背景:替诺福韦/恩曲他滨(TDF/FTC)每日口服HIV暴露前预防(PrEP)推荐用于注射药物(PWID)的人,但覆盖率较低。PrEP在PWID中的实际有效性尚不清楚,因为以前的研究是在受控环境中进行的,主要依靠自我报告。PrEP代谢物-二磷酸替诺福韦(TFVdp)和恩曲他滨三磷酸(FTCtp)的分析-提供了依从性的客观量度。
方法:为了分析乌克兰PWID中PrEP依从性的纵向模式,我们使用2020年7月至2021年3月在基辅进行的一项基于社区的实施试验的数据来测试SMS提醒改善依从性的有效性.在199名参与者中,156人(78.4%)保留到6个月。基于3个月和6个月时评估的TFVdp/FTCtp水平,我们确定了具有不同依从性模式的组(≥2剂量/周,改进,恶化,非粘附)。使用多项逻辑回归分析依从性的相关性。
结果:大多数参与者(53.8%,n=84/156)在两次评估中均没有可检测到的代谢物;7.1%(n=11/156)持续服用≥2剂/周;1.3%(n=2/156)持续服用≥4剂/周;与3个月相比,在6个月时,13.5%(n=21/156)表现出改善,21.8%(n=34/156)的依从性恶化。“白大衣依从性”(评估前增加剂量)很常见。一致的依从性与短信提醒相关联,年龄较小,employment,收入较低,注射药物使用持续时间更长,最近的高风险注射(接受式注射器共享,使用预填充注射器,后置或前置加载,容器共享),在过去的6个月内没有用药过量,通过性交感知的艾滋病毒风险和更高的PrEP自我效能。饮酒与PrEP使用不一致相关。依从性改善和恶化的组没有差异。
结论:作为独立干预措施,在PWID中,每日口服PrEP可能无法达到预期的效果,呼吁测试替代PrEP配方和创新的综合风险降低策略,特别是在东欧和中亚与注射毒品使用相关的艾滋病毒流行以及与俄罗斯战争引起的乌克兰公共卫生危机的背景下。SMS提醒在优先考虑PrEP的PWID中可能是有效的。我们的发现为确定可能从PrEP中受益的PWID以及需要额外支持的PWID提供了实用指导。
BACKGROUND: Daily oral HIV pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is recommended for people who inject drugs (PWID) but coverage is low. The real-life effectiveness of PrEP among PWID is unknown as previous studies were conducted in controlled settings and mainly relied on self-report. Analysis of PrEP metabolites-tenofovir diphosphate (TFVdp) and emtricitabine triphosphate (FTCtp)-offers an objective measure of adherence.
METHODS: To analyse longitudinal patterns of PrEP adherence among PWID in Ukraine, we used data from a community-based implementation trial conducted in Kyiv between July 2020 and March 2021 to test the efficacy of SMS reminders to improve adherence. Among 199 enrolled participants, 156 (78.4%) were retained through 6 months. Based on TFVdp/FTCtp levels assessed at 3 and 6 months, we identified groups with various adherence patterns (adherent at ≥2 doses/week, improved, worsened, non-adherent). Correlates of adherence were analysed using multinomial logistic regression.
RESULTS: Most participants (53.8%, n = 84/156) had no detectable metabolites at both assessments; 7.1% (n = 11/156) were consistently taking ≥2 doses/week; 1.3% (n = 2/156) were consistently taking ≥4 doses/week; 13.5% (n = 21/156) exhibited improved and 21.8% (n = 34/156) had worsened adherence at 6 compared to 3 months. \"White coat compliance\" (increased dosing prior to assessment) was common. Consistent adherence was associated with SMS reminders, younger age, employment, lower income, longer injection drug use duration, recent high-risk injecting (receptive syringe sharing, using pre-filled syringe, back- or front-loading, container sharing), absence of overdose in the past 6 months, perceived HIV risk through sexual intercourse and higher PrEP self-efficacy. Alcohol consumption was associated with inconsistent PrEP use. Groups with improved and worsened adherence did not differ.
CONCLUSIONS: Daily oral PrEP may not achieve the desired effectiveness among PWID as a standalone intervention, calling for testing of alternative PrEP formulations and innovative integrated risk reduction strategies, especially in the context of HIV epidemics associated with injection drug use in eastern Europe and central Asia and the public health crisis in Ukraine caused by the war with Russia. SMS reminders may be effective among PWID who prioritize PrEP. Our findings offer practical guidance in identifying PWID who are likely to benefit from PrEP and those who need additional support.