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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

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Abstract

We assessed the role of depressive symptoms on adherence to daily oral FTC/TDF for HIV PrEP in cisgender men who have sex with men (MSM) and transgender women who have sex with men (TGW) using data from the iPrEx OLE study. A marginal structural logistic regression model was used to estimate the effect of time-varying CES-D scores on having protective levels of drug concentration, adjusting for confounding by sexual practices over time, prior adherence, and baseline demographic characteristics. We found a non-monotonic relationship between CES-D score and odds of protective FTC/TDF levels in MSM. We found evidence that the effect of depression on adherence varied between MSM and TGW, and that depressive symptoms did not contribute greatly to decreased adherence on a population scale. We recommend that depressive symptoms not preclude the prescription of PrEP, and that MSM and TGW be studied separately.

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Acknowledgments

We would like to thank and acknowledge the iPrEx and iPrEx OLE study participants. The iPrEx OLE study was funded by the US National Institutes of Health (5U01AI064002); study medication was donated by Gilead Sciences, which also supported travel expenses for non-US investigators to attend study meetings.

Funding

This study was funded by the US National Institutes of Health: Grant Number 5U01AI064002.

Author information

Authors and Affiliations

  1. Grant Lab, J David Gladstone Institutes, GIVI, 5th Floor 1650 Owens St, San Francisco, CA, 94158, USA

    Megha L. Mehrotra, Vanessa McMahan, Patricia Defechereux & Robert M. Grant

  2. University of California, San Francisco, CA, USA

    Megha L. Mehrotra, David V. Glidden & Robert M. Grant

  3. School of Public Health, University of Michigan, Ann Arbor, MI, USA

    K. Rivet Amico

  4. Stroger Hospital of Cook County, Chicago, IL, USA

    Sybil Hosek

  5. Fenway Community Health, Boston, MA, USA

    Kenneth H. Mayer

  6. FIOCRUZ, Rio de Janeiro, Brazil

    Valdilea G. Veloso

  7. Desmond Tutu Health Foundation, Cape Town, South Africa

    Linda-Gail Bekker

  8. University of Sao Paulo Medical School, Sao Paulo, Brazil

    Vivian I. Avelino-Silva

  9. Projeto Praca Onze, Hospital Escola Sao Francisco de Assis, Universidade Federal do Rio de Janiero, Rio de Janeiro, Brazil

    Mauro Schechter

Authors
  1. Megha L. Mehrotra
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  11. Mauro Schechter
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  12. Robert M. Grant
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Corresponding author

Correspondence to Megha L. Mehrotra.

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Conflict of interest

DVG has received fees from ViiV, a manufacturer of an investigational compound being investigated for use as PrEP. RA has an educational grant from Gilead Sciences through the University of Michigan. KM has received unrestricted research and education grants from Gilead Sciences. RMG has received honoraria from Clinical Care Options. RMG served as a consultant for Siemens Healthcare on their guidelines panel. The remaining authors have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mehrotra, M.L., Glidden, D.V., McMahan, V. 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 Behav 20, 1527–1534 (2016). https://doi.org/10.1007/s10461-016-1415-9

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