Monica Gandhi

Monica Gandhi
University of California, San Francisco | UCSF · School of Medicine

MD< MPH

About

309
Publications
26,269
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
8,740
Citations
Introduction
Skills and Expertise

Publications

Publications (309)
Article
Importance Increasing rates of sexually transmitted infections (STIs) have been associated with rises in serious morbidity. While doxycycline postexposure prophylaxis (doxyPEP), a strategy in which individuals take doxycycline, 200 mg, after condomless sex to prevent bacterial STIs, has been shown to be efficacious in randomized clinical trials, do...
Article
Objective measures of oral PrEP adherence – especially point-of-care (POC) measures that enable real-time assessment, intervention, and feedback – have the potential to improve adherence. Our team previously developed and validated a novel urine-based POC metric of PrEP adherence. In this study, we sought to determine whether this assay is acceptab...
Article
Full-text available
Introduction Adolescent girls and young women (AGYW) account for two‐thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre‐exposure prophylaxis (PrEP) but low adherence, which might be improved by point‐of‐care adherence monitoring with tailored counselling. Methods From August 2022 to July 2023, we conducted a...
Article
Full-text available
Despite antiretroviral therapy (ART), HIV persists in latently-infected cells (the HIV reservoir) which decay slowly over time. Here, leveraging >500 longitudinal samples from 67 people living with HIV (PLWH) treated during acute infection, we developed a mathematical model to predict reservoir decay from peripheral CD4 + T cells. Nonlinear general...
Article
In a low-barrier long-acting PrEP program in a safety-net setting, permitting same-day or next-day initiation, 85% of injections were on-time, and six-month retention was 83%, surpassing outcomes from most previously-reported oral PrEP studies. With drop-in, wrap-around services, similar retention among housing-insecure populations was seen. Long-a...
Article
This JAMA Insights discusses the expanding PrEP options for preventing HIV, including the considerations for initiation and follow-up and implementation challenges of these medications.
Preprint
BACKGROUND Amongst people living with HIV, stimulant use disorder (StUD) has been linked with medication non-adherence and mortality. Contingency management (CM) is a strategy incentivizing measurable behavior change that is recommended as first-line treatment for StUD and can support antiretroviral therapy (ART) adherence. However, CM is not widel...
Article
Full-text available
Tenofovir alafenamide fumarate (F/TAF) pre-exposure prophylaxis (PrEP) is understudied in sub-Saharan Africa. The Tandika PrEP study was a randomized trial that evaluated same-day F/TAF initiation, the impact of drug-level feedback on PrEP adherence, and integrated PrEP and sexually transmitted infection (STI) services for HIV-negative transgender...
Article
Full-text available
Background Virtual activities, hybrid work and virtual mentoring have become part of the ongoing milieu of academic medicine. As the shift to remote mentoring continues to evolve, it is now possible to adapt, refine, and improve tools to support thriving mentoring relationships that take place virtually. This study explores strategies for virtual m...
Article
With rising overdose deaths globally and the social isolation of the COVID-19 pandemic, people with HIV (PWH) with substance use disorders (SUD) may have been disproportionately impacted. We examined whether there was a change in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Data were collected between 2018-2022 a...
Article
Full-text available
Background Long-acting cabotegravir (CAB-LA) is highly effective for HIV prevention, but delayed HIV diagnoses and INSTI resistance were observed in trials. We report the first case in routine clinical care of HIV infection on CAB-LA with INSTI resistance. Methods The SeroPrEP study enrolls individuals across the U.S. who acquire HIV on PrEP modal...
Article
Full-text available
Pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV acquisition. We aimed to estimate usage of oral-PrEP, and factors associated with adherence among female sex workers (FSWs) in Nairobi, Kenya, using a novel point-of-care urine tenofovir lateral flow assay (LFA). The Maisha Fiti study randomly selected FSWs from Sex Worker Outreach...
