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Real-Time Monitoring and Point-of-Care Testing: A Review of the Current Landscape of PrEP Adherence Monitoring

Authors Hannaford A, Arens Y, Koenig H

Received 27 October 2020

Accepted for publication 19 January 2021

Published 5 February 2021 Volume 2021:15 Pages 259—269


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Video abstract presented by Alisse Hannaford.

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Alisse Hannaford,1 Yotam Arens,2 Helen Koenig2

1Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; 2Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

Correspondence: Helen Koenig
Division of Infectious Diseases, Hospital of the University of Pennsylvania, MacGregor Infectious Disease Practice, 3400 Civic Center Boulevard, South Pavilion 4th Floor, Philadelphia, PA, 19104, USA
Tel +1 215-662-6932

Background: Despite pre-exposure prophylaxis (PrEP) being highly effective at preventing HIV, HIV infections among individuals prescribed PrEP continue to occur. The vast majority of these new infections occur among individuals with sub-optimal adherence. One factor that is likely to decrease HIV incidence among PrEP users is a real-time, objective measurement of adherence. Monitoring adherence to PrEP can identify those at risk of becoming lost to follow-up and therefore at greater risk of HIV infection, those in need of additional layers of support to overcome barriers to PrEP, and individuals who need enhanced adherence support.
Objective: This paper reviews subjective and objective methods for monitoring PrEP including self-report, drug level monitoring (including serum, plasma, peripheral blood mononuclear cells [PBMC], red blood cell dried blood spots [DBS], hair, and urine) and by measuring participant interaction with the study drug (pill counts, medication event monitoring systems [MEMS] caps).
Clinical Use: A multitude of methods exist for monitoring and supporting adherence. Objective monitoring using DBS and urine will provide a more accurate picture of adherence compared to subjective and non-biomarker objective methods. Preliminary data show that detection of non-adherence using biomarkers, followed by augmented adherence support and counseling, is associated with improved adherence, although more research is needed. PrEP providers will need knowledge of and access to these various strategies, which will require investment and resource allocation from clinics and other PrEP care sites to provide these tools.

Keywords: pre-exposure prophylaxis, PrEP, adherence, adherence monitoring, biomarker

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