Acceptability of a daily pill as a pre-exposure prophylaxis for HIV

Background: With an effective HIV vaccine years away, attention has been directed to the development and testing of an oral chemo-prophylactic. For any intervention to be effective it must be acceptable within the target population. This paper describes the experiences of Ghanaian women at high risk for HIV enrolled in a safety and efficacy oral tenofovir HIV-prevention trial.

Methods: The behavioral study included structured surveys with 364 trial participants at enrollment and 12 monthly clinic visits during the year-long trial. In-depth interviews were conducted with 24 of the study participants midway through the trial. Growth curve analysis was used to analyze various aspects of participants' use of the study pill. Thematic analysis was carried out on the qualitative data.

Results: Self-reported pill adherence (“last 7 days”) exceeded 74% throughout the trial. At month 1, 31% of participants reported a problem with the pill in the survey. This number decreased steadily until month 6, when it stabilized at <4%. The most commonly reported problems were physical (61%) - mainly gastrointestinal issues, fatigue and dizziness – and did not differ between placebo/treatment groups (Peterson et al. 2007). Additional problems were: forgetting to take the pill (20%), traveling (8%), and swallowing the pill (5%). Qualitative data confirmed that most problems diminished over time, as side effects eased and women adapted the pill-taking routine into their daily lives.

Conclusion: Oral prophylaxis as a strategy for HIV-prevention was acceptable to women at risk for HIV in the study site, and acceptability of the method improved over time.