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Selected Works of David Bangsberg
Article
Defining Success With HIV Pre-Exposure Prophylaxis: A Prevention-Effective Adherence Paradigm
AIDS (2015)
  • Jessica E. Haberer, Massachusetts General Hospital
  • David R. Bangsberg, Portland State University
  • Jared M. Baeten, University of Washington
  • Kathryn Curran, World Health Organization, Geneva, Switzerland
  • Florence Koechlin, World Health Organization, Geneva, Switzerland
  • K. Rivet Amico, University of Michigan-Ann Arbor
  • Peter Anderson, University of Colorado, Denver
  • Nelly R. Mugo, University of Washington
  • Francois Venter, WITS Reproductive Health and HIV Institute
  • Pedro Goicochea, University of California, San Francisco
  • Carlos Caceres, Network for Multidisciplinary Studies in ARV-based HIV Prevention, Lima, Peru
  • Kevin O’Reilly, World Health Organization, Geneva, Switzerland
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Abstract
Clinical trial data have shown that oral pre-exposure prophylaxis (PrEP) is efficacious when taken as prescribed; however, PrEP adherence is complex and must be understood within the context of variable risk for HIV infection and use of other HIV prevention methods. Different levels of adherence may be needed in different populations to achieve HIV prevention, and the optimal methods for achieving the necessary adherence for both individual and public health benefits are unknown. Guidance for PrEP use must consider these questions to determine the success of PrEP-based HIV prevention programs. In this article, we propose a new paradigm for understanding and measuring PrEP adherence, termed prevention-effective adherence, which incorporates dynamic HIV acquisition risk behaviors and the use of HIV alternative prevention strategies. We discuss the need for daily PrEP use only during periods of risk for HIV exposure, describe key issues for measuring and understanding relevant behaviors, review lessons from another health prevention field (i.e., family planning), and provide guidance for prevention-effective PrEP use. Moreover, we challenge emerging calls for sustained, near perfect PrEP adherence regardless of risk exposure and offer a more practical and public health-focused vision for this prevention intervention.
Disciplines
Publication Date
2015
DOI
10.1097/QAD.0000000000000647
Publisher Statement
At the time of publication David Bangsberg was affiliated with the Harvard Medical School.
Citation Information
Haberer JE, Bangsberg DR, Baeten JM, Curran K, Koechlin F, Amico KR, Anderson P, Mugo N, Venter F, Goicochea P, Caceres C, O'Reilly K. 2015. Defining success with HIV pre-exposure prophylaxis: a prevention-effective adherence paradigm. AIDS. 29(11):1277-85