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Female and younger subjects have lower adherence in PrEP trials: a meta-analysis with implications for the uptake of PrEP service to prevent HIV
  1. Ke Yun1,2,
  2. Jun-jie Xu1,2,
  3. Jing Zhang1,2,
  4. Jia-ming Li1,2,
  5. Qing-hai Hu1,2,
  6. Zhen-xing Chu1,2,
  7. Yong-jun Jiang1,2,
  8. Wen-qing Geng1,2,
  9. Hong Shang1,2,
  10. Ning Wang1,3
  1. 1 Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
  2. 2 Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
  3. 3 National Center for AIDS/STI Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  1. Correspondence to Hong Shang, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, Liaoning Province 110001, China; hongshang100{at}hotmail.com and Ning Wang, National Center for AIDS/STI Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing 102206, China; wangnbj{at}163.com

Abstract

Objective To estimate the medicine-taking compliance (MTC) level, explore its facilitators and barriers, and quantify the association between MTC level and pre-exposure prophylaxis (PrEP) protective efficacy in individuals at risk of acquiring HIV being administered oral PrEP.

Design Meta-analysis.

Data sources We searched PubMed, Cochrane and Embase databases for published randomized controlled trials (RCTs) pertaining to MTC of oral PrEP for HIV prevention up to 16 January 2017.

Review methods The pooled proportion of MTC and risk ratio (RR) of HIV incidences between intervention group and control group were estimated.

Results We identified 10 eligible studies with 24 193 participants. The overall pooled MTC for oral HIV PrEP was 59.9% (95% CI 43.1% to 74.6%). Subgroup analyses revealed that the MTC level of participants aged <30 years was lower than those equal or older than 30 years (34.9% vs 69.6%, p<0.001); those studies that enrolled only women as participants had lower MTC than those only recruiting either only men or both men and women (31.3% vs 71.7% and 31.3% vs 71.0%, all p<0.01). Additionally, the HIV infection risk increased as the MTC level declines, with the incidence RRs being 0.28 (95% CI 0.19 to 0.41), 0.42 (95% CI 0.29 to 0.62) and 0.75 (95% CI 0.45 to 1.25) in the good (≥80%), moderate (60%~80%) and poor (<60%) MTC subgroups, respectively (linear trend test p<0.01).

Conclusion According to the pooled proportion, the MTC of oral HIV PrEP is almost moderate, and its proportion in women and younger participants was relatively low. The protective efficacy of oral PrEP for HIV prevention increased with MTC level. These findings indicated that it is necessary to identify measures to enhance MTC of oral PrEP in future clinical usage, especially in women and younger participants with high HIV infection risk.

  • human immunodeficiency virus(HIV)
  • pre-exposure prophylaxis (PrEP)
  • medicine-taking compliance(MTC)

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors The work presented here was carried out in collaboration between all authors. KY and JJX contributed equally to the work. KY and JML worked on data collection and data abstraction. KY analysed the data, interpreted the results and wrote the paper. Others supplied comments and helped with interpretation of the results.

  • Funding This study was supported by the Mega-projects of national science research for the 12th Five-Year Plan (2012ZX10001-006).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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