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Counseling Helps Improve PrEP Adherence Among Serodiscordant Couples

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Cognitive-behavioral counseling sessions significantly increased the likelihood of consistently taking pills among participants with faltering adherence in an African trial of Truvada pre-exposure prophylaxis (PrEP) for serodiscordant (mixed HIV status) heterosexual couples, according to a report in the August 15 Journal of Acquired Immune Deficiency Syndromes.

Studies of heterosexual couples and men who have sex with men have shown that PrEP using daily Truvada (tenofovir/emtricitabine) reduced the risk of HIV infection by approximately 75% and 40%, overall. However, the protective effect can reach 90%-100% among people whose blood drug levels indicate that they took the pills consistently (at least 4 times per week in the iPrEx OLE study).

Christina Psaros from Massachusetts General Hospital Center in Boston and colleagues developed and tested a PrEP adherence intervention aimed at improving adherence levels among participants in the Partners PrEP study, a randomized trial comparing Truvada vs placebo for more than 4700 serodiscordant stable heterosexual couples in Kenya and Uganda.

The researchers conducted a companion adherence study at 3 of the Uganda sites. Participants with less than 80% adherence, as measured by unannounced pill counts, received additional adherence counseling based on an evidence-based HIV treatment adherence program called "Lifesteps," using the principles of cognitive-behavioral therapy (CBT). Participants in the program discussed beliefs about PrEP, adherence barriers, and stigma associated with HIV and PrEP use.

Results

  • Among 1147 HIV negative participants enrolled in the adherence substudy, 168 (15%) were eligible for the adherence intervention.
  • 62% of the eligible participants were men and the median age was 32.5 years.
  • Factors that significantly predicted suboptimal adherence were male sex, younger age, shorter relationship duration, and certain types of employment.
  • Participants took part in a median of 10 adherence counseling sessions.
  • Average adherence rose significantly, from 76% during the month before the intervention began to 84% during the month after the first counseling session.
  • Adherence declined thereafter, but even after 12 months it remained higher than the baseline level.
  • The barriers to adherence mentioned most frequently at the first session were travel (50%) and forgetting (45%).

"A PrEP adherence intervention was feasible in a clinical trial of PrEP in Uganda and PrEP adherence increased after the intervention," the study authors concluded.

"Future research should identify PrEP users with low adherence for enhanced adherence counseling and determine optimal implementation strategies for interventions to maximize PrEP effectiveness," they recommended. "Biomedical agents for the prevention of HIV should be used in conjunction with behavioral interventions to maximize their biological effectiveness."

9/4/14

Reference

C Psaros, JE Haberer, E Katabira, et al. An Intervention to Support HIV Preexposure Prophylaxis Adherence in HIV-Serodiscordant Couples in Uganda. Journal of Acquired Immune Deficiency Syndromes 66(5):522-529. August 15, 2014.