HIV self-testing plus biofeedback counseling increases PrEP adherence among women
An intervention for PrEP users and their partners that combined oral HIV self-testing with adherence biofeedback counseling almost doubled the recent adherence to PrEP among postpartum women in South Africa compared with standard of care.
“Preliminary findings from our research with HIV prevention and PrEP in pregnant and breastfeeding women in South Africa show high levels of PrEP initiation but low levels of continuation and adherence on PrEP,” Dvora Leah Joseph Davey, MPH, PhD, an adjunct assistant professor of infectious diseases at the University of California Los Angeles Fielding School of Public Health, told Healio.
“Given the high HIV incidence among pregnant and breastfeeding women and risk of infant HIV acquisition, new intervention strategies are urgently needed to improve adherence among PBFW at risk for HIV,” she said.
Davey said PrEP adherence counseling based on recent real-time adherence levels may improve adherence to daily PrEP. However, direct feedback to clients of real-time PrEP levels is difficult and expensive using standard blood testing because of the need for laboratory personnel and specialized equipment.
“A recently developed immunoassay using urine measures tenofovir (TFV) and is sensitive and specific when compared to plasma levels,” Davey explained. “The urine assay shows TFV concentrations if PrEP is taken in the past 48 to 72 hours and is processed within 10 to 15 minutes, enabling providers to adapt counseling messages immediately, potentially increasing motivation for adherence.”
To test the intervention, Davey and colleagues conducted a randomized control pilot trial that assessed the impact of combined interventions HIV self-testing for PrEP users and male partners plus biofeedback counseling through real-time adherence measures compared with standard of care (SOC) on recent PrEP adherence among postpartum women in Cape Town, South Africa, who took PrEP during pregnancy.
In total, 106 women were enrolled, of which 72% reported missing less than two doses in the 7 days before enrollment and 36% of whom had TFV present in their urine. According to the study, 62% of women in the intervention arm had TFV present in their urine 1 month after enrollment, compared with only 34% in the SOC group (RR = 1.83; 95% CI, 1.19-2.82). Additionally, the study showed that 66% of women in the intervention group reported that their partner tested for HIV compared with 17% in the SOC group. Lastly, researchers found that self-reported PrEP adherence with no TFV in a urine test was lower in the intervention group (17% vs. 46%).
“These preliminary results suggest that simple combination interventions may be highly 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 effect of the intervention.”