A new trial in Africa is highlighting how attitudes about HIV impact prevention programs’ efficacy.
The VOICE trial (for Vaginal and Oral Interventions to Control the Epidemic) used women who were not readily in any danger of contracting HIV. These women were given oral medications and a vaginal gel in order to prevent infection. Although many said that they adhered to the regimen — the initial figure was 86% — in actuality only 40% did so according to random blood tests. The researchers found that fear over HIV and the medications the doctors were prescribing prevented many from taking it.
Investigators at the Harborview Medical Center in Seattle conducted the study, which was recently published in The New England Journal of Medicine. This contrasted with other trials which showed that giving medication for prevention was effective. Researchers say they must formulate trials with better adherence mechanisms but also reach out to the people to find out why they may be hesitant to take the medications.
Drugs used in this trial included tenofovir (Viread), tenofovir/emtricitabine (Truvada) and Tenofovir vaginal gel along with placebo versions of the pills and gel. These results were similar to another study, the placebo-controlled FEM-PrEP trial, which experts are now saying may have had just as low an adherence rate.
If anti-HIV medications aren’t taken every day, they become ineffective against preventing the virus. The women who were given these medications but didn’t use them had also thrown them away, making them seem taken. Researchers and their colleagues began to wonder why these women went to such lengths. Lead author Jeanne Marrazzo, MD and her colleagues went back and interviewed 25 former participants as to why they had hid the truth. The women didn’t take the medication fearing toxicity, or being stigmatized in the community mistakenly, for having HIV.