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A qualitative assessment of Kenyan men who have sex with men taking daily and intermittent oral HIV pre-exposure prophylaxis (PrEP) found stigma, sex work, mobility, and alcohol impacted adherence. We analyzed quantitative data from the same cohort to explore different definitions of intermittent adherence. Volunteers were randomized to daily emtricitabine/tenofovir or placebo, or intermittent (prescription: Mondays/Fridays/after sex, maximum 1 dose/day) emtricitabine/tenofovir or placebo (2:1:2:1), and followed for 4 months. By electronic monitoring, median adherence for daily dosing was 80 %. Median adherence for intermittent dosing was 71 % per a "relaxed" definition (accounting for off-prescription dosing) and 40 % per a "strict" definition (limited to the prescription). Factors associated with lower adherence included travel, transactional sex, and longer follow-up; higher adherence was associated with daily dosing and an income. The definition of intermittent dosing strongly affects interpretation of adherence. These findings suggest interventions should address challenges of mobility, sex work, and long-term PrEP.

Original publication

DOI

10.1007/s10461-014-0958-x

Type

Journal article

Journal

AIDS Behav

Publication Date

05/2015

Volume

19

Pages

794 - 801

Keywords

Administration, Oral, Anti-HIV Agents, Dose-Response Relationship, Drug, Drug Administration Schedule, Emtricitabine, Female, HIV Infections, Homosexuality, Male, Humans, Kenya, Male, Medication Adherence, Middle Aged, Outcome Assessment (Health Care), Pre-Exposure Prophylaxis, Socioeconomic Factors, Tenofovir