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SEATTLE (FRONTLINE MEDICAL NEWS) – A behavioral intervention that takes a nontraditional approach to counseling for pre-exposure prophylaxis (PrEP) therapy boosted its adherence, according to a new study.
The New York City–based intervention program eschews the traditional approach that presents as a strategy to avoid risk. “We frame the choice of taking PrEP in terms of: Is PrEP something that’s going to help you have a safe and fulfilling sex life?” said Sarit A. Golub, PhD, MPH , a professor of psychology at Hunter College, N.Y., and the City University of New York, who presented a study examining its efficacy at a poster session at the Conference on Retroviruses & Opportunistic Infections in partnership with the International Antiviral Society.
Blood plasma measurements confirmed the efficacy of the program in comparison to a control group who received an educational control. “This is the first intervention to my knowledge that shows a significant impact on PrEP adherence, especially for drug levels in the blood,” Dr. Golub said.
Typically, HIV clinics focus on identifying people at high risk as PrEP candidates and encourage them to adopt the regimen, but Dr. Golub thinks that approach can be counterproductive. “They say to a patient: ‘You have been identified as being at risk.’ As a psychologist, I see that [this] is rife for a self-fulfilling prophecy. ‘My doctor thinks I’m so high risk that I’m going to get HIV’ ” for sure, Dr. Golub said.
The sexual health intervention, designed to encourage adoption of PrEP, begins with a simple query: What is your ideal sex life? “People are like, ‘Excuse me?’ We’ve actually had guys cry and say, ‘Nobody has ever asked me that,’ ” Dr. Golub said.
The adherence intervention, provided to subjects who have decided to adopt PrEP, helps patients understand what happens if they stop taking the drugs and encourages them to link taking the pills to an activity that they engage in every day.
“The language and the frame in both is about patient empowerment and patient agency,” Dr. Golub said.
To test the efficacy of the two interventions, the researchers recruited 300 men who have sex with men and transgender women (aged 18-63 years; 49% white) who had chosen to start PrEP. They were randomized to one of four groups: sexual health intervention only; adherence intervention only; both interventions; or neither intervention.
The researchers assessed adherence by measuring drug concentrations in dried blood spot testing at 3-month and 6-month follow-up visits.
Across all participants, adherence was high at 3 months: 90.3% had drug concentrations at a level suggesting they were taking their medication at least four times a week. Among participants receiving at least one of the interventions, adherence was 96.6%, compared with 84% (P = .002) among those who received neither intervention.
At 6 months, those who received at least one intervention continued to outperform those who received neither intervention (92.1% vs. 85.7%), but the difference did not reach statistical significance.
The study impressed K. Rivet Amico, PhD , a research associate professor at the University of Michigan, Ann Arbor. “I think it’s incredibly important. It focuses on really prioritizing sexual health, as opposed to just the dispensation of drug and medication monitoring. It’s a very comprehensive kind of approach, and it engages people more,” she said.
Many cities are rolling out programs similar to the one described by Dr. Golub, but the approach remained unproven. The study “is building the evidence base. We have a lot of anecdotal evidence, but it’s very nice to be collecting data,” Dr. Amico added.
The study was funded by the National Institutes of Health and Gilead. Dr. Golub reported having no financial disclosures. Dr. Amico has received an educational grant from Gilead.
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