PrEP Discontinuation and Prevention-Effective Adherence: Experiences of PrEP Users in Ugandan HIV Serodiscordant Couples

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dc.contributor.authorGilbert, Hannah N.
dc.contributor.authorWyatt, Monique A.
dc.contributor.authorPisarski, Emily E.
dc.contributor.authorMuwonge, Timothy R.
dc.contributor.authorHeffron, Renee
dc.contributor.authorKatabira, Elly T.
dc.contributor.authorCelum, Connie L.
dc.contributor.authorBaeten, Jared M.
dc.contributor.authorHaberer, Jessica E.
dc.contributor.authorWare, Norma C.
dc.date.accessioned2023-02-08T16:50:30Z
dc.date.available2023-02-08T16:50:30Z
dc.date.issued2019
dc.description.abstractOptimal adherence to oral pre-exposure prophylaxis (PrEP) for HIV prevention involves aligning consistent PrEP use with periods of risk to achieve prevention-effective adherence. Prevention-effective adherence is predicated on individuals discontinuing PrEP during periods without expected risk. For stable, serodiscordant couples, ART adherence by the HIV-positive partner markedly decreases HIV transmission risk, potentially obviating the need for continued PrEP use; yet little is known about actual lived experiences of discontinuing PrEP. Methods: In-depth qualitative interviews were carried out with HIV-uninfected PrEP users in serodiscordant couples taking part in the Partners Demonstration Project at IDI-Kasangati, Kampala, Uganda. Open-ended interviews elicited information on the partnered relationship; understandings of PrEP; prevention strategies; and experiences of PrEP discontinuation. An inductive, thematic, content-analytic approach was used to analyze study data. Results: Uninfected partners experienced PrEP as a valued resource for preventing HIV acquisition. Despite ongoing ART use by HIV-positive partners for a period of time consistent with viral suppression, discontinuation of PrEP was experienced as a loss of protection and a corresponding increase in risk of HIV acquisition. Uninfected partners responded with strategies aimed at offsetting this subjective sense of increased risk, specifically: (1) changing sexual practices; (2) prioritizing fidelity in the relationship; (3) increasing reliance on condoms; and (4) seeking evidence of partners’ ART adherence. Conclusions: These experiences highlight the challenges PrEP users in serodiscordant couples face in discontinuing PrEP for prevention-effective adherence. Flexible interventions that support individuals during this transition may increase comfort with discontinuing PrEP when alternative prevention strategies provide protection, such as a partner’s consistent adherence to ART.en_US
dc.identifier.citationGilbert, H. N., Wyatt, M. A., Pisarski, E. E., Muwonge, T. R., Heffron, R., Katabira, E. T., ... & Ware, N. C. (2019). PrEP discontinuation and prevention-effective adherence: experiences of PrEP users in Ugandan HIV serodiscordant couples. Journal of acquired immune deficiency syndromes (1999), 82(3), 265. doi:10.1097/QAI. 0000000000002139.en_US
dc.identifier.other10.1097/QAI. 0000000000002139.
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7647
dc.language.isoenen_US
dc.publisherJournal of acquired immune deficiency syndromesen_US
dc.subjectPrevention-Effective Adherenceen_US
dc.subjectHIV Risk Perceptionen_US
dc.subjectSerodiscordant Couplesen_US
dc.subjectPrEP Discontinuationen_US
dc.titlePrEP Discontinuation and Prevention-Effective Adherence: Experiences of PrEP Users in Ugandan HIV Serodiscordant Couplesen_US
dc.typeArticleen_US
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