Impact of an Adherence Intervention on the Effectiveness of Tenofovir Gel in the CAPRISA 004 Trial

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• 作者：Leila Essop Mansoor (1)
  Quarraisha Abdool Karim (1)
  Lise Werner (1)
  Bernadette Madlala (1)
  Nelisiwe Ngcobo (1)
  Deborah H. Cornman (1)
  K. Rivet Amico (1)
  Jeffrey Fisher (1)
  William A. Fisher (1)
  Kathleen M. MacQueen (1)
  Salim S. Abdool Karim (1)
  
• 关键词：Tenofovir gel ; HIV prevention ; Adherence support ; Motivational interviewing
• 刊名：AIDS and Behavior
• 出版年：2014
• 出版时间：May 2014
• 年：2014
• 卷：18
• 期：5
• 页码：841-848
• 全文大小：408 KB
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• 作者单位：Leila Essop Mansoor (1)
  Quarraisha Abdool Karim (1)
  Lise Werner (1)
  Bernadette Madlala (1)
  Nelisiwe Ngcobo (1)
  Deborah H. Cornman (1)
  K. Rivet Amico (1)
  Jeffrey Fisher (1)
  William A. Fisher (1)
  Kathleen M. MacQueen (1)
  Salim S. Abdool Karim (1)
  
  1. Centre for the AIDS Programme of Research in South Africa, 2nd Floor, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
  
• ISSN：1573-3254

文摘

High adherence is important in microbicide trials, but no adherence interventions to date have demonstrated empiric improvements in microbicide adherence or effectiveness. Approximately midway during the CAPRISA 004 trial, we implemented a novel adherence intervention (Adherence Support Program—ASP), based on an Information–Motivation–Behavioral Skills model and incorporating a Motivational Interviewing approach. We assessed the impact of the ASP on adherence and tenofovir gel effectiveness using a before-and-after comparison. Of the 889 women in the trial, 774 contributed 486.1 women-years of follow-up pre-ASP and 828 contributed 845.7 women-years of follow-up post-ASP. Median adherence rose from 53.6?% pre-ASP to 66.5?% post-ASP. Detectable tenofovir levels increased from 40.6?% pre-ASP to 62.5?% post-ASP in 64 women who had paired tenofovir drug samples. Gel effectiveness improved post-ASP; HIV incidence in the tenofovir gel arm was 24?% lower pre-ASP compared to 47?% lower post-ASP. Following implementation of the ASP, microbicide adherence improved with a concomitant increase in the effectiveness of tenofovir gel.