Abstract
IntroductionLimited data exist on acceptability of candidate pre‐exposure prophylaxis (PrEP) regimens among US women. We evaluated PrEP experiences, attitudes and future use intentions among sexually active women who completed the US‐based HIV Prevention Trials Network 069/AIDS Clinical Trials Group 5305 study.MethodsWomen participated in the study between March 2013 and November 2015. We analysed computer‐assisted self‐interview (CASI) surveys among 130 women and conducted in‐depth interviews among a subset of 26 women from three sites. Interviews were conducted in mid/late‐2015.ResultsMost women (57%) reported very good/excellent PrEP adherence on CASI, although 21% acknowledged over‐reporting adherence at least some of the time. Commitment to preventing HIV infection, a sense of ownership of the study, and keeping pills stored in a visible location facilitated adherence. Adherence barriers included “simply forgetting” and being away from home. Most women interviewed did not intend to use PrEP in the future because of lack of perceived need due to their own (as opposed to their partners’) low‐risk behaviour and concerns about affordability – but not because of side effects or other characteristics of the regimens.DiscussionImproving HIV prevention options for US women will require access to affordable PrEP as well as expanding women's understanding of relationship‐ and community‐level factors that increase their risk of acquiring HIV.
Highlights
Limited data exist on acceptability of candidate pre-exposure prophylaxis (PrEP) regimens among United States (US) women
A review of oral PrEP efficacy trials in women found that drug levels consistent with daily pill-taking were associated with protection [7], suggesting that adherence is the critical factor influencing protective outcomes
Despite PrEP’s promise as an HIV prevention tool for US women, the lack of data on product acceptability and adherence in this population may challenge its successful implementation for HIV prevention among women in the US
Summary
The number of new HIV infections in the United States (US) has declined over the past decade, as of 2015, women constituted almost one quarter (24%) of all people living with HIV [1]. Despite PrEP’s promise as an HIV prevention tool for US women, the lack of data on product acceptability and adherence in this population (especially in the setting of inconsistent adherence demonstrated in international clinical trials) may challenge its successful implementation for HIV prevention among women in the US. In response to this paucity of data, we collected quantitative and qualitative data from women participating in HIV Prevention Trials Network (HPTN) 069/AIDS Clinical Trials Group (ACTG) 5305 study [29] to better understand reasons for adherence and/or non-adherence to study drug, attitudes towards PrEP and intentions to use PrEP after the end of the study. Given the few PrEP trials involving US women and demonstration projects seeking to involve them, the results of this study may help develop approaches for supporting adherence in the rollout of current and future PrEP technologies
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