Table 2.
Meta-analysis for the suboptimal adherence among PrEP Users who continued
| Subgroups | Number of studies | Number of participants | Pooled estimate of suboptimal adherence (95% CI) | Heterogeneity (I2, %) | Tau square | P Value |
|---|---|---|---|---|---|---|
|
| ||||||
| Overall | 24 | 10,183 | ||||
| Study follow-up length* | ||||||
| 6 months and less | 4 | 330 | 37.7 (8.4–66.9) | 95.9 | 1.8 | 0.932 |
| 7–12 months | 17 | 9,170 | 41.6 (32.1–51.1) | 98.6 | 0.9 | |
| 13 months and more | 3 | 683 | 43.1 (17.5–68.7) | 97.6 | 0.9 | |
| Study Design | ||||||
| RCT | 4 | 1,697 | 38.1 (19.0–61.9) | 97.4 | 0.9 | 0.158 |
| Observational (Demonstration) | 12 | 6,330 | 49.0 (37.4–60.8) | 98.1 | 0.7 | |
| Observational (real world implementation) | 8 | 2,156 | 25.7 (11.6–47.5) | 98.2 | 1.8 | |
| Region | ||||||
| North America | 14 | 3,443 | 34.2 (22.0–49.1) | 98.0 | 1.3 | 0.175 |
| Sub-Saharan | 6 | 1,756 | 51.7 (27.3–75.2) | 98.3 | 1.6 | |
| Asia and Pacific | 2 | 4,273 | 53.2 (14.5–88.4) | 99.7 | 1.9 | |
| Europe | 1 | 336 | 28.6 (24.0–33.6) | 00.0 | 0.0 | |
| South America | 1 | 375 | 26.1 (21.9–30.8) | 00.0 | 0.0 | |
| Age (Median or Mean) of study subjects | ||||||
| Mainly Adults (age≥25) | 19 | 9,687 | 33.7 (25.1–43.6) | 98.4 | 0.8 | 0.004 |
| Mainly Youths (age≤24) | 5 | 486 | 62.5 (45.6–76.7) | 90.6 | 0.5 | |
| Measurement of adherence | ||||||
| Pill Counts and refills records | 3 | 5,891 | 18.4 (9.8–32.0) | 98.9 | 0.4 | 0.017 |
| Self-report | 5 | 1,629 | 43.7 (15.6–76.5) | 99.2 | 0.6 | |
| Drug concentrations | 16 | 2,663 | 43.1 (33.6–53.1) | 95.3 | 2.7 | |
| HIV incidence of the study | ||||||
| Higher than 0.5/100PY | 6 | 1,704 | 51.1 (23.2–78.3) | 98.6 | 2.3 | 0.653 |
| Lower than 0.5/100PY | 12 | 7,299 | 35.5 (25.4–47.0) | 98.4 | 0.7 | |
| Did not provide | 6 | 1,180 | 35.9 (14.3–65.4) | 98.3 | 2.3 | |
| Provided intervention for adherence | ||||||
| Yes | 5 | 729 | 36.1 (17.1–60.7) | 96.6 | 1.3 | 0.753 |
| No | 19 | 9,454 | 40.2 (30.3–51.0) | 98.5 | 0.9 | |
| GBMSM | 16 | 6,882 | -- | |||
| Follow-up length* | ||||||
| 6 months and less | 3 | 264 | 27.5 (5.0–73.3) | 96.9 | 2.9 | 0.764 |
| 7–12 months | 11 | 6,051 | 34.3 (25.6–44.2) | 96.8 | 0.5 | |
| 13 months and more | 2 | 567 | 47.4 (15.5–81.7) | 98.7 | 1.3 | |
| Study Design | ||||||
| RCT | 2 | 441 | 31.3 (9.2–67.2) | 97.7 | 1.1 | 0.555 |
| Observational (Demonstration) | 7 | 5,257 | 41.8 (32.2–52.0) | 96.3 | 0.3 | |
| Observational (real world implementation) | 7 | 1,184 | 28.3 (11.2–55.1) | 97.9 | 2.2 | |
| Regimen of PrEP provided in the study | ||||||
| daily | 15 | 6,546 | 35.8 (26.9–45.7) | 97.2 | 0.6 | 0.172 |
| Non-daily | 1 | 336 | 28.6 (24.0–33.6) | 00.0 | 0.0 | |
| Both | 0 | 0 | -- | -- | ||
| Region | ||||||
| North America | 13 | 2,471 | 36.8 (24.1–51.6) | 97.4 | 1.2 | 0.280 |
| Sub-Saharan | 0 | 0 | -- | -- | -- | |
| Asia and Pacific | 1 | 3,700 | 30.1 (28.7–31.6) | 00.0 | 0.0 | |
| Europe | 1 | 336 | 28.6 (24.0–33.6) | 00.0 | 0.0 | |
| South America | 1 | 375 | 26.1 (21.9–30.8) | 00.0 | 0.0 | |
| Age (Median or Mean) of subjects | ||||||
| Mainly Adults (age≥25) | 12 | 6,433 | 29.1 (21.8–37.7) | 96.6 | 0.4 | 0.005 |
| Mainly Youths (age≤24) | 4 | 449 | 57.0 (39.3–73.1) | 91.4 | 0.5 | |
| Measurement of suboptimal adherence | ||||||
| Self-report | 4 | 1,056 | 35.6 (9.6–74.1) | 98.9 | 2.8 | 0.508 |
| Pill Counts | 1 | 3,700 | 30.1 (28.7–31.6) | 00.0 | 0.0 | |
| Drug concentrations | 11 | 2,126 | 35.9 (26.3–46.8) | 95.1 | 0.5 | |
| HIV incidence of the study | ||||||
| Higher than 0.5/100PY | 3 | 298 | 55.5 (29.6–78.7) | 89.8 | 0.8 | 0.193 |
| Lower than 0.5/100PY | 8 | 5,470 | 30.9 (26.3–35.9) | 87.6 | 0.1 | |
| Did not provide | 5 | 1,114 | 32.3 (10.5–66.0) | 98.6 | 2.5 | |
| Provided intervention for adherence | ||||||
| Yes | 5 | 729 | 36.1 (17.1–60.7) | 96.6 | 1.3 | 0.945 |
| No | 11 | 6,153 | 35.2 (25.8–45.9) | 97.4 | 0.5 | |
| Cisgender girl and women | 1 | 66 | 56.1 (44.0–67.5) | 00.0 | 0.0 | |
| Heterosexual men and women (follow-up length ranged from 1 months to more than 12 months) | 2 | 1,256 | 49.1 (3.7–96.1) | 98.1 | 5.3 | -- |
| Sero-discordant couples (follow-up length was 1–6 months) | 1 | 116 | 33.6 (25.6–42.7) | 00.0 | 0.0 | |
| Clinical and pharmacy records without population specified (follow-up length was 7–12 months) | 1 | 972 | 12.1 (10.2–14.3) | 00.0 | 0.0 | |
| FSW (follow-up length was 7–12 months) | 2 | 318 | 62.4 (51.5–72.7) | 76.3 | 0.1 | |
| PWID (follow-up length was 7–12 months) | 2 | 573 | 75.0 (71.3–78.4) | 00.0 | 0.0 | |