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Trust in the PrEP provider is associated with accurate self-reported PrEP adherence among adolescent girls and young women in sub-Saharan Africa

Title
Trust in the PrEP provider is associated with accurate self-reported PrEP adherence among adolescent girls and young women in sub-Saharan Africa
Presenter
Geetha Beauchamp
Authors
G. Beauchamp * (1), D. Donnell (1), S. Hosek (2), P. Anderson (3), K.C.G. Chan (4), N. Mgodi (5), L.-G. Bekker (6), S. Delany-Moretlwe (7), C. Celum (8)
Institutions
(1) Fred Hutchinson Cancer Research Center, Biostatistics, Bioinformatics, and Epidemiology, Seattle, United States, (2) Stroger Hospital of Cook County, Department of Psychiatry, Chicago, United States, (3) University of Colorado, Department of Pharmaceutical Sciences, Aurora, United States, (4) University of Washington, Department of Biostatistics and Health Services, Seattle, United States, (5) University of Zimbabwe College of Health Sciences, Clinical Trials Research Centre, Harare, Zimbabwe, (6) University of Cape Town, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa, (7) University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa, (8) University of Washington, Department of Global Health, Seattle, United States

BACKGROUND: Trust is the cornerstone of patient-provider communication, including about pre-exposure prophylaxis (PrEP). Accurate reporting of PrEP adherence by adolescent girls and young women (AGYW) in sub-Saharan Africa is important for providers to determine who needs adherence support. It is not known if trust in the PrEP provider is associated with concordance between patient-reported and tenofovir diphosphate (TFV-DP) levels, an adherence biomarker.
METHODS: HPTN 082, an open-label PrEP demonstration study, enrolled 451 AGYW (ages 16-25 years old) from 2016-2018 in Cape Town and Johannesburg, South Africa, and Harare, Zimbabwe. At month three, participants' responses to indicators of trust were dichotomized as 'agree' (strongly-agree/agree) versus 'disagree' (neither/disagree/strongly-disagree). Patient-reported adherence response to 'In the past month, how often did you take the tablet?' was dichotomized as 'high' (every day/most days), and 'low' (some days/not many days/never). Objective evidence of adherence was defined as 'high' if TFV-DP '¥ 700 fmol/dried blood spot (DBS) punch, and 'low' if < 350 fmol/punch. Log odds of
concordant adherence (high patient-reported and high TFV-DP) and
concordant non-adherence (low patient-reported and low TFV-DP) relative to
discordant non-adherence (high patient-reported and low TFV-DP) were modeled as linear functions of trust, using multinomial logistic regression.
RESULTS: Of 427 (95%) AGYW who initiated PrEP, 354 (83%) had month three TFV-DP and patient-reported adherence data. Most responses were 'agree' for the trust indicators: 'trusting relationship with PrEP provider' was 86%; 'let PrEP-providers know if missed doses' was 78%; and 'I know how to contact the PrEP providers if I have problems or questions about PrEP' was 85%. Nearly 50% were 'discordant non-adherent', 31% were 'concordant adherent', and 20% were 'concordant non-adherent'. AGYW who reported strong trusting relationships with their PrEP providers had increased odds of 'concordant adherence' than 'discordant non-adherence' (aOR 3.72, 95% CI 1.20-11.51, p = 0.02). All three trust indicators had non-significant lower odds of being 'concordant non-adherent' than 'discordant non-adherent'.
CONCLUSIONS: Drug levels provide an objective marker of PrEP adherence and identify AGYW who over-report PrEP adherence. When there is high-level of trust in the PrEP providers among AGYW, there is concordance between patient-reported adherence and biomarker concentration of PrEP.