AIDS and Behavior

, Volume 22, Issue 4, pp 1174–1183 | Cite as

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

  • Zoë Baker
  • Marjan Javanbakht
  • Stan Mierzwa
  • Craig Pavel
  • Michelle Lally
  • Gregory Zimet
  • Pamina Gorbach
Original Paper


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.


HIV 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.


This study was funded by the National Institute of Allergy and Infectious Diseases (K01AI091861).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.


  1. 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).
  2. 2.
    HIV Surveillance Report: diagnoses of HIV infection in the United States and dependent areas, 2014; 26. 3 Jan 2017.
  3. 3.
    Black D, Gates G, Sanders S, Taylor L. Demographics of the gay and lesbian population in the United States: evidence from available systematic data sources. Demography. 2000;37(2):139–54.CrossRefPubMedGoogle Scholar
  4. 4.
    CDC FACT SHEET: HIV among Gay and Bisexual Men. 2016. Accessed 3 Jan 2017.
  5. 5.
    Mustanski BS, Newcomb ME, Bois SND, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48(2–3):218–53.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;. Scholar
  8. 8.
    Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV-1 prevention among heterosexual men and women. N Engl J Med. 2012;367(5):399–410.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Grant RM, Anderson PL, McMahan V, Liu A, Amico KR, Mehrotra M, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Celum C, Baeten J. Tenofovir-based pre-exposure prophylaxis for HIV prevention: evidence and evolving questions. Curr Opin Infect Dis. 2012;25(1):51–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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
  12. 12.
    Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based preexposure prophylaxis for HIV infection among african women. N Engl J Med. 2015;372(6):509–18.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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;. Scholar
  14. 14.
    Corneli AL, Deese J, Wang M, Taylor D, Ahmed K, Agot K, et al. FEM-PrEP: adherence patterns and factors associated with adherence to a daily oral study product for pre-exposure prophylaxis. JAIDS J Acquir Immune Defic Syndr. 2014;66(3):324–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Amico KR, Marcus JL, McMahan V, Liu A, Koester KA, Goicochea P, et al. Study product adherence measurement in the iPrEx placebo-controlled trial: Concordance with drug detection. J Acquir Immune Defic Syndr (1999). 2014;66(5):530–7.CrossRefGoogle Scholar
  16. 16.
    Amico KR, Stirratt MJ. Adherence to preexposure prophylaxis: current, emerging, and anticipated bases of evidence. Clin Infect Dis. 2014;59(suppl_1):S55–60.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rudy B, Murphy D, Harris R, Muenz L, Ellen J. Patient-related risks for nonadherence to antiretroviral therapy among HIV-infected youth in the United States: a study of prevalence and interactions. AIDS Patient Care STDs. 2009;23:185–94.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hosek S, Rudy B, Landovitz R, Kapogiannis B, Siberry G, Rutledge B, et al. An HIV preexposure prophylaxis demonstration project and safety study for young MSM. J Acquir Immune Defic Syndr. 2017;74(1):21–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gorbach PM, Mensch BS, Husnik M, Coly A, Mâsse B, Makanani B, et al. Effect of computer-assisted interviewing on self-reported sexual behavior data in a microbicide clinical trial. AIDS Behav. 2012;17(2):790–800.CrossRefGoogle Scholar
  20. 20.
    Greenland S. Model and variable selection in epidemiologic analysis. Am J Public Health. 1989;79:340–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ford CV. Lies! lies‼ lies‼!: The psychology of deceit. American Psychiatric Pub; 1999. Accessed 7 Oct 2017
  22. 22.
    Brener ND, Billy JOG, Grady WR. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents—assessment of factors affecting the validity.pdf. J Adolesc Health. 2003;33:436–57.CrossRefPubMedGoogle Scholar
  23. 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
  24. 24.
    Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers. 2007;14(2):56–60.PubMedGoogle Scholar
  25. 25.
    Eiser A, Ellis G. Viewpoint: cultural competence and the African American experience with health care: the case for specific content in cross-cultural education. Acad Med. 2007;82(2):176–83.CrossRefPubMedGoogle Scholar
  26. 26.
    Corbie-Smith G, Thomas S, George DMMS. Distrust, race, and research. Arch Intern Med. 2002;162(2):2458–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Zheng J-H, Guida L, Rower C, Castillo-Mancilla JR, Meditz A, Klein B, et al. Quantitation of tenofovir and emtricitabine in dried blood spots (DBS) with LC–MS/MS. J Pharm Biomed Anal. 2014;88(25):144–51.CrossRefPubMedGoogle Scholar
  28. 28.
    Castillo-Mancilla JR, Zheng J-H, Rower JE, Meditz A, Gardner EM, Predhomme J, et al. Tenofovir, emtricitabine, and Tenofovir diphosphate in dried blood spots for determining recent and cumulative drug exposure. AIDS Res Hum Retroviruses. 2012;29(2):384–90.PubMedGoogle Scholar
  29. 29.
    Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2007;12(1):86–94.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Zoë Baker
    • 1
  • Marjan Javanbakht
    • 1
  • Stan Mierzwa
    • 2
  • Craig Pavel
    • 2
  • Michelle Lally
    • 3
  • Gregory Zimet
    • 4
  • Pamina Gorbach
    • 1
    • 5
  1. 1.Department of EpidemiologyUniversity of California Los AngelesLos AngelesUSA
  2. 2.Population CouncilNew YorkUSA
  3. 3.Department of Infectious DiseasesBrown University Warren Alpert Medical SchoolProvidenceUSA
  4. 4.Department of PediatricsIndiana University School of MedicineIndianapolisUSA
  5. 5.Division of Infectious Diseases, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA

Personalised recommendations