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Review
. 2023 Jul;27(7):2131-2162.
doi: 10.1007/s10461-022-03948-3. Epub 2022 Dec 20.

Substance Use and Adherence to HIV Pre-Exposure Prophylaxis in Studies Enrolling Men Who Have Sex with Men and Transgender Women: A Systematic Review

Nioud Mulugeta Gebru  1   2 , Shantrel S Canidate  3   4   5 , Yiyang Liu  3   4   5 , Sage E Schaefer  6 , Emmely Pavila  6 , Robert L Cook  3   4   5 , Robert F Leeman  6   3
Affiliations
Review

Substance Use and Adherence to HIV Pre-Exposure Prophylaxis in Studies Enrolling Men Who Have Sex with Men and Transgender Women: A Systematic Review

Nioud Mulugeta Gebru et al. AIDS Behav. 2023 Jul.

Abstract

Optimal adherence to pre-exposure prophylaxis (PrEP) is critical, but challenging. Men who have sex with men and transgender women have high rates of HIV incidence and substance use. Substance use is associated with reduced adherence to other medications, but associations between substance use and adherence to PrEP are less clear. Thus, the current review 1) systematically evaluates the measurement of substance use and PrEP adherence in studies examining both and 2) summarizes reported findings. Peer-reviewed articles published between 2010 - April 2021 examining associations between substance use and PrEP adherence were reviewed. Fifty studies met inclusion criteria. Assessment of substance use (i.e., mostly via self-reports at baseline) and PrEP adherence (i.e., often via tenofovir diphosphate [TFV-DP] concentration levels at follow-up) varied considerably across studies. Many studies used categorical variables (e.g., substance use: yes/no). Studies using TFV-DP levels defined adherence consistently (i.e., TFV-DP ≥ 700 fmol/punch), with slight variations. Qualitative studies (n = 10) indicated that substance use (mainly alcohol) is related to poorer PrEP adherence. While quantitative findings to date are equivocal for alcohol, there is a pattern of findings linking stimulant use with poorer PrEP adherence. This review reveals four methodological gaps, which can be addressed in future research by: 1) use of uniform benchmarks for substance use measures, 2) prospective assessment for substance use, 3) use of continuous outcome variables wherever possible, and 4) more extensive consideration of potential confounders. Addressing these methodological gaps may help us reach more definitive conclusions regarding associations between substance use and PrEP adherence.

Keywords: PrEP adherence; alcohol use; medication adherence; non-stimulant use; stimulant use.

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Conflict of interest statement

Conflicts of Interest All authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA diagram showing identification, screening, eligibility, and inclusion of studies
See this image and copyright information in PMC

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