Urine testing plus feedback can increase PrEP adherence in pregnant women
Key takeaways:
- HIV incidence is high among pregnant and breastfeeding women in South Africa.
- Providing biofeedback counseling following urine tenofovir testing was associated with increased PrEP adherence.
SAN FRANCISCO — Providing feedback following point-of-care urine testing for tenofovir concentrations was associated with increased PrEP adherence among pregnant and postpartum women, researchers found.
“HIV incidence remains unacceptably high among pregnant and breastfeeding women in South Africa. Studies have demonstrated that pregnant and postpartum women have greater than two times the risk of acquiring HIV infection compared to nonpregnant/postpartum women,” Dvora Joseph Davey, PhD, MPH, an infectious diseases epidemiologist at the UCLA David Geffen School of Public Health, told Healio.
“While oral PrEP is available in South African clinics for pregnant and lactating women, nonadherence to oral PrEP undermines its effectiveness in preventing HIV in pregnancy/postpartum and also vertical transmission from mother to infant,” Davey said.
In a study presented at the Conference on Retroviruses and Opportunistic Infections, Davey and colleagues assessed the use of urine tenofovir (TFV) testing — which detects medication taken in the past 72 hours — among women taking oral PrEP. For the study, the researchers enrolled pregnant women attending primary care antenatal services in Cape Town who were aged older than 15 years, more than 20 weeks’ gestation and initiating or taking PrEP during pregnancy. They randomly assigned the women in a 1:1 ratio to receive the urine TFV test with biofeedback counseling based on their test results, or to receive standard of care, which was defined as receiving PrEP counseling without biofeedback and urine testing performed after the visit without the participant present.
The primary study outcome was the impact of the urine TFV biofeedback intervention on PrEP adherence at 6 months.
Among 750 women without HIV who were or initiated PrEP during pregnancy, 375 were randomly assigned to the intervention group and 375 to the standard-of-care group. Overall, 54% of women attended the 6-month primary outcome visit, of whom 66% self-reported PrEP in the past week — 68% from the intervention group and 64% from the standard-of-care group.
Adherence as measured by urine testing was much lower, but higher in the intervention group, according to the researchers. At the 6-month visit, 32% of women in the intervention group tested positive for TFV in their urine vs. 25% in the standard-of-care group (RR = 1.29; 95% CI, 1.03-1.63).
According to the study, the difference persisted after adjusting for sociodemographic and HIV risk factors. The results were also consistent across subgroups of pregnant and postpartum women based on age, timing of enrollment and follow-up and HIV risk markers.
“In this setting with high HIV incidence in pregnancy and postpartum, providing biofeedback following point-of-care urine tenofovir testing was associated with increases in PrEP adherence in pregnant and postpartum women,” Davey said. “These findings point to the urgent need for long-acting PrEP modalities for this population, and among women who use oral PrEP, the potential impact of biofeedback interventions to enhance adherence through peripartum.”
She added that the study also demonstrated that the urine testing was simple to integrate and was “acceptable by pregnant women.”
“Women report that they like to get feedback on the level of PrEP in their bodies,” she said.
According to Davey, next steps include evaluating this method outside of a trial setting to evaluate acceptability and feasibility in standard of ante and postnatal care.
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Davey DJ, et al. Abstract 166. Presented at: Conference on Retroviruses and Opportunistic Infections; March 9-12, 2025; San Francisco.
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