Article
Full-text available
Objectives We evaluated a recently developed and validated point-of-care urine tenofovir (POC TFV) test to determine whether its use improves the accuracy of self-reported adherence to pre-exposure prophylaxis (PrEP) and sexual behavior. Design We enrolled sexually active HIV-negative women ages 16–25 years in Kampala, Uganda. Methods Women were...
Article
Full-text available
Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV...
Conference Paper
Full-text available
Preferences Regarding a Real-time Urine Assay for Monitoring and Providing Feedback on Pre-Exposure Prophylaxis Adherence among Women in Kenya. Phelix Okello1, Kenneth Ngure2, Vallery Ogello1, Emmah Owidi1, Peter Mogere1, Stephen Gakuo1, Deepalika Chakravarty3, Charlene Biwott1, Purba Chatterjee3, Jennifer Velloza3, Nelly Mugo1, Monica Gandhi3 1P...
Article
Background Adherence challenges with oral tenofovir-based pre-exposure prophylaxis (PrEP) are common. We developed a point-of-care assay to objectively assess tenofovir in urine and conducted a pilot trial examining the impact of counselling informed by use of this urine assay on long-term PrEP adherence. Methods This randomised trial enrolled wom...
Article
Full-text available
Background Young men who have sex with men and transgender women (YMSM/TGW) have disproportionately high HIV incidence and lower PrEP adherence. Point-of-care (POC) urine tenofovir (TFV) rapid assay (UTRA) testing permits real-time monitoring for nonadherence within clinical settings. We performed UTRA testing among PrEP users to examine the relati...
Article
Background People with HIV (PWH) have higher risk of COVID-19 mortality. SARS-CoV-2 vaccination is highly effective among PWH, although vaccine hesitancy could limit the population-level impact. Setting From 2/2021-4/2022, PWH from 8 sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) completed a vaccine hesitancy...
Article
(Abstracted from N Engl J Med 2024;389:2331–2340) Around the globe, bacterial sexually transmitted infections (STIs) are increasing, with 374 million estimated annual infections of Chlamydia trachomatis , Neisseria gonorrhoeae , and Treponema pallidum . The burden of STI sequelae is disproportionately endured by women, with resulting effects such a...
Article
Full-text available
Background Injectable cabotegravir (CAB)/rilpivirine (RPV) is the only combination long-acting (LA) antiretroviral regimen approved for HIV. RPV may not be effective among individuals with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance, which has >10% prevalence in many countries. Lenacapavir (LEN) is an LA capsid inhibitor given...
Article
Full-text available
OBJECTIVES/GOALS: Contingency management (CM), wherein patients earn prizes for behavior change, is the gold-standard for reducing stimulant misuseand has been shown to improve medication adherence.We aim to describe the feasibility, acceptability, and effectiveness of CM to reduce stimulant use and optimize ART adherence in Women’s HIV primary car...
Preprint
Full-text available
Antiretroviral therapy (ART) is not a cure. Upon ART cessation, virus rapidly rebounds from latently-infected cells ("the HIV reservoir"). The reservoir is largely stabilized at the time of ART initiation and then decays slowly. Here, leveraging >500 longitudinal samples from 67 people with HIV (PWH) treated during acute infection, we developed a n...
Article
Background Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists on implementation strategies for this population. Setting Ward 86, a clinic serving publicly insured PWH in San Fran...
Article
Introduction: Although effective antiretroviral and pre-exposure prophylaxis/PrEP regimens are available globally, adherence challenges persist. Objective measures of adherence can both measure adherence accurately and can be used to drive interventions. The first point-of-care pharmacologic adherence measure, urine tenofovir testing using a later...
Article
Full-text available
Background: Doxycycline postexposure prophylaxis (PEP) has been shown to prevent sexually transmitted infections (STIs) among cisgender men and transgender women, but data from trials involving cisgender women are lacking. Methods: We conducted a randomized, open-label trial comparing doxycycline PEP (doxycycline hyclate, 200 mg taken within 72...
