschutz Medical Campus Aurora Colorado USADivision of Clinical Pharmacology Department of Medicine University of Cape Town Cape Town South AfricaDivision of Clinical Pharmacology Department of Medicine University of Cape Town Cape Town South AfricaDivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaDivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaCentre for Infectious Disease Epidemiology and Research University of Cape Town Cape Town South AfricaThe Desmond Tutu Health Foundation University of Cape Town Cape Town South AfricaDivision of Infectious Diseases Geffen School of Medicine University of California Los Angeles Los Angeles California USADivision of Infectious Diseases Geffen School of Medicine University of California Los Angeles Los Angeles California USADivision of Epidemiology and Biostatistics School of Public Health University of Cape Town Cape Town South AfricaAbstract Introduction Daily oral pre‐exposure prophylaxis (PrEP) can reduce HIV acquisition. However, prevention effectiveness requires daily adherence prior to and during periods of sexual activity. Little is known about pharmacologic measures of PrEP adherence during pregnancy and postpartum and the factors related to optimal adherence during periods of sexual activity in this population. Methods Between August 2019 and October 2021, we enrolled pregnant women without HIV at their first antenatal care visit followed‐up through 12 months postpartum. Eligible women ≥16 years old received HIV prevention counselling and were offered oral PrEP (TDF‐FTC). We quantified tenofovir‐diphosphate (TFV‐DP) in dried blood spots in women who reported taking PrEP in the past 30 days (at quarterly follow‐up visits). We used regression models with generalized estimating equations to evaluate correlates of TFV‐DP (any vs. none, and ≥2 vs. <2 doses/week), adjusting for maternal age and pregnancy status. Results and discussion In 382 women who started PrEP in pregnancy, returned for follow‐up and reported PrEP use in the past 30 days, the median age was 27 years (interquartile range [IQR] = 23–32), and the median time on PrEP was 168 days (IQR = 84–252 days). Half of the samples had quantifiable TFV‐DP at any time point (52%), declining from 67% of pregnant women 3 months post‐initiation to 31% of postpartum women by 12 months. Overall, 72% had concentrations corresponding to <2 doses/week; 25% ≥2 doses/week; 3% 7 doses/week. Concentrations were lower in postpartum versus pregnancy (age‐adjusted odds ratio [aOR] = 0.44; 95% confidence interval [CI] = 0.35–0.54). The correlation of self‐reported adherence and TFV‐DP ranged from –0.07 in pregnancy to 0.25 in postpartum women. Variables associated with having quantifiable TFV‐DP included partner living with HIV/unknown serostatus (aOR = 1.50; 95% CI = 1.01–2.22), and reported frequency of sexual activity in the past month (aOR sex >5/month vs. no sex or <5 times/month = 2.11; 95% CI = 1.58–2.82) adjusting for age and pregnancy versus postpartum status. TFV‐DP concentrations declined over follow‐up time (aOR for 6 vs. 3 months = 0.49; 95% CI = 0.36–0.67). Conclusions Objectively measured adherence to PrEP was low overall and did not correlate with self‐reported use. There is an urgent need for objective adherence measures to support clinical decision‐making as well as adherence support interventions as part of PrEP services for pregnant and postpartum women at risk of HIV.https://doi.org/10.1002/jia2.26044adherencebreastfeedingpre‐exposure prophylaxispregnantPrEPSouth Africa |
| spellingShingle | Dvora Joseph Davey Dorothy C. Nyemba Jose Castillo‐Mancilla Lubbe Wiesner Jennifer Norman Rufaro Mvududu Nyiko Mashele Leigh F. Johnson Linda‐Gail Bekker Pamina Gorbach Thomas J. Coates Landon Myer Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study Journal of the International AIDS Society adherence breastfeeding pre‐exposure prophylaxis pregnant PrEP South Africa |
| title | Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study |
| title_full | Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study |
| title_fullStr | Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study |
| title_full_unstemmed | Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study |
| title_short | Adherence challenges with daily oral pre‐exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study |
| title_sort | adherence challenges with daily oral pre exposure prophylaxis during pregnancy and the postpartum period in south african women a cohort study |
| topic | adherence breastfeeding pre‐exposure prophylaxis pregnant PrEP South Africa |
| url | https://doi.org/10.1002/jia2.26044 |
| work_keys_str_mv | AT dvorajosephdavey adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT dorothycnyemba adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT josecastillomancilla adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT lubbewiesner adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT jennifernorman adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT rufaromvududu adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT nyikomashele adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT leighfjohnson adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT lindagailbekker adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT paminagorbach adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT thomasjcoates adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy AT landonmyer adherencechallengeswithdailyoralpreexposureprophylaxisduringpregnancyandthepostpartumperiodinsouthafricanwomenacohortstudy |