Comparing PrEP adherence via objective and self-reported measures among fishermen working on Lake Victoria, Kenya

This is the authors' abstract. We don't add key points for this paper.

Fishermen working along Lake Victoria experience high rates of HIV acquisition that can be mitigated by pre-exposure prophylaxis (PrEP), which requires adequate adherence for effective prevention. We evaluated PrEP adherence among Kenyan fishermen using objective metrics and examine non-adherence. Data are from the Owete study (NCT04772469), a cluster randomized-controlled trial using a social network approach among fishermen to increase HIV testing and linkage to care. Survey and lab data were collected from PrEP users. We measured recent objective adherence via a point-of-care tenofovir urine assay. We conducted a logistic regression to assess the relationship between self-reported adherence data and urine tenofovir detection. Among 71 PrEP users, 34% self-reported ≥90% PrEP adherence. Reasons for non-adherence included not feeling at risk (31%), being away and without medication (27%), or feeling they did not need PrEP (24%). Detectable PrEP in urine was low (17%). Self-reported PrEP non-adherence within 30 days was associated with 13.29 times the odds of non-detection of urine tenofovir (95% CI: 2.20, 80.43). The point-of-care tenofovir assay was a valuable tool for objectively measuring PrEP adherence. Interventions to bolster PrEP adherence are needed to prevent HIV acquisition among fishermen, as are longer-acting products with lower demands for adherence.