High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort
Abstract Introduction Adolescent girls and young women (AGYW) account for two‐thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre‐exposure prophylaxis (PrEP) but low adherence, which might be improved by point‐of‐care adherence monitoring with tailored counselli...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-12-01
|
| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26389 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846108051628621824 |
|---|---|
| author | Brenda Gati Mirembe Deborah Donnell Meighan Krows Zinhle Zwane Elizabeth Bukusi Ravindre Panchia Cheryl Louw Noluthando Mwelase Pearl Selepe Melissa Senne Logashvari Naidoo Rachel Chihana Margaret Kasaro Harriet Nuwagaba‐Biribonwoha Philip Kotze Katherine Gill Pippa MacDonald Alastair vanHeerden Shannon Bosman Manjeetha Jaggernath Phillip du Preez Amy Ward Remco P. H. Peters Sinead Delany‐Moretlwe Sue Peacock Rachel Johnson Jason Caucutt Susan Morrison Guohong Wang Monica Gandhi Jennifer Velloza Renee Heffron Connie Celum the INSIGHT Study Team |
| author_facet | Brenda Gati Mirembe Deborah Donnell Meighan Krows Zinhle Zwane Elizabeth Bukusi Ravindre Panchia Cheryl Louw Noluthando Mwelase Pearl Selepe Melissa Senne Logashvari Naidoo Rachel Chihana Margaret Kasaro Harriet Nuwagaba‐Biribonwoha Philip Kotze Katherine Gill Pippa MacDonald Alastair vanHeerden Shannon Bosman Manjeetha Jaggernath Phillip du Preez Amy Ward Remco P. H. Peters Sinead Delany‐Moretlwe Sue Peacock Rachel Johnson Jason Caucutt Susan Morrison Guohong Wang Monica Gandhi Jennifer Velloza Renee Heffron Connie Celum the INSIGHT Study Team |
| author_sort | Brenda Gati Mirembe |
| collection | DOAJ |
| description | Abstract Introduction Adolescent girls and young women (AGYW) account for two‐thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre‐exposure prophylaxis (PrEP) but low adherence, which might be improved by point‐of‐care adherence monitoring with tailored counselling. Methods From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16−30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia. Participants were offered oral tenofovir‐based PrEP at enrolment and followed up at 1, 3 and 6 months. PrEP adherence was assessed by a point‐of‐care qualitative lateral flow urine tenofovir (TFV) assay indicating PrEP use in the prior 4 days, which accompanied real‐time adherence counselling that incorporated urine TFV results when testing was available (70.8% of month 1, 35.3% of month 3 and 83.9% of month 6 visits). We estimated overall adherence, correcting for missing test results, and analysed the association of having received urine TFV results at month 1 or 3 with subsequent urine TFV test positivity, using modified Poisson regression. Results Of the 3087 AGYW enrolled, the median age was 24 years (interquartile range 21−27), 75.7% were from South Africa, 2878 (93.2%) initiated PrEP at enrolment and 107 (3.5%) after enrolment. Visit retention was 92.0−96.2% for months 1, 3 and 6, and 2518 (90.1%) exited the study with a PrEP refill. Adherence, based on the point‐of‐care urine tenofovir test positivity rate, was estimated as 72%, 71% and 65% at months 1, 3 and 6, respectively. Women who received one prior urine TFV test had a 42% higher likelihood of a subsequent positive urine TFV test (adjusted odds ratio, OR = 1.42, 95% confidence interval, CI 1.27−1.60), and those having received two prior tests had a 67% higher likelihood (adjusted OR = 1.67; 95% CI 1.41−1.98). Observed HIV incidence was 1.38/100 person‐years (95% CI 0.97−2.08). Conclusions Oral PrEP uptake, recent adherence and persistence were high in a multisite cohort of young African women over 6 months of follow‐up. The use of a novel point‐of‐care tenofovir assay with tailored real‐time adherence counselling was associated with increased adherence to PrEP at subsequent visits, warranting further study. Clinical trials registration clinicaltrials.gov NCT05746065 |
| format | Article |
| id | doaj-art-184794dafd9049ddaaf15f1649bba9e6 |
| institution | Kabale University |
