Association between substance use and PrEP adherence among adolescent girls and young women enrolled in an HIV prevention study in Southern Africa
Bibliographic record
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa are at substantial risk of HIV acquisition and could benefit from oral pre-exposure prophylaxis (PrEP) for HIV prevention. Substance use may result in poor adherence, diminishing PrEP effectiveness. The effects of substance use on PrEP adherence in AGYW within the African context have not been extensively studied. We sought to determine the prevalence of substance use and its association with PrEP adherence in AGYW enrolled in an HIV prevention trial. The HIV Prevention Trials Network (HPTN) 082 study enrolled healthy, HIV-negative, sexually active young women (16-25 years) from Cape Town, Johannesburg, South Africa, and Harare, Zimbabwe, between October 2016-2018. Participants were offered oral PrEP. Data on hazardous drinking was collected using the AUDIT-C questionnaire and defined as having an AUDIT-C score ≥3. Data on substance use was collected using the abridged ASSIST questionnaire, with responses categorized as 0 (never used a substance) and 1 (ever substance use). Tenofovir-diphosphate (TFV-DP) levels in dried blood spots at weeks 13, 26, and 52 were used to measure PrEP adherence. Low adherence was defined as TFV-DP concentration <700 fmol/punch. Repeated measure multinomial regression modeling was used to determine associations between substance use and hazardous drinking vs PrEP adherence. Of the 451 participants enrolled, 427 (95%) initiated PrEP. The prevalence of hazardous drinking and substance use at baseline was 37% and 24%, respectively. Hazardous drinking was highest in Cape Town (53%). Substance use was highest in Johannesburg (31%). Cannabis (7%) and sedatives (6%) were the most frequently used substances. Hazardous drinking (aOR=1.55, 95%CI = 1.05-2.29) was associated with increasing odds of low PrEP adherence. Substance use was not associated with low PrEP adherence. There is a need for increased screening for hazardous drinking and substance use and its integration within PrEP programs in AGYW in Africa.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".