Perspectives on the utility and interest in a point-of-care urine tenofovir test for adherence to HIV pre-exposure prophylaxis and antiretroviral therapy: an exploratory qualitative assessment among U.S. clients and providers

Abstract

Background: Real-time, objective measures of adherence to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are needed to better assess adherence levels and to expedite clinical response for those with suboptimal adherence. Point-of-care tenofovir (POC-TFV) testing has been proposed as a solution to facilitate real-time antiretroviral adherence monitoring, but little is known about how health care providers, people living with HIV (PLWH) receiving ART, and people receiving PrEP will perceive POC-TFV testing. Methods: We conducted an exploratory qualitative study to assess perspectives on the utility and interest in POC-TFV testing from potential end users. We conducted three focus group discussions (FGDs) among 17 PLWH receiving ART and four individuals receiving PrEP, as well as eight in-depth interviews (IDIs) with health care providers in the Seattle area and presented participants with a hypothetical urine-based POC-TFV test. FGDs and IDIs were audio recorded, transcribed, coded, and analyzed to describe emerging themes. Results: Overall, study participants demonstrated divergent opinions about the POC-TFV test. Among study participants, PLWH were most ambivalent about POC-TFV testing, first demonstrating reluctance to TFV-level monitoring and shifting positions during the FGDs. However, all PLWH participants were receptive to POC-TFV testing if requested by their provider. PrEP participants were generally supportive of POC-TFV testing for routine adherence monitoring and emphasized potential value in self-administered testing. Providers' perceptions were equally divided-half suggested POC-TFV testing would be valuable, particularly for people receiving PrEP, while half indicated the test would have little benefit for most individuals receiving ART or PrEP in the U.S. All providers agreed that POC-TFV test results could be beneficial for assessing discrepancies in viral load results and self-reported adherence among PLWH. The study also revealed that a low-cost, non-urine-based POC-TFV test with a long-term limit of detection would be preferred over the hypothetical urine-based test.

Simplifying TREAtment and Monitoring for HIV (STREAM HIV): protocol for a randomised controlled trial of point-of-care urine tenofovir and viral load testing to improve HIV outcomes

“…25 Encouragingly, a qualitative study found that healthcare providers may be interested in implementing POC TFV testing to assess ART adherence, and PLHIV may be receptive to POC TFV testing if it were incorporated into care. 28 Other studies have found that people receiving TFV-based pre-exposure prophylaxis are interested in druglevel testing and that receiving drug-level feedback may motivate improved medication adherence. [50][51][52][53] Integrating POC VL and TFV adherence monitoring into a single client encounter may offer other benefits to clients, providers, health systems and society such as earlier identification of HIV drug resistance and prevention of unnecessary switches to second-line ART regimens, which in turn can prevent HIV transmission, reduce costs of care and improve health outcomes for PLHIV.…”

“…[22][23][24][25][26] Routine real-time ART adherence monitoring may also be beneficial in motivating subsequent good adherence among PLHIV and improving engagement in care. 27 28 However, little is known about the effects of implementing POC TFV adherence testing among PLHIV.…”

Point-of-care and Near Real-time Testing for Antiretroviral Adherence Monitoring to HIV Treatment and Prevention

“…Additionally, these studies will evaluate the potential effects of integrating POC urine TFV testing into care with other POC tests, such as a POC VL test. A qualitative study of providers, PLHIV receiving ART, and people receiving PrEP in Seattle found that POC urine TFV testing was acceptable and potentially useful for better informed clinical decision-making (85).…”

Real-Time Monitoring and Point-of-Care Testing: A Review of the Current Landscape of PrEP Adherence Monitoring

“…Real-time, objective measures of adherence for PrEP are essential to assess how and when people are taking medication, and to accelerate a clinical and/or other supportive response for those with inadequate adherence. 20 , 21 Quantifying and monitoring adherence to PrEP can identify those at risk of becoming lost to follow-up and therefore at greater risk of HIV infection, 22 those in need of additional layers of support to overcome barriers to PrEP (impending health insurance loss, harm reduction tools, logistical support such as tokens), and individuals who need enhanced adherence support (more frequent visits, pill boxes, smart pill bottles, etc.). Indeed, metrics of PrEP adherence were strongly associated with future loss to follow-up in a US demonstration project study.…”