Haberer, J.E. Current Opinion in HIV and AIDS (January 2016), 11(1):10–17, doi: 10.1097/COH.0000000000000220.
The author reviewed interventions on adherence to pre-exposure prophylaxis (PrEP) to date, and presented recommendations for further research and best practices for clinical implementation. Drug detection is the only adherence measurement that documents ingestion; this measure was widely employed in PrEP clinical trials. Alternative approaches to drug detection include hair and dried blood spots. Numerous ongoing demonstration projects are also using electronic monitoring with medication event monitoring system, which offers a way of determining day-to-day adherence patterns and can be used to determine adherence and risk for HIV acquisition. However, despite the known role of adherence in PrEP efficacy, few PrEP adherence interventions have been developed and evaluated. Studies among men who have sex with men suggest several key considerations for a behavioral adherence intervention for PrEP, including motivations to use PrEP, barriers to PrEP use, and facilitators of PrEP use, among others. The authors concluded that enhanced counseling can be targeted to those who are struggling, and can be facilitated through technology such as two-way texting services. They also recommended that future research on PrEP adherence interventions should include more studies involving women, and especially adolescents, for whom adherence may be particularly challenging.