Gilbert, Hannah N.Wyatt, Monique A.Pisarski, Emily E.Muwonge, Timothy R.Heffron, ReneeKatabira, Elly T.Celum, Connie L.Baeten, Jared M.Haberer, Jessica E.Ware, Norma C.2023-02-082023-02-082019Gilbert, 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. 0000000000002139.10.1097/QAI. 0000000000002139.https://nru.uncst.go.ug/handle/123456789/7647Optimal 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.enPrevention-Effective AdherenceHIV Risk PerceptionSerodiscordant CouplesPrEP DiscontinuationArticle