Background
Trust is an important cornerstone of patient-provider communication. Accurate reporting of pre-exposure prophylaxis (PrEP) adherence is vital for providers to determine who needs adherence support, especially adolescent girls, and young women (AGYW) who are disproportionately affected by newly diagnosed HIV infections.
Methods
We examined if trust in the PrEP provider was associated with concordance between patient-reported adherence and intracellular tenofovir-diphosphate (TFV-DP) in dried blood spots. The patient-reported adherence response ‘In the past month, how often did you take the tablet?’ was dichotomized as ‘high’ if the response was every day or most days, and ‘low’ if some days or not many days or never. The biomarker marker evidence of adherence was defined as ‘high’ if TFV-DP ≥ 700, and ‘low’ if < 350 fmol/punch.
Results
The HPTN 082, an open-label PrEP demonstration study enrolled 451 AGYW (ages16-25 years) from 2016–2018 in Cape Town and Johannesburg, South Africa, and Harare, Zimbabwe. Of the 427 AGYW who initiated PrEP in the HPTN-082 open-label PrEP demonstration study, 354 (83%) had month three patient-reported adherence responses and TFV-DP measurement. AGYW who reported trust in their providers were almost four-fold (aOR 3.72, 95% CI 1.20-11.51) more likely to have high self-reported adherence and high TFV-DP concentrations (concordant adherent) compared to those who reported high adherence but had low TFV-DP concentrations (discordant non-adherent).
Conclusion
Education and training to build trusting relationships between providers and AGYW may lead to more accurate reporting of PrEP adherence. With accurate reporting, adequate support can be provided to bolster adherence.
Trial Registration: ClinicalTrials.gov Identifier: NCT02732730 (11/04/2016)