HIV pre-exposure prophylaxis initiation, persistence, and adherence during pregnancy through the postpartum period.
AIDS
; 37(11): 1725-1737, 2023 09 01.
Article
em En
| MEDLINE
| ID: mdl-37289583
ABSTRACT
OBJECTIVE:
We evaluated pre-exposure prophylaxis (PrEP) initiation, persistence, and adherence measured via tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots (DBS) among women offered PrEP during pregnancy.METHODS:
We prospectively analyzed data from participants in the PrIMA Study (NCT03070600) who were offered PrEP during the second trimester and followed through 9 months postpartum. At follow-up visits (monthly in pregnancy; 6âweeks, 6âmonths, 9âmonths postpartum), self-reported PrEP use was assessed, and DBS were collected for quantifying TFV-DP concentrations.RESULTS:
In total, 2949 participants were included in the analysis. At enrollment, median age was 24âyears [interquartile range IQR) 21-29], gestational age 24âweeks (IQR 20-28), and 4% had a known partner living with HIV. Overall, 405 (14%) participants initiated PrEP in pregnancy with higher frequency among those with risk factors for HIV acquisition, including >2 lifetime sexual partners, syphilis during pregnancy, forced sex, and intimate partner violence ( P â<â0.05). At 9 months postpartum, 58% of PrEP initiators persisted with PrEP use, of which 54% self-reported not missing any PrEP pills in the last 30âdays. Among DBS randomly selected from visits where participants persisted with PrEP ( n â=â427), 50% had quantifiable TFV-DP. Quantifiable TFV-DP was twice as likely in pregnancy than postpartum [adjusted risk ratio (aRR) = 1.90, 95% confidence interval (CI) 1.40-2.57, P â<â0.001]. Having a partner known to be living with HIV was the strongest predictor of PrEP initiation, persistence, and quantifiable TFV-DP ( P â<â0.001).CONCLUSIONS:
PrEP persistence and adherence waned postpartum, though over half of PrEP initiators persisted through 9-months postpartum. Interventions should prioritize increasing knowledge of partner HIV status and sustaining adherence in the postpartum period.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Fármacos Anti-HIV
/
Profilaxia Pré-Exposição
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
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Infant
/
Pregnancy
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article