PrEP Adherence Strategies for Women: Expert Recommendations
Explore expert advice on managing PrEP adherence in women, including counseling on the risks of resistance and the importance of adherence. Understand the pharmacokinetic data on FTC/TDF in women and learn about the effectiveness of F/TDF with sub-optimal adherence among certain populations. Stay informed to provide optimal care for patients on PrEP.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Case 4 PrEP Adherence
Case Continued HPI continued The patient start oral TDF/FTC. She missed her 3-month follow-up apt, but is now here at 6- months. She is still with her same partner. She reports missing at least 2-3 doses of PrEP a week. This is because she frequently forgets to take her medicine. She denies any side effects. PE Vitals nl and exam without abnl Labs HIV 4thgeneration and HIV RNA testing negative STI testing (oral and vaginal) CT/Trich/syphilis/GC negative
Case Question At this visit, what should you do about continuing her in PrEP care? a) Stop oral PrEP due to poor adherence b) This dosage of PrEP protects for vaginal exposure, so no intervention is needed c) Counsel the patient about risks of resistance if she were to acquire HIV and importance of adherence d) None of the above
Case Question At this visit, what should you do about continuing her in PrEP care? a) Stop oral PrEP due to poor adherence b) This dosage of PrEP protects for vaginal exposure, so no intervention is needed c) Counsel the patient about risks of resistance if she were to acquire HIV and importance of adherence d) None of the above
Pharmacokinetic Data on FTC/TDF in Women Single-dose, phase I PK study of mucosal tissue concentrations in healthy women (N = 47) % of Women Achieving Target Exposure With FDC Population Achieving EC90 100 Ratio in FGT Tissue (%) 80 60 40 20 0 1234 567 1234 567 1234 567 FTC TDF + FTC TDF Doses/Wk Dosing twice/wk with FTC/TDF resulted in only 65% of women attaining target exposure in female genital tract vs 95% of population in colorectal tissue Daily TDF plus FTC required for 100% of women to be protected from HIV infection Slide credit: clinicaloptions.com Cottrell. J Inf Dis. 2016;214:55.
Similar F/TDF Effectiveness with Sub-optimal Adherence among CGW Conclusions Pooled analysis of > 6000 CGW Effectiveness of F/TDF was similar among CGW with consistently high (> 4 doses/wk) or high (7 doses/wk) adherence > 50% of participants did not use F/TDF consistently Marrazzo et al. CROI 2023
Counseling CGW on Adherence to PrEP Adherence is important: Daily pill (still recommended) or every-2-mo injection HIV testing and monitoring Medication adherence important for efficacy with any PrEP option PK modeling predicted 6/7 weekly doses of FTC/TDF needed to protect the female genital tract from HIV infection vs recent pooled cohort findings Most experts still recommend strict adherence Tools for adherence support: reminder apps, pill boxes, phone alarms, scheduling follow-up visits, etc. CDC. PrEP Guidelines. 2021. Cottrell. J Inf Dis. 2016;214:55
Seroconversions on PrEP Person with Positive HIV Test IF new infection seems unlikely, reasonable to continue PrEP while waiting for HIV viral load IF infection seems possible/probable on TDF/FTC Start Biktarvy (FTC/TAF/BIC), while awaiting HIV viral load Works even with M184V mutation (most common mutation) IF infection seems possible/probably on LAI Start TAF/FTC with r/DRV Parikh et al. IAS 2021
Effect of 6-month PrEP Dispensing 495 PrEP clients Intervention arm PrEP dispensed every 6 months Home HIV/STI testing kits provided every 3 months Control group every 3 month PrEP dispensing After 12 months HIV/STI testing no difference Adherence no difference Ortblad et al. JAMA Network Oepn. 2023
