Efficacy estimates of oral pre-exposure prophylaxis for HIV prevention in cisgender women with partial adherence

Mia Moore*, Sarah Stansfield, Deborah J. Donnell, Marie-Claude Boily, Kate M. Mitchell, Peter L. Anderson, Sinead Delany-Moretlwe, Linda-Gail Bekker, Nyaradzo M. Mgodi, Connie L. Celum, Dobromir Dimitrov

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
28 Downloads (Pure)

Abstract

Pre-exposure prophylaxis (PrEP) with tenofovir (TFV) disoproxil fumarate and emtricitabine administered orally daily is effective in preventing human immunodeficiency virus (HIV) acquisition in both men and women with sufficient adherence; however, the adherence-efficacy relationship in cisgender women has not been well established. We calculated the adherence-efficacy curve for cisgender women by using HIV incidence and plasma TFV concentration data from three trials (FEM-PrEP, VOICE and Partners PrEP). We imputed TFV diphosphate (TFV-DP) concentrations, a measure of long-term adherence, from TFV quantification by using data from the HIV Prevention Trials Network 082 study, which measured both TFV-DP and TFV concentrations. Two, four and seven pills per week reduced HIV incidence by 59.3% (95% credible interval (CrI) 29.9-95.8%), 83.8% (95% CI 51.7-99.8%) and 95.9% (95% CI 72.6-100%), respectively. Our adherence-efficacy curve can be validated and updated by HIV prevention studies that directly measure TFV-DP concentrations. The curve suggests that high adherence confers high protection in cisgender women. However, the lower efficacy with partial adherence highlights the need for new PrEP products and interventions to increase adherence.

Original languageEnglish
Pages (from-to)2748-2752
Number of pages5
JournalNature medicine
Volume29
Early online date5 Oct 2023
DOIs
Publication statusPublished - Nov 2023
Externally publishedYes

ASJC Scopus subject areas

  • General Biochemistry,Genetics and Molecular Biology

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