Danielle Giovenco1,2, Audrey Pettifor1, Kimberly A Powers1, Lisa Hightow-Weidman3, Brian W Pence1, Connie Celum4,5, Sinead Delany-Moretlwe6, Sybil Hosek7, Deborah Donnell4,8, Peter L Anderson9, Nyaradzo Mgodi10, Linda-Gail Bekker2. 1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 2. The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa. 3. Department of Health Behavior and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 4. Department of Global Health. 5. Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA. 6. Wits RHI, University of Witwatersrand, Johannesburg, South Africa. 7. Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois. 8. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 9. University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. 10. University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.
Abstract
OBJECTIVE: To estimate the effect of intimate partner violence (IPV) on oral pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW). DESIGN: We conducted a secondary analysis of data from HIV Prevention Trials Network 082 (HPTN 082), a multisite prospective study designed to assess oral PrEP adherence among AGYW in southern Africa. METHODS: We estimated the relative prevalence of high PrEP adherence 3 and 6 months after initiation among AGYW 16-25 years who reported a history of any IPV in the past year at enrollment versus AGYW who did not, both overall and by age. High adherence was defined as an intracellular tenofovir-diphosphate concentration at least 700 fmol/punch or more dried blood spots. RESULTS: Among 409 PrEP-initiating AGYW, half (49%) reported experiencing any IPV by a current/recent partner in the year prior to enrollment. Overall, a similar proportion of AGYW who reported IPV had high PrEP adherence at months 3 and 6 as AGYW who did not report IPV. There was, however, evidence of effect modification by age at month 3: among AGYW less than 21 years old, those who reported IPV were less than half as likely to have high adherence [adjusted PR (aPR) = 0.43, 95% confidence interval (CI) 0.22-0.86]; among AGYW aged 21 years or older, those who reported IPV were more than twice as likely to have high adherence (aPR = 2.21, 95% CI 1.34-3.66). At month 6, effect estimates within each age stratum were consistent in direction to those at month 3. CONCLUSION: IPV events may either impede or motivate PrEP adherence among African AGYW, with age appearing to be an important consideration for IPV-related adherence interventions.
OBJECTIVE: To estimate the effect of intimate partner violence (IPV) on oral pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW). DESIGN: We conducted a secondary analysis of data from HIV Prevention Trials Network 082 (HPTN 082), a multisite prospective study designed to assess oral PrEP adherence among AGYW in southern Africa. METHODS: We estimated the relative prevalence of high PrEP adherence 3 and 6 months after initiation among AGYW 16-25 years who reported a history of any IPV in the past year at enrollment versus AGYW who did not, both overall and by age. High adherence was defined as an intracellular tenofovir-diphosphate concentration at least 700 fmol/punch or more dried blood spots. RESULTS: Among 409 PrEP-initiating AGYW, half (49%) reported experiencing any IPV by a current/recent partner in the year prior to enrollment. Overall, a similar proportion of AGYW who reported IPV had high PrEP adherence at months 3 and 6 as AGYW who did not report IPV. There was, however, evidence of effect modification by age at month 3: among AGYW less than 21 years old, those who reported IPV were less than half as likely to have high adherence [adjusted PR (aPR) = 0.43, 95% confidence interval (CI) 0.22-0.86]; among AGYW aged 21 years or older, those who reported IPV were more than twice as likely to have high adherence (aPR = 2.21, 95% CI 1.34-3.66). At month 6, effect estimates within each age stratum were consistent in direction to those at month 3. CONCLUSION: IPV events may either impede or motivate PrEP adherence among African AGYW, with age appearing to be an important consideration for IPV-related adherence interventions.
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