1009 – PrEP Adherence and Acceptability of Urine Tenofovir Testing in Pregnant and Postpartum Women

Background

Oral PrEP is effective at preventing HIV in pregnant and postpartum women (PPW). Measuring urine tenofovir (TFV) in people taking PrEP is a new, objective method to evaluate recent PrEP use. We report on rapid urine TFV test acceptability, usability, and results in PPW in a randomized control trial (RCT) in Cape Town, South Africa where urine TFV was used objectively measure adherence in women on PrEP. 

Methods

SCOPE-PP (Stepped care to optimized PrEP effectiveness in PPW) is an ongoing RCT among PPW on oral PrEP aimed to improve PrEP adherence. Women across arms reporting taking PrEP in the last 7-days received a urine TFV test at baseline and quarterly visits if they report using PrEP in the past 7-days. The intervention arm received biofeedback counseling on the urine test with results to be presented later. This analysis evaluated predictors of recent urine TFV result at 3-months follow-up across arms using logistic regression adjusted for age and gestational age (GA), with the acceptability of urine TFV testing.

Results

In n=750 pregnant women, median age was 26 (IQR:22-32); median GA at baseline was 29 weeks (IQR:22-35); 42% were primigravid, 48% had completed secondary or tertiary education, 34% were lowest socio-economic status. At 3-months, n=588 women attended the study visit (78%), 84% reported taking PrEP in the last 30-days (87% in pregnancy, 75% postpartum, p<0.01) and 47% in the last 7-days (n=51% in pregnancy; 39% postpartum, p<0.01). Overall 550 women met criteria and completed a urine TFV test: 49% of women had positive urine TFV results (n=272; 59% in pregnancy vs 42% postpartum; p<0.01). (Table 1).Correlation between reported adherence and urine TFV+ was 0.60. Younger age (<24 vs >24: aOR=1.47;95%CI=1.04-2.06), education (secondary vs primary: aOR=1.47;95%CI=1.04-2.05), earlier GA at enrollment (3^rd trimester vs. 2^nd trimester aOR=1.85;95%CI=1.32-2.62) and taking PrEP at baseline (vs. not; aOR=1.83;95%CI=1.27-2.64) were associated with urine TFV+ results at 3m follow-up. 11% (40/374) reported taking PrEP in last week with urine TFV- results. Acceptability was high: 99% reported they understood the result, 92% said the result was as expected, 92% expressed satisfaction with the test, 63% reported that the result influenced their adherence. 

Conclusions

Urine TFV measurement is an acceptable, objective measure of recent PrEP adherence in PPW and can be used to measure recent PrEP use.  Postpartum women continue to need additional support for optimal adherence. 

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