Pill Fatigue in PrEP is the Biggest Challenge in Fighting HIV in Adolescents

The Plus Pills study, led by Professor Bekker, is a part of a three-part study examining PrEP use in different groups. PrEP, which stands for PreExposure Prophylaxis, is an HIV prevention drug that can be taken by HIV-negative people to protect them from infection. This wonder-drug is a game changer in the fight to end HIV, but its existence isn’t enough. We need well-planned strategies to rollout the drug into communities for it to be effective.

The antiretroviral drug Truvada which is a combination of tenofovir and emtricitabine | Jeffrey Beall

Currently, there is not a lot of PrEP data on heterosexual adolescents or adolescents in Africa. The main purpose of the Plus Pills study is to inform future policy for PrEP rollout in adolescents and young women.

The Plus pills study assessed the acceptability of PrEP in adolescents between the ages of 15-19. The prevention package offered included HIV and STI testing, at two sites, in Soweto and Masiphumelele. This 12 month study started screening in 2015 and recruited around 150 suitable applicants. For the first three months, everyone took PrEP and at the three month mark had the option to continue or to stop. This group was at high risk of contracting HIV: The mean age of sexual debut was 14 and a half years and only a third always used a condom during intercourse.

In total, a third of the participants committed to PrEP for the entire year, but what is unknown is whether these participants were those at highest risk. The greatest factor affecting their adherence to PrEP was time. As time went on, adolescents were more likely to stop using PrEP.

Adherence to a daily pill regimen is notoriously difficult for adolescents worldwide. One of the main problems being fatigue, where adolescents get bored or tired of taking a pill once-a day. Loss of motivation might be a factor that prevention programs can combat with frequent visits to a healthcare specialist. Gill concluded that “it probably isn’t a good idea to have three months pass without a visit.”

For future studies, it would be worth seeing whether more frequent support would improve adherence and reduce pill fatigue. This could include creating a community between the participants or more frequent visits to clinics. Additionally, Prof Linda Gail Bekker says that maybe a pill ‘holiday’ at the weekend is something to consider. For example, taking pills during the week and having a break at the weekend. Bekker recognises that recommending a break from PrEP is not ideal, however, this age range is notorious for their pill fatigue and the Plus Pills study only strengthens this conclusion. A pill holiday might have to be an unideal reality in the fight to end HIV.


Dr Katherine Gill & Brady Hooley | Caroline Reid

This research came from the Desmond Tutu HIV Foundation research meeting where Dr Katherine Gill and Brady Hooley presented their research. Gill spoke on the results of the Plus Pills study which examined how PrEP might be received in South African adolescents. Hooley summarised the findings from the uChoose study which examined women’s preference for different HIV prevention tools.


Written by Caroline Reid