HPTN 067 (ADAPT) is an open Phase II study of Truvada PrEP based in three cities around the world (Cape Town, Bangkok and Harlem, New York). The objective is to evaluate the ease of use and viability of three different PrEP schemes: daily dosing, timed dosing (meaning two drinks per week, plus an extra dose two hours after sex, when it does)And the dosage oriented events, which means a dose of two tablets 24 hours before the expected sex and, two hours later, should this occur.For data on adherence, pill use and HIV infection, see this report. Each of the three city studies also had qualitative studies linked to it so that participants could relate the experience of taking prep. Cape Town In Cape Town, 18 of the 179 men involved gave in-depth interviews to the researchers - six in each arm of the scheme, three in the first half of the study and three near the end. There are also six other focus groups of seven participants each. Thus, 60 people, or about one-third of the study participants, gave qualitative information. Rivet Amico of the University of Michigan who led the qualitative study said the attitudes of participants in this and other prevention studies ranged across the spectrum of full support to complete confidence. Adherence (the percentage of tablets taken) and persistence (the length of time participants remained in the study as active participants) were compared to these attitudes. She said attitudes to the study ranged from total mistrust and avoidance of the pill to empowerment and people acting as champions of PrEP. Factors that can especially influence participating Africans include "Ubuntu", the belief that the value of an individual depends on their contribution to its surrounding community: the trial would be weighed against utility community standards. Skepticism about the study was not necessarily bad: participants may be well aware that in a scientific study the result was uncertain; and may be fearful of taking PrEP and mistrust the integrity and reliability of the study and its researchers. These can be amplified or attenuated by the influence of the community and in particular by the other champions in PrEP or even the anti PrEP, he argues. Mistrust was more common in PrEP than this and other studies in South Africa than in some other settings because participants were more likely to participate in the study for other reasons, such as the medical benefits it offered, while in fact they did not believe in benefit of PrEP. Participants may also act as counsel against PrEP. "I'm never going to drink these pills because I do not trust them," he said. "Careful Exploration" was the most appropriate term for the next category, which was not what they thought about PrEP and could be influenced by arguments for or against, with resulting irregular adherence. "I was getting confused and embarrassed because I do not know if I continue to take pills or not," said one participant. Provisional acceptance characterizes the next group, which was motivated to try to take prep. Their persistence was good, but they find themselves often remembering to take the pills as something challenging: they were characterized by a determination to be good participants of a sense of power: "I would not do it [ie, not taking the pills] because I want to see if these pills really work, "he said. Property was not the best word to describe the attitude of the fourth group, which not only feels like participants who signed up, but as partners of a joint venture. They often acted as the PrEP champions and saw how their work was good at countering negative perceptions and beliefs. One factor that African participants in the PrEP trials in particular have cited as a barrier to adhering to the assumption by family and friends that someone taking an antiretroviral pill should have HIV. One participant described his struggle with these statements: "And I said, 'Look here, ask me. And you would not dare say I HAVE HIV, telling everyone to this store. We're doing research here. '" Rivet Amico commented that depending on where they were in this spectrum, customary adherence and counseling strategies may help but may also have counterproductive effects. If someone was already suspicious of the judgment, then asking them to resolve the barriers to membership can only consolidate mistrust: the necessary beliefs to be addressed rather than difficulties. Similarly, people who have felt like partners and advocates may feel helpless and feeling "underneath" to be constantly reminded of the importance of adherence: instead, counseling can focus on supporting their advocacy. "Do not assume; people enter a study titled "neutral," Amico said. In Bangkok, 38's 180 men who have sex with men (MSM) involved took part in the qualitative evaluation of the study, 32 in six focus groups of five men, and 6 in one-on-one interviews. They were only interviewed at the end of the study. The MSM in the Bangkok study tended to speak more specifically about the pros and cons of the three different regimes in terms of sex and relationships. Presenter Tareerat Chemnasiri said that daily PrEP was preferred by many because there was no association with sex and it can be conveyed as another remedy: "it would be difficult to have a tablet before or after intercourse. My partner that the tablet was in favor. But the daily dose, I could