Infectious Disease

HIV self-testing plus biofeedback counseling increases PrEP adherence in women

January 15, 2022

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The authors report no relevant financial information.

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An intervention for PrEP users and their partners that combined oral HIV self-testing with adherence biofeedback counseling nearly doubled recent PrEP adherence in postpartum women in South Africa compared to standard of care.

Dvora Leah Davey

“Preliminary results from our research on HIV prevention and PrEP in pregnant and lactating women in South Africa show high levels of PrEP initiation but low levels of PrEP continuation and adherence,” The court Leah Joseph Davey, MPH, PhD, an associate assistant professor of infectious diseases at the University of California Los Angeles Fielding School of Public Health, Healio said.

“Given the high incidence of HIV in pregnant and lactating women and the risk of HIV disease in infants, new intervention strategies are urgently needed to improve adherence in PBFW at risk of HIV,” she said.

Davey said that PrEP compliance advice based on current, real-time compliance levels could improve adherence to daily PrEP. However, reporting real-time PrEP values ​​directly to clients with standard blood tests is difficult and expensive, requiring laboratory staff and specialized equipment.

“A recently developed immunoassay using urine measures tenofovir (TFV) and is sensitive and specific compared to plasma levels,” explained Davey. “The urine test shows TFV levels when the PrEP was taken in the past 48 to 72 hours and processed within 10 to 15 minutes, allowing providers to adjust counseling messages immediately, potentially increasing motivation for compliance.”

To test the intervention, Davey and colleagues conducted a pilot randomized controlled study comparing the effects of combined interventions, HIV self-testing for PrEP users and male partners, plus biofeedback counseling through real-time adherence measurements versus the standard of care (SOC). recently evaluated PrEP adherence in postpartum women in Cape Town, South Africa who took PrEP during pregnancy.

A total of 106 women were enrolled, of whom 72% reported missing less than two doses in the 7 days prior to enrollment and 36% had urinary TFV present. According to the study, 62% of women in the intervention arm had urinary TFV 1 month after admission, compared to only 34% in the SOC group (RR = 1.83; 95% CI, 1.19-2.82). In addition, the study showed that 66% of women in the intervention group reported that their partner had been tested for HIV, compared to 17% in the SOC group. Finally, the researchers found that self-reported PrEP adherence without TFV in a urine test was lower in the intervention group (17% vs. 46%).

“These preliminary results suggest that simple combination interventions can be very effective in improving PrEP adherence in pregnant and postpartum women,” Davey said. “More research is needed to understand the mechanisms of action, scalability, and longer-term effects of the intervention.”

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