Adherence & Retention
Study Results: Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men (iPrEx)
I wanted to also draw attention to the pivotal role of pill-use in the iPrEx results. About a year or so before the end of the study we developed, disseminated, and implemented a strengths-based, motivational-interviewing-advised approach to support pill-use among iPrEx participants that also involved the removal of the interview-based adherence assessment from the counseling session (pill-use discussion). What I think is clear in the iPrEx results, echoing what CAPRISA found as well, is that having the active drug in your system is (1) critical to improved prevention effects and (2) not as high as self-report would suggest. iPrEx made a dramatic move away from a messaging based approach to a motivational one in part because of concerns that the frequent messaging around taking a pill every day was promoting bias in self-presentation of reported adherence for some participants and was cutting short the possibility for frank conversations about difficulties and concerns surrounding pill-use.
I don’t know that we'll be able to cleanly assess the impact/effect of the introduction of this new pill-use support strategy (we call it Next Step Counseling) within iPrEx or the training on interview-based adherence assessment (Neutral Assessment) but lessons learned from the counselors and assessors to date been generally quite supportive. We are in the process of gathering more information, but in the meantime I wanted to emphasize that adherence in any PrEP trial is a critical factor-- it will set the upper limit of true efficacy. Many on-going biomedical HIV prevention trials are developing innovative ways to support study-drug use that go beyond providing information or messages. Certainly adherence is not the only factor-- there needs to be efficacy in the first place-- but it is a critical factor to keep in mind with any prevention strategy that require self-administration, self-directed adoption of the strategy. I think it is important that we as a community contribute to these conversations and innovations. PrEP adherence will differ in many ways from ARV therapy adherence, but we have a fair amount to offer here!
Sincerely,
Rivet
K Rivet Amico, PhD
Research Scientist
Center for Health, Intervention and Prevention
University of Connecticut
810 360 8716
800 518 0243 (fax)
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