A systematic review of adherence to oral pre-exposure prophylaxis for HIV – how can we improve uptake and adherence?

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Introduction

Oral pre-exposure prophylaxis (PrEP) is an effective strategy to reduce the risk of HIV transmission in high risk individuals. However, the effectiveness of oral pre-exposure prophylaxis is highly dependent on user adherence, which some previous trials have struggled to optimise particularly in low and middle income settings. This systematic review aims to ascertain the reasons for non-adherence to pre-exposure prophylaxis to guide future implementation.

Methods

We performed structured literature searches of online databases and conference archives between August 8, 2016 and September 16, 2017. In total, 18 prospective randomized control trials and implementation studies investigating oral pre-exposure prophylaxis were reviewed. A structured form was used for data extraction and findings summarized regarding efficacy, effectiveness, adherence and possible reasons for non-adherence.

Results

Adherence varied between differing populations both geographically and socioeconomically. Common reasons for non-adherence reported over multiple studies were; social factors such as stigma, low risk perception, low decision making power, an unacceptable dosing regimen, side effects, and the logistics of daily life. Oral pre-exposure prophylaxis with included antiviral regimens was not associated with a high risk of antiviral resistance development in the reviewed studies.

Conclusion

Our findings indicate that oral pre-exposure prophylaxis should be delivered within a holistic intervention, acknowledging the other needs of the targeted demographic in order to maximise acceptability. Socioeconomic factors and poor governmental policy remain major barriers to widespread implementation of pre-exposure prophylaxis.

Related collections

Most cited references 45

Record: found
Abstract: found
Article: not found

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2012)

David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

0 comments Cited 5638 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Prevention of HIV-1 infection with early antiretroviral therapy.

Myron S Cohen, Ying Q Chen, Marybeth McCauley … (2012)

Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. In nine countries, we enrolled 1763 couples in which one partner was HIV-1-positive and the other was HIV-1-negative; 54% of the subjects were from Africa, and 50% of infected partners were men. HIV-1-infected subjects with CD4 counts between 350 and 550 cells per cubic millimeter were randomly assigned in a 1:1 ratio to receive antiretroviral therapy either immediately (early therapy) or after a decline in the CD4 count or the onset of HIV-1-related symptoms (delayed therapy). The primary prevention end point was linked HIV-1 transmission in HIV-1-negative partners. The primary clinical end point was the earliest occurrence of pulmonary tuberculosis, severe bacterial infection, a World Health Organization stage 4 event, or death. As of February 21, 2011, a total of 39 HIV-1 transmissions were observed (incidence rate, 1.2 per 100 person-years; 95% confidence interval [CI], 0.9 to 1.7); of these, 28 were virologically linked to the infected partner (incidence rate, 0.9 per 100 person-years, 95% CI, 0.6 to 1.3). Of the 28 linked transmissions, only 1 occurred in the early-therapy group (hazard ratio, 0.04; 95% CI, 0.01 to 0.27; P<0.001). Subjects receiving early therapy had fewer treatment end points (hazard ratio, 0.59; 95% CI, 0.40 to 0.88; P=0.01). The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV-1 and clinical events, indicating both personal and public health benefits from such therapy. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 052 ClinicalTrials.gov number, NCT00074581.).

0 comments Cited 758 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men

Robert M Grant, Javier R Lama, Peter L Anderson … (2010)

Antiretroviral chemoprophylaxis before exposure is a promising approach for the prevention of human immunodeficiency virus (HIV) acquisition. We randomly assigned 2499 HIV-seronegative men or transgender women who have sex with men to receive a combination of two oral antiretroviral drugs, emtricitabine and tenofovir disoproxil fumarate (FTC-TDF), or placebo once daily. All subjects received HIV testing, risk-reduction counseling, condoms, and management of sexually transmitted infections. The study subjects were followed for 3324 person-years (median, 1.2 years; maximum, 2.8 years). Of these subjects, 10 were found to have been infected with HIV at enrollment, and 100 became infected during follow-up (36 in the FTC-TDF group and 64 in the placebo group), indicating a 44% reduction in the incidence of HIV (95% confidence interval, 15 to 63; P=0.005). In the FTC-TDF group, the study drug was detected in 22 of 43 of seronegative subjects (51%) and in 3 of 34 HIV-infected subjects (9%) (P<0.001). Nausea was reported more frequently during the first 4 weeks in the FTC-TDF group than in the placebo group (P<0.001). The two groups had similar rates of serious adverse events (P=0.57). Oral FTC-TDF provided protection against the acquisition of HIV infection among the subjects. Detectable blood levels strongly correlated with the prophylactic effect. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT00458393.).

0 comments Cited 744 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

David Sidebottom:

ORCID: http://orcid.org/0000-0003-3455-6659

dbsidebottom@gmail.com

Anna Mia Ekström: anna.mia.ekstrom@ki.se

Susanne Strömdahl: susanne.stromdahl@ki.se

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 16 November 2018

Publication date PMC-release: 16 November 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 581

Affiliations

[1 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Public Health Sciences, , Karolinska Institutet, ; Stockholm, Sweden

[2 ]ISNI 0000 0004 1936 9457, GRID grid.8993.b, Department of Medical Sciences, Section of Infectious Diseases, , Uppsala University, ; Uppsala, Sweden

[3 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Department of Infectious Diseases, , Karolinska University Hospital, ; Stockholm, Sweden

Author information

David Sidebottom http://orcid.org/0000-0003-3455-6659

Article

Publisher ID: 3463

DOI: 10.1186/s12879-018-3463-4

PMC ID: 6240194

PubMed ID: 30445925

SO-VID: 93ea780c-3f3f-4422-93ac-ba6d5b6784b3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 January 2018

Date accepted : 31 October 2018

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv,pre-exposure prophylaxis,hiv prevention,systematic review,medication adherence,antiviral drug resistance

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv, pre-exposure prophylaxis, hiv prevention, systematic review, medication adherence, antiviral drug resistance