Article
Objectives Psychostimulant-related mortality is rising alongside increasing substance use-related hospitalizations, which are commonly complicated by patient-directed (or “against medical advice”) discharges. Contingency management (CM) is an underused evidence-based treatment for substance use disorders with proven efficacy to support medication a...
Article
Full-text available
Decarceration policies, enacted for SARS-CoV-2 mitigation in carceral settings, potentially exacerbated barriers to care for people living with HIV (PWH) with criminal legal involvement (CLI) during Shelter-in-Place (SIP) by limiting opportunities for engagement in provisions of HIV and behavioral health care. We compared health care engagement for...
Article
Full-text available
Background Alcohol use is common among people with HIV and is a risk factor for tuberculosis disease and non-adherence to isoniazid preventive therapy (IPT). Few interventions exist to reduce alcohol use and increase IPT adherence in sub-Saharan Africa. The aim of this study was to test the hypothesis that financial incentives conditional on point-...
Article
Pharmacy refill records (PRR), are an accessible strategy for estimating adherence in low- and middle-income countries (LMICs). However, the low-cost urine-tenofovir point-of-care test opens up the possibility of an objective metric of adherence that is scalable to LMICs. This study compared adherence to tenofovir-based regimens using urine-tenofov...
Article
We examined changes in the proportion of people with human immunodeficiency virus (PWH) with virologic suppression (VS) in a multisite US cohort before and since the coronavirus disease 2019 (COVID-19) pandemic. Overall, prior gains in VS slowed during COVID-19, with disproportionate impacts on Black PWH and PWH who inject drugs.
Article
Full-text available
Introduction: Human mobility is a critical aspect of existence and survival, but may compromise care engagement among people living with HIV (PLHIV). We examined the association between various forms of human mobility with retention in HIV care and antiretroviral treatment (ART) interruptions. Methods: In a cohort of adult PLHIV in Kenya and Uga...
Article
Objective HIV prevention service delivery models that offer product choices, and the option to change preferences over time, may increase prevention coverage. Outpatient departments in sub-Saharan Africa diagnose a high proportion of new HIV infections, but are an understudied entry point to biomedical prevention. Design Individually randomized tr...
Article
Full-text available
Background Postacute sequelae of COVID‐19 (PASC) and HIV are both associated with reduced exercise capacity, but whether SARS‐CoV‐2 or PASC are associated with exercise capacity among people with HIV (PWH) is unknown. We hypothesized that PWH with PASC would have reduced exercise capacity from chronotropic incompetence. Methods and Results We cond...
Article
Background Investments early in the academic pathway are essential to increasing the diversity of the HIV research workforce. Applied mentored research experiences can advance research skills, self-efficacy, and retention in science among scholars considered to be underrepresented minorities. Setting The UCSF Center for AIDS Research Scholars Prog...
Article
This Viewpoint discusses the importance of the US Congress reauthorizing funding for the President’s Emergency Plan for AIDS Relief, a program developed in 2003 that has played a critical role in fighting HIV/AIDS worldwide as well as other emerging infections and noncommunicable diseases.
Article
Background Preexposure prophylaxis (PrEP) significantly reduces HIV infection risk but is dependent on adherence. Available approaches to measuring adherence have limitations related to accuracy, cost, practicality, and timeliness. This study compared the performance of two methods implementable in clinics and research studies (interview and urine...
Article
Full-text available
This qualitative study explored the experiences of people living with HIV (PLWH) in the San Francisco Bay Area, United States, during the COVID-19 pandemic and subsequent public health restrictions at a safety net HIV clinic. Patients (N = 30) were recruited for Spanish/English language semi-structured interviews (n = 30), translated when necessary...
Article
Objectives: We sought to characterize atherosclerotic cardiovascular disease (ASCVD) risk and metrics of CV health in persons with HIV (PWH) eligible for primary prevention of ASCVD. Design: Cross-sectional study of PWH 40 years and older without documented ASCVD who received care at three HIV clinics in San Francisco from 2019-2022. Methods:...
