Predictors of Over-Reporting HIV Pre-exposure Prophylaxis (PrEP) Adherence Among Young Men Who Have Sex With Men (YMSM) in Self-Reported Versus Biomarker Data
Young men who have sex with men (YMSM) face a disproportionately high burden of HIV. Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition, but adherence to PrEP among YMSM may be inadequate. Medication adherence may be assessed via biomarkers, which are expensive and invasive, or via self-report through Audio Computer Assisted Self-Interview (ACASI), which may result in over-reporting of adherence. In this paper we assess the potential of a new method of self-report, the Interactive Questionnaire System (iQS), in validly estimating true adherence rates. PrEP adherence among 167 YMSM aged 15–23 was measured via dried blood spot (DBS), ACASI, and iQS twice over a 24-week study period. Both ACASI- and iQS-reported data revealed that over 40% of individuals self-reporting adequate PrEP adherence had DBS-estimated drug levels indicating inadequate adherence. Adjusted logistic repeated measures random intercept regression analyses indicated that younger YMSM had higher odds of over-reporting adherence than older YMSM—each 1 year increase in age was associated with 0.79 times the odds of over-reporting adherence (95% CI 0.63, 0.98; p value = 0.031), and being African American was associated with 3.22 times greater odds of over-reporting than non-African Americans (95% CI 1.51, 6.90; p-value = 0.0003). These results suggest that ACASI and iQS methods of self-report significantly overestimate true PrEP adherence rates among YMSM, and that the odds of over-reporting adherence may be affected by both age and race.
KeywordsHIV Pre-exposure prophylaxis Adherence Adolescents Men who have sex with men
This study was reviewed by the Adolescent Medicine Trials Network for HIV/Aids Intervention’s (ATN) Behavioral Leadership Group. Network operations and data management support were provided by the ATN Data and Operations Center at Westat Inc. We acknowledge the contribution of the investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Straub, Enriquez-Bruce), Children’s Hospital of Los Angeles (Belzer, Tucker), Children’s National Medical Center (D’Angelo, Trexler), Children’s Hospital of Philadelphia (Douglas, Tanney), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Henry-Reid, Bojan), Montefiore Medical Center (Futterman, Campos), Tulane University Health Sciences Center (Abdalian, Kozina), University of Miami School of Medicine (Friedman, Maturo), St. Jude’s Children’s Research Hospital (Flynn, Dillard), Baylor College of Medicine, Texas Children’s Hospital (Paul, Head); Wayne State University (Secord, Outlaw, Cromer); Johns Hopkins University School of Medicine (Agwu, Sanders, Anderson); The Fenway Institute (Mayer, Dormitzer); and University of Colorado (Reirden, Chambers). We also acknowledge NIH support through NICHD with supplemental funding from NIDA and NIMH. We would like to thank the ATN Community Advisory Board and the youth who participated in the study.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest to declare.
All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Estimated HIV Incidence in the United States, 2007–2010. CDC HIV Surveill Rep. 2012;17(4). http://www.cdc.gov/hiv/pdf/statistics_hssr_vol_17_no_4.pdf.
- 2.HIV Surveillance Report: diagnoses of HIV infection in the United States and dependent areas, 2014; 26. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf.Accessed 3 Jan 2017.
- 4.CDC FACT SHEET: HIV among Gay and Bisexual Men. 2016. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf. Accessed 3 Jan 2017.
- 11.Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2012;17(6):2162–72.CrossRefGoogle Scholar
- 13.Hosek S, Siberry G, Bell M, Lally M, Kapogiannis B, Green K, et al. Project PrEPare (ATN082): the acceptability and feasibility of an HIV pre-exposure prophylaxis (PrEP) trial with young men who have sex with men (YMSM). J Acquir Immune Defic Syndr. 1999;. https://doi.org/10.1097/QAI.0b013e3182801081.Google Scholar
- 21.Ford CV. Lies! lies‼ lies‼!: The psychology of deceit. American Psychiatric Pub; 1999. https://books.google.com/books?hl=en&lr=&id=_FSc5C2bFYUC&oi=fnd&pg=PR9&dq=age+and+lying+deceit+psychology&ots=_85dKq9gci&sig=f4fjQqQx4oBlyxEtbeBfRhr7ZDk. Accessed 7 Oct 2017
- 23.Tangmunkongvorakul A, Chariyalertsak S, Amico KR, Saokhieo P, Wannalak V, Sangangamsakun T, et al. Facilitators and barriers to medication adherence in an HIV prevention study among men who have sex with men in the iPrEx study in Chiang Mai, Thailand. AIDS Care. 2013;25(8):961–7.CrossRefPubMedGoogle Scholar