| issn | 1758-2652 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj-art-184794dafd9049ddaaf15f1649bba9e62024-12-26T04:04:34ZengWileyJournal of the International AIDS Society1758-26522024-12-012712n/an/a10.1002/jia2.26389High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohortBrenda Gati Mirembe0Deborah Donnell1Meighan Krows2Zinhle Zwane3Elizabeth Bukusi4Ravindre Panchia5Cheryl Louw6Noluthando Mwelase7Pearl Selepe8Melissa Senne9Logashvari Naidoo10Rachel Chihana11Margaret Kasaro12Harriet Nuwagaba‐Biribonwoha13Philip Kotze14Katherine Gill15Pippa MacDonald16Alastair vanHeerden17Shannon Bosman18Manjeetha Jaggernath19Phillip du Preez20Amy Ward21Remco P. H. Peters22Sinead Delany‐Moretlwe23Sue Peacock24Rachel Johnson25Jason Caucutt26Susan Morrison27Guohong Wang28Monica Gandhi29Jennifer Velloza30Renee Heffron31Connie Celum32the INSIGHT Study TeamMakerere University‐Johns Hopkins University Kampala UgandaFred Hutchinson Cancer Center Seattle Washington USADepartment of Global Health University of Washington Seattle Washington USASetshaba Research Centre Pretoria South AfricaDepartment of Global Health University of Washington Seattle Washington USAPerinatal Research HIV Research Unit Soweto South AfricaMadibeng Centre for Research Madibeng South Africa Brits South AfricaHelen Joseph Hospital Clinical HIV Research Unit University of the Witwatersrand Johannesburg South AfricaAurum Klerksdorp Clinical Research Centre Klerksdorp South AfricaAurum Rustenburg Clinical Research Centre Rustenburg South AfricaSouth African Medical Research Center Chatsworth Clinical Research Site Chatsworth South AfricaKamuzu University of Health Sciences – Johns Hopkins Research Project Blantyre MalawiUniversity of North Carolina Global Projects Zambia Lusaka ZambiaInternational Center for AIDS and Treatment Program Mbabane eSwatiniQhakaza Mbokodo Research Clinic Ladysmith South AfricaDesmond Tutu HIV Centre University of Cape Town Cape Town South AfricaDesmond Tutu HIV Centre University of Cape Town Cape Town South AfricaHuman Sciences Research Council Center for Community Based Research (CCBR) Pietermaritzburg South AfricaHuman Sciences Research Council Center for Community Based Research (CCBR) Pietermaritzburg South AfricaMATCH Research Unit University of the Witwatersrand Durban South AfricaDepartment of Medicine University of Cape Town, Vuka Research Clinic Cape Town South AfricaDepartment of Medicine University of Cape Town, Vuka Research Clinic Cape Town South AfricaFoundation for Professional Development Pretoria South AfricaWits Reproductive Health and HIV Unit University of the Witwatersrand Johannesburg South AfricaDepartment of Global Health University of Washington Seattle Washington USADepartment of Global Health University of Washington Seattle Washington USADepartment of Global Health University of Washington Seattle Washington USADepartment of Global Health University of Washington Seattle Washington USAAbottt Research Laboratories Pomona California USAUniversity of California San Franscisco San Fransisco California USAUniversity of California San Franscisco San Fransisco California USADepartment of Medicine University of Alabama at Birmingham Birmingham Alabama USADepartment of Global Health University of Washington Seattle Washington USAAbstract Introduction Adolescent girls and young women (AGYW) account for two‐thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre‐exposure prophylaxis (PrEP) but low adherence, which might be improved by point‐of‐care adherence monitoring with tailored counselling. Methods From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16−30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia. Participants were offered oral tenofovir‐based PrEP at enrolment and followed up at 1, 3 and 6 months. PrEP adherence was assessed by a point‐of‐care qualitative lateral flow urine tenofovir (TFV) assay indicating PrEP use in the prior 4 days, which accompanied real‐time adherence counselling that incorporated urine TFV results when testing was available (70.8% of month 1, 35.3% of month 3 and 83.9% of month 6 visits). We estimated overall adherence, correcting for missing test results, and analysed the association of having received urine TFV results at month 1 or 3 with subsequent urine TFV test positivity, using modified Poisson regression. Results Of the 3087 AGYW enrolled, the median age was 24 years (interquartile range 21−27), 75.7% were from South Africa, 2878 (93.2%) initiated PrEP at enrolment and 107 (3.5%) after enrolment. Visit retention was 92.0−96.2% for months 1, 3 and 6, and 2518 (90.1%) exited the study with a PrEP refill. Adherence, based on the point‐of‐care urine tenofovir test positivity rate, was estimated as 72%, 71% and 65% at months 1, 3 and 6, respectively. Women who received one prior urine TFV test had a 42% higher likelihood of a subsequent positive urine TFV test (adjusted odds ratio, OR = 1.42, 95% confidence interval, CI 1.27−1.60), and those having received two prior tests had a 67% higher likelihood (adjusted OR = 1.67; 95% CI 1.41−1.98). Observed HIV incidence was 1.38/100 person‐years (95% CI 0.97−2.08). Conclusions Oral PrEP uptake, recent adherence and persistence were high in a multisite cohort of young African women over 6 months of follow‐up. The use of a novel point‐of‐care tenofovir assay with tailored real‐time adherence counselling was associated with increased adherence to PrEP at subsequent visits, warranting further study. Clinical trials registration clinicaltrials.gov NCT05746065https://doi.org/10.1002/jia2.26389adherenceAfricapoint‐of‐carePrEPtenofovirwomen |