Article
Background: Intramuscular cabotegravir (CAB) and rilpivirine (RPV) is the only long-acting antiretroviral therapy (LA-ART) regimen approved for people with HIV (PWH). Long-acting ART holds promise for improving outcomes among populations with barriers to adherence but is only approved for PWH who have virologic suppression with use of oral ART bef...
Article
The massive scale-up of HIV treatment and prevention over the past two decades has resulted in important reductions in new infections and mortality globally. Reduction in HIV incidence, however, has been unequal, with worsening epidemics in regions where the reach and scale of HIV control programmes have been insufficient, especially in eastern Eur...
Article
Full-text available
Objective measures of adherence for antiretrovirals used as pre-exposure prophylaxis (PrEP) are critical for improving preventative efficacy in both clinical trials and real-world application. Current objective adherence measures either reflect only recent behavior (eg days for plasma or urine) or cumulative behavior (eg months for dried blood spot...
Article
Full-text available
Background: Adolescent girls and young women (AGYW) account for 29% of new HIV infections in Uganda despite representing just 10% of the population. Peer support improves AGYW linkage to HIV care and medication adherence. We evaluated the feasibility and acceptability of peer delivered HIV self-tests (HIVST) and oral pre-exposure prophylaxis (PrEP...
Preprint
Background Long COVID has been associated with reduced exercise capacity, but whether SARS-CoV-2 infection or Long COVID is associated with reduced exercise capacity among people with HIV (PWH) has not been reported. We hypothesized that PWH with cardiopulmonary post-acute symptoms of COVID-19 (PASC) would have reduced exercise capacity due to chro...
Article
Intramuscular injection of long-acting cabotegravir and rilpivirine is a novel, long-acting antiretroviral therapy (ART) combination approved for use as a fully suppressive regimen for people living with HIV. Long-acting cabotegravir with rilpivirine ART has reduced required dosing frequency from once daily to once every month or every 2 months inj...
Article
Full-text available
HIV pre-exposure prophylaxis (PrEP) use is limited among male sex workers, who are at exceptionally high-risk for HIV infection. We developed a theory-informed, two-pronged intervention (“PrEPare-for-Work”) to optimize PrEP initiation and adherence among male sex workers, which was preliminarily evaluated in a two-stage pilot randomized controlled...
Article
Full-text available
Background and objective: Quantifying exposure to drugs for personalized dose adjustment is of critical importance in patients with tuberculosis who may be at risk of treatment failure or toxicity due to individual variability in pharmacokinetics. Traditionally, serum or plasma samples have been used for drug monitoring, which only poses collectio...
Article
Current antiretroviral therapy (ART) adherence monitoring is premised on patients’ self-reported adherence behaviour (prone to recall error) and verified by blood viral load measurement (which can delay results). A newly developed Urine Tenofovir Rapid Assay (UTRA) assesses tenofovir in urine at point-of-care and is a novel tool to test and immedia...
Preprint
Objective measures of adherence for antiretrovirals used as pre-exposure prophylaxis (PrEP) are critical for improving preventative efficacy in both clinical trials and real-world application. Current objective adherence measures either reflect only recent behavior (eg days for plasma or urine) or cumulative behavior (eg months for dried blood spot...
Article
Full-text available
Background Amidst interrelated problems of increasing infections related to drug use and overdose deaths, contingency management (CM) is an underutilized substance use disorder treatment that leverages incentives for objective behavior change. CM implementation outside of drug treatment settings is limited, despite its regard as gold-standard treat...
Article
We found that urine tenofovir (TFV) levels >1500 ng/ml strongly predict virologic suppression among patients with HIV taking tenofovir alafenamide (TAF, OR 5.66; 95% CI 1.59-20.14; p = 0.007). This suggests an existing point-of-care assay developed for tenofovir disoproxil fumarate (TDF) will support adherence monitoring for patients on all TFV-bas...
