Amsterdam 2015
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| Abstract #2011 - Treatment adherence | ||||
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Session: 48.6: Treatment adherence (Parallel) on Friday @ 09.00-10.30 in C002 Chaired by Kendra Blackett Dabinga, Aoife Molloy Authors: Presenting Author: Dr Ariane van der Straten - RTI International, United States |
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| Additional Authors: | ||||
| Aim: In the VOICE trial, adherence to daily tenofovir (TFV) based oral or vaginal Pre-Exposure Prophylaxis was low and none of the study products demonstrated effectiveness. VOICE-D, a qualitative ancillary study conducted after release of VOICE findings, retrospectively provided plasma TFV results to participants and explored their product use experiences during VOICE. We investigated reported patterns of use among those who had evidence of non-adherence by plasma TFV pharmacokinetic (PK) data. | ||||
| Method / Issue: We systematically recruited VOICE participants who had their plasma samples tested TFV detection indicated recent product use. This analysis focuses on seronegative participants with =3 quarterly plasma samples tested, classified as low (0% TFV detected, N=72) or inconsistent (mean TFV detection 32% (range 11-71%) N=25) users. We conducted 12 FGD and 38 IDIs, evenly distributed among those assigned to active tablet or gel in VOICE. Coded data was analyzed for themes related to adherence patterns. | ||||
| Results / Comments: Among the 97 VOICE-D participants (22 South Africans, 38 Zimbabweans, 37 Ugandans), mean age was 29 (range 21-41), 90% had a primary partner and mean time in VOICE was 17 months. Plasma TFV was undetectable at all visits in the low group in the inconsistent group, TFV detection decreased from 48% (quarter 1 visit) to 20% (final quarterly visit). Women’s narratives around intention to use, product initiation, implementation and discontinuation suggest an erratic pattern of product use. Few stated lack of intention and disinterest throughout VOICE some recalled initiating but discontinuing early, triggered by side effects, fear of product harm and/or disapproval from family, peers or partners. Others, as corroborated by drug data, used their products irregularly or incorrectly: some intentionally adjusted their regimen or doses in accordance with their beliefs, needs or circumstances while others reported they forgot or mis-dosed because of rigid and burdensome daily regimen. Despite low and inconsistent use, women reportedly remained in VOICE because of the health and educational benefits they received, as well as in deference to the trial staff. | ||||
| Discussion: Women’s accounts of their journey along the path of non-adherence in VOICE revealed varied trajectories influenced by product attributes, regimen, personal circumstances and social influences. Analyses of these patterns help clarify the timing and reasons for poor implementation and discontinuation, and can inform interventions to support sustained product adherence. | ||||
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