| spellingShingle | Brenda Gati Mirembe Deborah Donnell Meighan Krows Zinhle Zwane Elizabeth Bukusi Ravindre Panchia Cheryl Louw Noluthando Mwelase Pearl Selepe Melissa Senne Logashvari Naidoo Rachel Chihana Margaret Kasaro Harriet Nuwagaba‐Biribonwoha Philip Kotze Katherine Gill Pippa MacDonald Alastair vanHeerden Shannon Bosman Manjeetha Jaggernath Phillip du Preez Amy Ward Remco P. H. Peters Sinead Delany‐Moretlwe Sue Peacock Rachel Johnson Jason Caucutt Susan Morrison Guohong Wang Monica Gandhi Jennifer Velloza Renee Heffron Connie Celum the INSIGHT Study Team High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort Journal of the International AIDS Society adherence Africa point‐of‐care PrEP tenofovir women |
| title | High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort |
| title_full | High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort |
| title_fullStr | High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort |
| title_full_unstemmed | High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort |
| title_short | High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort |
| title_sort | high recent prep adherence with point of care urine tenofovir testing and adherence counselling among young african women results from the insight cohort |
| topic | adherence Africa point‐of‐care PrEP tenofovir women |
| url | https://doi.org/10.1002/jia2.26389 |
| work_keys_str_mv | AT brendagatimirembe highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT deborahdonnell highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT meighankrows highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT zinhlezwane highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT elizabethbukusi highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT ravindrepanchia highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT cheryllouw highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT noluthandomwelase highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT pearlselepe highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT melissasenne highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT logashvarinaidoo highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT rachelchihana highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT margaretkasaro highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT harrietnuwagababiribonwoha highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT philipkotze highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT katherinegill highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT pippamacdonald highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT alastairvanheerden highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT shannonbosman highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT manjeethajaggernath highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT phillipdupreez highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT amyward highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT remcophpeters highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT sineaddelanymoretlwe highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT suepeacock highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT racheljohnson highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT jasoncaucutt highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT susanmorrison highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT guohongwang highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT monicagandhi highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT jennifervelloza highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT reneeheffron highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT conniecelum highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort AT theinsightstudyteam highrecentprepadherencewithpointofcareurinetenofovirtestingandadherencecounsellingamongyoungafricanwomenresultsfromtheinsightcohort |