Risk factors for PrEP and ART medication adherence challenges in cis-gender South African men who have sex with men in Johannesburg and Pretoria

Abstract

Background Mental health challenges are common among men who have sex with men (MSM) in South Africa and may impact medication adherence. Methods We determined the prevalence and risk factors of medication adherence challenges among 160 pre-exposure prophylaxis (PrEP)- and 40 antiretroviral therapy (ART)-taking MSM registered at two key population clinics in Johannesburg and Pretoria in 2023. We used modified Poisson regression to estimate associations between participant characteristics and medication adherence challenges (missed dosage on ≥1 d in the last month). Results A total of 106 (53.5%) participants (57.6% on PrEP, 37.5% on ART; p=0.02) had medication adherence challenges and 61 (30.5%) participants (31.2% on PrEP, 27.5% on ART; p=0.23) met criteria for moderate to severe symptoms of depression (score ≥10 on the 9-item Patient Health Questionnaire). In multivariable analysis, predictors included PrEP use (adjusted prevalence ratio [aPR]=1.81 [95% confidence interval {CI} 1.21 to 2.73), clinic in Pretoria (aPR 1.43 [95% CI 1.08 to 1.89]), transactional sex (aPR 1.81 [95% CI 1.34 to 2.44]), moderate to severe depression (aPR 1.50 [95% CI 1.19 to 1.89]) and use of social media (aPR 1.45 [95% CI 1.05 to 2.00]). Conclusions Depression is common and may be an important risk factor for poor medication adherence among MSM in South Africa. Future research should leverage a longitudinal study design to inform potential interventions.