Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine is 99% effective in preventing HIV when taken daily. Young men/transgender women of color who have sex with men are the most at risk to become infected with HIV, with the lowest PrEP adherence. We investigated the association of depression, anxiety, and history of childhood trauma with PrEP adherence. PrEP adherence was measured by urine TDF testing. Patients were evaluated for depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and history of childhood trauma (Adverse Childhood Experiences [ACEs]). Urine TDF levels were compared across scores on each screening tool using a Student’s t-test. A p-value of ≤ 0.05 was considered significant. Thirty-one subjects (mean age: 21.7 years, SD: 2.8) were enrolled between 3/2015 and 7/2016. Lower PrEP adherence was associated with a GAD-7 score diagnostic for generalized anxiety (80.7% versus 92.7%, p = 0.04) and a high ACE score (4+) (84.5% versus 95.7%, p = 0.05). A PHQ-9 score diagnostic for major depression was not associated with PrEP adherence. The presence of generalized anxiety and a history of childhood trauma, but not major depression, were associated with decreased PrEP adherence. The benefits of mental health interventions and trauma-informed care in PrEP programs should be considered in larger studies to potentially increase adherence.
GrantRMLamaJRAndersonPL, et al.
Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med2010;
363: 2587–2599.
2.
Hosek S, Rudy B, Landovitz R, et al. An HIV pre-exposure prophylaxis (PrEP) demonstration project and safety study for young men who have sex with men in the United States. J Acquir Immune Defic Syndr 2017; 74(1): 21–29.
3.
Garcia-LermaJGPaxtonLKilmarxPH, et al.
Oral pre-exposure prophylaxis for HIV prevention. Trends Pharmacol Sci2010;
31: 74–81.
4.
SullivanPSRosenbergESSanchezTH, et al.
Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann Epidemiol2015;
25: 445–454.
5.
RolleCPRosenbergESSieglerAJ, et al.
Challenges in translating PrEP interest into uptake in an observational study of young black MSM. J Acquir Immune Defic Syndr2017;
76: 250–258.
6.
CalabreseSKKrakowerDSMayerKH.Integrating HIV preexposure prophylaxis (PrEP) into routine preventive health care to avoid exacerbating disparities. Am J Public Health2017;
107: 1883–1889.
7.
CalabreseSKUnderhillK.How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize “Truvada Whores”. Am J Public Health2015;
105: 1960–1964.
8.
PrejeanJSongRHernandezA, et al.
Estimated HIV incidence in the United States, 2006–2009. PLoS One2011;
6: e17502.
9.
Centers for Disease Control and Prevention (CDC).
Subpopulation estimates from the HIV incidence surveillance system – United States, 2006. MMWR Morb Mortal Wkly Rep2008;
57: 985–989.
10.
RosenbergESSullivanPSKelleyCF, et al. Race and age disparities in HIV incidence and prevalence among MSM in Atlanta, GA. In: Presented at the conference on retroviruses and opportunistic infections, Boston, MA, 2014, [38].
HorbergMASilverbergMJHurleyLB, et al.
Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr2008;
47: 384–390.
13.
AschSMKilbourneAMGiffordAL, et al.
Underdiagnosis of depression in HIV. J Gen Intern Med2003;
18: 450–460.
14.
CamposLNGuimaraesMDRemienRH.Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS Behav2010;
14: 289–299.
15.
NelAKageeA.The relationship between depression, anxiety and medication adherence among patients receiving antiretroviral treatment in South Africa. AIDS Care2013;
25: 948–955.
16.
CampbellJAWalkerRJEgedeLE.Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood. Am J Prev Med2015.
17.
FelittiVJAndaRFNordenbergD, et al.
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med1998;
14: 245–258.
18.
BoroughsMSValentineSEIronsonGH, et al.
Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men. Arch Sex Behav2015;
44: 1891–1902.
19.
SalehLDvan den BergJJChambersCS, et al.
Social support, psychological vulnerability, and HIV risk among African American men who have sex with men. Psychol Health2015; 1–29.
20.
StorholmEDSatreDDKapadiaF, et al.
Depression, compulsive sexual behavior, and sexual risk-taking among urban young gay and bisexual men: the p18 cohort study. Arch Sex Behav2015.
21.
OsterAMWiegandRESioneanC, et al.
Understanding disparities in HIV infection between black and white MSM in the United States. AIDS2011;
25: 1103–1112.
22.
SpitzerRLKroenkeKWilliamsJB.Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA1999;
282: 1737–1744.
23.
KroenkeKSpitzerRLWilliamsJB.The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med2001;
16: 606–613.
24.
ManeaLGilbodySMcMillanD.A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry2015;
37: 67–75.
25.
MoriartyASGilbodySMcMillanD, et al.
Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta- analysis. Gen Hosp Psychiatry2015;
37: 567–576.
26.
SpitzerRLKroenkeKWilliamsJB, et al.
A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med2006;
166: 1092–1097.
27.
KroenkeKSpitzerRLWilliamsJB, et al.
Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med2007;
146: 317–325.
28.
KoenigHCMounzerKDaughtridgeGW, et al.
Urine assay for tenofovir to monitor adherence in real time to tenofovir disoproxil fumarate/emtricitabine as pre-exposure prophylaxis. HIV Med2017;
18: 412–418.
29.
MehrotraMLGliddenDVMcMahanV, et al.
The effect of depressive symptoms on adherence to daily oral PrEP in men who have sex with men and transgender women: a marginal structural model analysis of the iPrEx OLE study. AIDS Behav2016;
20: 1527–1534.
30.
LiuAYKittredgePVVittinghoffE, et al.
Limited knowledge and use of HIV post- and pre-exposure prophylaxis among gay and bisexual men. J Acquir Immune Defic Syndr2008;
47: 241–247.
31.
StorholmEDVolkJEMarcusJL, et al.
Risk perception, sexual behaviors, and PrEP adherence among substance-using men who have sex with men: a qualitative study. Prev Sci2017;
18: 737–747.
32.
BrooksRAKaplanRLLieberE, et al.
Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care2011;
23: 1136–1145.
33.
GolubSAGamarelKERendiaHJ, et al.
From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDs2013;
24: 248–254. Apr
34.
GershJKFiorilloSPBurghardtL, et al.
Attitudes and barriers toward pre-exposure prophylaxis (PrEP) among high-risk HIV-seronegative men who have sex with men. J AIDS Clin Res2014;
5.
35.
BonacciRAFrascaKSwiftL, et al.
Antiretroviral refill adherence correlates with, but poorly predicts retention in HIV care. AIDS Behav2016;
20: 1060–1067.
36.
WoodSM. Social support as a facilitator of adherence to HIV pre-exposure prophylaxis among young MSM of color. NIH Grant 5F32-MH111341-02. Philadelphia, PA: Children’s Hospital of Philadelphia.
37.
Black American adults: a meta-analytic review. J Couns Psychol2012;
59: 1–9.
