Strategies for Maintaining Adherence to PrEP

Segment Description: Ian Frank, MD, professor of medicine, Perelman School of Medicine, University of Pennsylvania, discusses strategies that individuals taking PrEP can use to maintain adherence to the daily regimen.

Interview transcript: (modified slightly for readability)

Contagion®:What are strategies that individuals taking PrEP can use to maintain adherence to the daily regimen?

Ian Frank, MD: “It's important for people to understand that they should be taking tenofovir and emtricitabine, 1 pill a day, and for people who aren't used to taking medications, getting into a pill taking habit is the best way to maintain your adherence. So, I would suggest that people put the medication in a location where they're going to be every day — in the bathroom, near their toothbrush or in the kitchen on the counter. It may be helpful to have a calendar and to check off the date when the medication is taken, so one remembers that they've taken it because sometimes people who are in a habit don't remember whether or not they've actually done the pill-taking, because it has become so automatic.

It's also okay for people who are not sexually active for periods of time to say, ‘okay, I don't need to take this right now because I'm not in a relationship, I'm not going out, I'm not seeking a relationship with anybody.’ And, sometimes people may need a break from the pill-taking and that little break can then help them get back into the pill-taking habit in a little bit of a more comfortable way.

People should remember that the medication may not be as effective if people just start it the day that they're having sex. The way the regimen was taken in the iPrEx study, which was an intermittent PrEP study, was 2 tenofovir/emtricitabine the day before sex or before sex, 1 the next day, 1 the day after that. And, we only know this intermittent strategy works for men who have sex with men, we don't know that it would be effective for women. In fact, we think that women need to be on tenofovir/emtricitabine for a longer period of time than men before they have drug levels that may be protective."