Article
Full-text available
Background Isoniazid (INH) preventative therapy is recommended for people with HIV (PWH) in resource-constrained settings. Valid measures are needed to assess adherence. We aimed to examine agreement between measures overall and by level of social desirability. Methods PWH with latent TB were recruited in Mbarara, Uganda. Past 30-day adherence was...
Article
Full-text available
Background: We examined change in antiretroviral treatment (ART) adherence after breastfeeding (BF) cessation using hair tenofovir (TFV) concentrations as an objective metric of medication consumption. Methods: A subset of postpartum women in Zimbabwe randomized in IMPAACT PROMISE to take ART while BF and post BF cessation had hair TFV measured...
Article
Full-text available
Background Tenofovir-diphosphate (TFV-DP) measured in dried blood spots (DBS) and tenofovir (TFV) measured in urine/plasma have been used to measure tenofovir based oral pre-exposure prophylaxis (PrEP) adherence. However, there is limited data comparing these three metrics and their appropriate use for PrEP adherence monitoring. METHODS We collect...
Article
Objective: Access to viral load measurements is constrained in resource-limited settings. A lateral flow urine tenofovir (TFV) rapid assay (UTRA) for patients whose regimens include TFV offers an affordable approach to frequent adherence monitoring. Design: We conducted a cross-sectional study of patients to assess the utility of UTRA to predict...
Article
Full-text available
Purpose of Review In this review, we examine the intersection of the HIV and COVID-19 epidemics with focus on COVID-19-related health outcomes and risk factors for SARS-CoV-2 among people living with HIV (PLWH). Recent Findings Evidence to date do not suggest a higher incidence of SARS-CoV-2 infection among PLWH compared to the general population,...
Article
Full-text available
Background: Long-acting injectable antiretroviral therapy (LAI-ART) is approved for treatment-naïve or experienced people living with HIV (PLWH) based on trials that only included participants with viral suppression. We performed the first LAI-ART demonstration project to include PLWH unable to achieve or maintain viral suppression due to challeng...
Article
Full-text available
Background: Limited data are available on the long-term clinical and immunologic consequences of SARS-CoV-2 infection in people with HIV (PWH). Methods: We measured SARS-CoV-2-specific humoral and cellular responses in people with and without HIV recovering from COVID-19 (n = 39 and n = 43, respectively) using binding antibody, surrogate virus n...
Article
Full-text available
Background: Strategies to support adherence are constrained by the lack of tools to objectively monitor medication intake in low-resource settings. Pharmacologic measures are objective, but pharmacy refill data is more accessible and cost-efficient. This study compared short-term and long-term efavirenz (EFV) drug levels with pharmacy refill adher...
Article
Full-text available
Background Women in Africa face disproportionate risk of human immunodeficiency virus (HIV) acquisition, accounting for more than half of new infections in Africa and similarly face a disproportionate burden of sexually transmitted infections (STIs). Very high STI prevalence is being observed globally, especially among people taking pre-exposure pr...
Article
Full-text available
Background Nearly 50% of men living with HIV in many countries are unaware of their HIV status; men also have lower uptake of HIV treatment and pre-exposure prophylaxis (PrEP). In SSA, highly mobile men such as those working in fishing communities alongside Lake Victoria have low uptake of HIV testing and low rates of linkage to HIV treatment and P...
Article
Full-text available
Couple relationships can be leveraged to improve adherence to antiretroviral therapy (ART), but few studies have identified relationship factors to target in interventions in sub-Saharan Africa. We conducted a cross-sectional study with 211 couples in southern Malawi with at least one partner on ART to test for associations between ART adherence an...
Article
Background: older HIV-positive adults experience a significant burden of geriatric conditions. However, little is known about the association between geriatric conditions and healthcare utilisation in this population. Setting: outpatient safety-net HIV clinic in San Francisco. Methods: in 2013, HIV-positive adults ≥50 years of age underwent ge...
