Adherence to recommendations for ART and targeted PrEP use among HIV serodiscordant couples in East Africa: the “PrEP as a bridge to ART” strategy

BMC Public Health

Nelly R. Mugo¹  Renee Heffron²  Lara Kidoguchi³  Jared M. Baeten⁴  Connie L. Celum⁴  Nicholas Musinguzi⁵  Elly Katabira⁶  Jessica E. Haberer⁷  Kenneth Ngure⁸ 

[1]Centres for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya

[2]Department of Global Health, University of Washington, Seattle, USA

[3]Department of Global Health, University of Washington, Seattle, USA

[4]Department of Epidemiology, University of Washington, Seattle, USA

[5]Department of Medicine, University of Washington, Seattle, USA

[6]Department of Medicine, University of Washington, Seattle, USA

[7]Department of Global Health, University of Washington, Seattle, USA

[8]Department of Epidemiology, University of Washington, Seattle, USA

[9]Global Health Collaborative, Mbarara University of Science and Technology, P. O Box 434, Mbarara, Uganda

[10]Infectious Disease Institute, Makerere University, Kampala, Uganda

[11]Massachusetts General Hospital and Harvard Medical School, Boston, USA

[12]School of Public Health, Jomo Kenyatta University of Agriculture and Technology Nairobi, Nairobi, Kenya

关键词: PrEP;    ART;    Adherence;    Demonstration project;    Kenya;    Uganda;   

DOI  :  10.1186/s12889-020-09712-3

来源: Springer

【 摘 要 】

BackgroundPrEP use should be aligned with periods of risk for HIV acquisition. For HIV serodiscordant couples, PrEP can be used as a bridge until the partner living with HIV takes antiretroviral therapy (ART) long enough to achieve viral suppression (the “PrEP as a Bridge to ART” strategy). However, adherence to this strategy is unknown.MethodsIn a demonstration project in Kenya and Uganda, HIV-uninfected partners of serodiscordant couples were advised to take PrEP until the partner living with HIV took ART for ≥ 6 months. PrEP discontinuation was then recommended unless there were concerns about ART adherence, immediate fertility intentions, or outside partners with unknown HIV/ART status. Electronic adherence monitoring and socio-behavioral questionnaire data were used in logistic regression models to explore completion of this strategy and continuation of PrEP beyond recommendations to stop its use.ResultsAmong 833 serodiscordant couples, 436 (52%) HIV-uninfected partners completed ≥ 6 months of PrEP as a bridge to ART. Strategy completion was associated with older age (aOR per 5 years = 1.1; p = 0.008) and having fewer children (aOR = 0.9; p = 0.019). Of the 230 participants encouraged to stop PrEP according to strategy recommendations, 170 (74%) did so. PrEP continuation among the remaining 60 participants was associated with more education (aOR = 1.1; p = 0.029), a preference for PrEP over ART (aOR = 3.6; p = 0.026), comfort with managing their serodiscordant relationship (aOR = 0.6; p = 0.046), and believing PrEP makes sex safe (aOR = 0.5; p = 0.026).ConclusionHalf of participants completed the PrEP as a bridge to ART strategy and the majority stopped PrEP as recommended. These findings suggest that targeting PrEP to periods of risk is a promising approach; however, tailoring counseling around aligning PrEP use and HIV risk will be important for optimal strategy implementation.

【 授权许可】

CC BY