Background:
Objective measures of oral pre-exposure prophylaxis (PrEP) adherence – especially point-of-care (POC) measures that enable real-time assessment, intervention, and feedback – have the potential to improve adherence. Our team previously developed and validated a novel urine-based POC measure of PrEP adherence. In this study, we sought to determine whether this urine assay for real-time adherence monitoring is acceptable and feasible among women taking PrEP and PrEP providers in Kenya
Methods:
We conducted semi-structured in-depth interviews with 17 women on PrEP who were enrolled in the POC assay arm of the PUMA trial (NCT03935464) and their seven providers in Thika, Kenya. Interviews were conducted after the 12-month study follow-up period. Interview guides explored acceptability, feasibility, and perceived benefits of and concerns about POC urine adherence testing for PrEP among participants and providers. Transcripts were analyzed using rapid qualitative analysis approaches with memo-writing and data tables used to synthesize key themes.
Results:
Most participants reported that the POC test improved their PrEP adherence since they wanted to receive positive results. For example, one woman said, “I don’t skip drugs as [I did] before to avoid negative results”. Positive adherence results also led to less worry of acquiring HIV. Women liked that the POC test was clinic-based because subsequent counseling and interpretation of results was aided by clinic providers. The providers reported that having real-time adherence results enabled them to tailor counseling to individual needs, what some referred to as ‘evidence-based counseling’. Concerns expressed by participants included perception of lack of trust among providers and embarrassment associated with providing a urine sample. Provider concerns included the POC test not measuring long term adherence and potentially affecting retention of women with adherence challenges. The initial interpretation of results was challenging for providers, although they reported improvements with more familiarity with the test. Additionally, providers reported that the POC test would be more feasible if the kits were widely available and marketed for clinical use.
Conclusions:
Our findings suggest that the POC urine TFV adherence test is highly acceptable and feasible for women on PrEP and their providers. Future studies should evaluate the impact of this novel test on adherence patterns over time in diverse populations.