Article
Background: HIV-uninfected persons being evaluated for sexually transmitted infections (STIs) may be good HIV pre-exposure prophylaxis (PrEP) candidates. We measured PrEP use in a sentinel STI patient population. Design: Cross-sectional study, New York City Sexual Health Clinics (January-June 2019). Methods: Remnant serum samples from 644 HIV-...
Article
In NYC, 91% of sexually transmitted infection clinic patients reported pre-exposure prophylaxis (PrEP) use that matched detection of PrEP in their serum. Self-report had 80% sensitivity and 96% specificity (kappa = 0.79) compared to measured PrEP. Our findings suggest that self-report may be a valid indicator of PrEP uptake.
Article
Background/setting: In San Francisco, HIV viral suppression is 71% among housed individuals, but only 20% among unhoused individuals. We conducted a discrete choice experiment (DCE) at a San Francisco public HIV clinic to evaluate care preferences among people living with HIV (PLH) experiencing homelessness/unstable housing during the COVID-19 pan...
Article
Background: After COVID-19 shelter-in-place (SIP) orders, viral suppression (VS) rates initially decreased within a safety-net HIV clinic in San Francisco, particularly among people living with HIV (PLWH) experiencing homelessness. We sought to understand if (1) proactive outreach to provide social services, (2) scaling up of in-person visits, and...
Article
Full-text available
Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV but requires sustained adherence. Conditional economic incentives (CEIs) can improve medication-taking behaviors, yet preferences for programs that employ CEIs to increase PrEP use among male sex workers (MSWs) have not been investigated. We conducted a discrete choice experiment...
Article
Background Biological sex and the estrogen receptor (ESR1) modulate residual HIV activity. Few women have been enrolled in clinical trials of latency reversal agents(LRAs); their effectiveness in women is unknown. We hypothesized that ESR1 antagonism would augment induction of HIV expression by the LRA vorinostat. Methods ACTG A5366 enrolled 31 vi...
Preprint
Full-text available
Background Limited data are available on the long-term clinical and immunologic consequences of SARS-CoV-2 infection in people with HIV (PWH). Methods We measured SARS-CoV-2 specific humoral and cellular immune responses in people with and without HIV recovering from COVID-19 (n=39 and n=43, respectively) using binding antibody, surrogate virus ne...
Article
Full-text available
BACKGROUND There is mounting evidence for the presence of post-acute sequelae of SARS-CoV-2 infection (PASC), but there is limited information on the spectrum, magnitude, duration, and patterns of these sequelae as well as their influence on quality of life. METHODS We assembled a cohort of adults with documented history of SARS-CoV-2 RNA-positivi...
Article
Full-text available
Background There is an urgent need to fully understand the impact of variable COVID-19 experiences and the optimal management of post-acute sequelae of SARS-CoV-2 infection. We characterized the variability in the acute illness experience and ongoing recovery process from participants in a COVID-19 recovery cohort study in Northern California in 20...
Article
Following SARS-CoV-2 mRNA vaccination, people living with HIV (PLWH) had lower surrogate virus neutralization test response (p=0.03) and a trend towards lower IgG response (p=0.08), particularly among those with lower CD4+T-cell counts and who received the BNT162b2 vaccine. Study of the impact of supplemental vaccine doses among PLWH is needed.
Article
Full-text available
Background Limited data are available on whether there are differences in the immune response to SARS-CoV-2 vaccination by HIV status or by mRNA vaccine type. Methods We saved residual outpatient laboratory samples of all previously mRNA-vaccinated individuals in the adult medicine clinics of a public hospital with a large outpatient HIV clinic du...
Preprint
Full-text available
Background: Women in Africa face disproportionate risk of human immunodeficiency virus (HIV) acquisition, accounting for more than half of new infections in Africa and similarly face a disproportionate burden of sexually transmitted infections (STIs). Very high STI prevalence is being observed globally, especially among people taking pre-exposure p...