PrEP Users Credit 6 Strategies for High Level of Adherence

A new study has identified 6 strategies used by individuals taking HIV pre-exposure prophylaxis (PrEP) medications to promote adherence to the daily regimen. Investigators say these strategies may assist health care providers treating patients who take PrEP.

According to the US Centers for Disease Control and Prevention (CDC), people who are at high risk of HIV infection can reduce their risk by 92% with consistent daily use of PrEP, but the pill is much less effective if not taken consistently. Only an estimated 10% of adults at risk of HIV infection currently take PrEP.

“Adding a daily pill for prevention can be challenging for some,” Christian Grov, PhD, MPH, chair of the Department of Community Health and Social Sciences at the City University of New York School of Public Health and a co-author of the study, told Contagion® in an interview. “In our study, we identified several easily adapted strategies that can help people to remember to take their medication at roughly the same time every day. Providers working with patients who are struggling with or concerned about adherence could recommend to their patients any number of the strategies we identified in our study.”

In research published in Prevention Science, Grov and the team of investigators from CUNY examined strategies to maximize PrEP adherence, noting that there is limited data focused on facilitators and barriers to PrEP use among men who have sex with men (MSM).

The study included interview data from 103 MSM participants who were recruited between November 2015 and November 2016 through advertising and preliminary screening in MSM-concentrated neighborhoods and settings along with digital recruitment on social networking websites and apps. Participants included cisgender males aged 18 years or older who had been taking PrEP for at least 30 days. Additionally, individuals were required to be residents of the New York City area in order to participate in an in-person interview, have internet access to complete online components of the study, and identify as gay, bisexual, or queer.

Through semi-structured, audio recorded qualitative interviews, investigators identified 6 strategies used by participants to adhere consistently to PrEP use.

The strategies included: integrating PrEP into part of a daily routine; using a pillbox; cognitive strategies and visual cues; setting smartphone reminders; keeping medication physically on oneself at all times; and partner or peer support for reminders and/or pill sharing. Of study participants, 84% cited using more than 1 of these strategies to achieve a high level of PrEP adherence, and overall participants reported an average of 1.6 missed doses in the prior 30 days.

Dr. Grov noted that PrEP has a long half-life in the bloodstream and said that current clinical trials are investigating the use of alternate dosing strategies. For now, although PrEP is fairly forgiving of the occasional missed dose, daily PrEP use continues to be the recommended regiment.

“From our study, in which everyone was on PrEP, participants described being able to easily incorporate a daily pill into their other daily regimens such as taking vitamins or brushing teeth,” said Dr. Grov. “Barriers to PrEP initiation are plentiful and include people not being aware of what PrEP is, not perceiving themselves as an appropriate candidate for PrEP, not having a doctor who will prescribe PrEP, not having a way to pay for it, prevailing stigma against PrEP, and concerns about side effects of taking a medication.”