Frame PrEP as part of a ‘healthy sex life’ for better adherence
Brief, empowering messaging around pre-exposure prophylaxis (PrEP) can lead to better medication adherence, new research has found. When PrEP counselors framed PrEP as part of a healthy sex life, new PrEP clients were significantly more likely to have high levels of adherence to the medication. This was true even among demographics that typically struggle with adherence including young people and people of color.
“Small and simple shifts to ‘treatment as usual’ can increase PrEP adherence,” said Sarit Golub, PhD, MPH, from Hunter College. “And brief PrEP counseling interventions can be integrated into real-world practice.”
The PrEP messages, which Golub described last month at the Conference on Retroviruses and Opportunistic Infections, did a few things. The first message, which Golub called the Sexual Health Intervention, framed PrEP as part of a healthy and fulfilling sex life and stressed the client’s agency in choosing PrEP for themselves (as opposed to having a provider identify them as an ‘appropriate’ candidate for PrEP).
The second message, called the Adherence Intervention, presented information about PrEP adherence to empower and motivate people to take PrEP consistently, and helped people anticipate and brainstorm adherence challenges and ways to overcome them.
Both messages individually, and when combined, increased adherence to PrEP among a group of 300 men having sex with men and transgender women. Adherence was assessed by dried blood spot analysis after three, six and 12 months.
After three months, 85% of people who did not receive either of these messages had tenofovir (one of the drugs in Truvada, taken for PrEP) levels consistent with more than or equal to four doses of Truvada per week. This is compared to 94%, 98%, and 97% of people who received both messages, the Sexual Health Intervention or the Adherence Intervention (respectively). This pattern of results was similar after six and 12 months, said Golub. The bottom line: people who heard either of the messages, or both, had significantly higher PrEP adherence than those who received neither.
Of particular note, said Golub, is that these messages were effective among people who in previous studies have shown to have lower PrEP adherence—young people and people of color. Overall, 35% of the group was between the ages of 18 and 29; and 50% were people of color.
The median tenofovir levels detected among young people, and Black and Latinx participants remained well over the threshold of doses required for HIV prevention over the entire course of the study.
“I think we often pay lip service to the idea that biomedical prevention is actually behavioral. But we do not actually act to integrate this idea into research and practice. What I hope our data draw attention to is the extent to which there are easy and important changes that we can make to provider behavior that can impact patients’ experience of PrEP, and that this experience impacts adherence behavior,” said Golub.
During the question and answer portion of the presentation, Golub clarified that the Sexual Health Intervention and the Adherence Intervention were delivered by PrEP counselors. The Sexual Health Intervention included information about PrEP uptake and counseling, assessed whether the client wanted to start PrEP, and lasted between 12 and 15 minutes. The Adherence Intervention was about 10 minutes long. In collaboration with the New York City Department of Health and Mental Hygeine, Golub reported that a training about how to deliver these interventions has been developed for PrEP counselors in New York, and that they hope to be able to expand the training to other regions of the country soon.
Golub, S. Brief behavioral intervention increases PrEP drug levels in a real-world setting. CROI 2017. Watch the webcast.