say it was dietary supplement, "said one of the participants. A number of participants pointed out that they did not always have control over when they had sex: "My boyfriend always controls when to have sex, even if often it is not. So I continue to have a tablet two days a week and just wait for sex to happen, "he said. With others, the lack of opportunity and lack of control was the problem, and here at twice the weekly dose made more sense: "I do not plan sex, [but] the tablets are with me all the time. "One participant said he would prefer event-driven PrEP as he did not have enough sex to justify daily dosing. But several others had difficulty with post-sex, the intermittent dose of PrEP: "After coming back from the bar, I took a tablet on 2 the morning before having sex and I had to wait for 2 hours to take post-dose 4 sex (This, incidentally, was one of the major problems cited by one of the few other PrEP studies on MSM in a non-high income country, a small study done in Kenya). One participant, however, said: I liked the intermittent PrEP because it actually served as a warning to sex, almost an aphrodisiac: "I always ask to have sex with my boyfriend. Sometimes he says yes. Sometimes he is tired. But if I'm really tastes I would like to have a tablet and get what I want New York In the study in New York 37 men participated in qualitative interviews with six in-depth interviews and 31 in focus groups. Here, many of the participants also focused on the practical aspects of everyday or event-driven dosing. Many do not like the idea of associating pills with sex, some just feel "strange" if the other partner is not also taking a pill, while some have found open hostility: "My partners would be like," Why do you are taking the pills? "[and] sometimes would never get to intercourse. It would just stop at night. They're crazy and they leave. "Even some with stable partners, however, have been forced to hide their PrEP:" If you have a fixed partner you know when you will do it or not. You can have [the pill]; "Wait, let me go to the bathroom" - pop. Because ... some people are not ready to accept things. They live in ... in a fantasy world where you do not think this can happen to you. "However the participants were also more concerned than the Thais in stigmatizing gay men about their attitudes towards others including health professionals, relatives and friends: again, there was a widespread assumption that the participant should have HIV if they were taking a pill. "To tell them that you are taking a pill to prevent it; they think you take a pill to stop it, "he said. Participants had found the 'shame of the slut' and hypothesized that they should be promiscuous if they were to take PrEP while others were suspicious that PrEP functioned and therefore presumed to exist a person who took PrEP is in greater risk than HIV: "One of my partners, like, 'ooo. What does that mean? What are you doing? "Indicating that the pill means I'm having unprotected intercourse right and wrong." "Some of them were just like -" I'd rather not have sex with you because I do not know if PrEP works, 'or' you probably is a great prostitute. "However, participants also described feelings of anxiety, relief, protection, and empowerment with PrEP. One said he called his "Superman - the pill" while on another said "I was protected. I would like [pill] to be my big brother and I was getting hit by bully at school. "Presenter Julie Franks of Columbia University stated that interventions for HIV-related Stigma related to the context of PrEP use were needed for black men who has sex with men in the United States. However, she added that "our qualitative sample of Black MSM above all valued PrEP as a significant improvement in existing HIV prevention strategies." Written by Gus Cairns Published: 22 July 2015 Panel at Symposium PrEP IAS of the original in: The pros and cons of PrEP: trial volunteers recount Their experience of the ADAPT study References Amico KR et al. PrEP experiences among South African women in the HPTN067 (ADAPT) study: Healthy paranoia (skepticism), Ubuntu, champions and challenges to resolving PrEP dissonance. Symposium presentation, Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Symposium in MOSY01. 2015. The webcast of this presentation is available on the YouTube channel. You can download the slides of this presentation from the conference website. Chemnasiri T et al. Patterns of sex and PrEP in Bangkok MSM (HPTN 067 / ADAPT Study). Symposium presentation, Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Symposium in MOSY01. 2015. The webcast of this presentation is available on the YouTube channel. You can download the slides of this presentation from the conference website. Franks J et al. Patterns of Sex and PrEP in Harlem MSM: A qualitative study (HPTN 067). Symposium presentation, Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Symposium in MOSY01. 2015. The webcast of this presentation is available on the YouTube channel. You can download the slides of this presentation from the conference website. Where available, you can view details of sessions, view abstracts, download presentation slides and find webcasts using the 'Program at a Glance' tool. You can also download a PDF of the abstract book from the conference website
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