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. 2020 Oct 28;20(1):1621.
doi: 10.1186/s12889-020-09712-3.

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

Nicholas Musinguzi  1 , Lara Kidoguchi  2 , Nelly R Mugo  3   4 , Kenneth Ngure  5 , Elly Katabira  6 , Connie L Celum  2   4   7 , Jared M Baeten  2   4   7 , Renee Heffron  4   7 , Jessica E Haberer  8 ; Partners Demonstration Project Team
Affiliations

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

Nicholas Musinguzi et al. BMC Public Health. .

Abstract

Background: PrEP 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.

Methods: In 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.

Results: Among 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).

Conclusion: Half 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.

Keywords: ART; Adherence; Demonstration project; Kenya; PrEP; Uganda.

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Conflict of interest statement

All authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Evaluation of PrEP use per the PrEP as a Bridge to ART strategy. The light gray boxes indicate the populations compared in the first analysis, while the dark gray boxes indicate the populations compared in the second analysis
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