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Preferences for Daily or Intermittent Pre-exposure Prophylaxis Regimens and Ability to Anticipate Sex Among HIV Uninfected Members of Kenyan HIV Serodiscordant Couples

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Abstract

Intermittent dosing for pre-exposure prophylaxis (PrEP) has been proposed as an alternative to daily PrEP to reduce cost and patient drug exposure and to improve adherence. One possible dosing regimen is pre-intercourse PrEP, which requires anticipating sex in advance. We examined preferences for daily versus pre-intercourse PrEP and ability to anticipate sex among 310 HIV uninfected members of HIV serodiscordant heterosexual couples in Thika, Kenya, with high HIV knowledge and experience with daily PrEP use in a clinical trial setting. Preferences were evenly split between daily PrEP (47.4 %) and pre-intercourse PrEP (50.7 %). Participants were more likely to prefer daily PrEP if they reported unprotected sex during the prior month (adjusted prevalence ratio [aPR] 1.48, 95 % CI 1.20–1.81) or <80 % adherence to study drug (aPR 1.50, 95 % CI 1.25–1.79), and were less likely to prefer daily PrEP if sex was usually planned, versus spontaneous (aPR 0.76, 95 % CI 0.61–0.96). A minority (24.2 %) reported anticipating sex >3 h in advance, with younger participants being less likely to do so (aPR 0.43, 95 % CI 0.23–0.83 for ages 18–29 vs. ≥40). Findings suggest that intermittent PrEP could be a popular option in this population, but that optimal adherence and sufficient drug levels might be challenging with a pre-intercourse regimen.

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Acknowledgments

The authors thank the couples who participated in this study and the teams at the Thika, Kenya study site and at the University of Washington for work on data collection and management. This research is supported by grants from the National Institutes of Health (R21 NR012663), the Bill and Melinda Gates Foundation (Grant OOP47674), and by the University of Washington Graduate School and the ARCS® Foundation Seattle Chapter Endowment Fund.

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Authors and Affiliations

  1. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Sarah T. Roberts, Connie Celum, Kathryn Curran & Jared M. Baeten

  2. Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA

    Sarah T. Roberts, Renee Heffron, Kenneth Ngure, Connie Celum, Kathryn Curran, Nelly Mugo & Jared M. Baeten

  3. Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya

    Kenneth Ngure

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Connie Celum & Jared M. Baeten

  5. College of Nursing, New York University, New York, NY, USA

    Ann Kurth

  6. Kenya Medical Research Institute, Nairobi, Kenya

    Nelly Mugo

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  1. Sarah T. Roberts
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Correspondence to Sarah T. Roberts.

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Roberts, S.T., Heffron, R., Ngure, K. et al. Preferences for Daily or Intermittent Pre-exposure Prophylaxis Regimens and Ability to Anticipate Sex Among HIV Uninfected Members of Kenyan HIV Serodiscordant Couples. AIDS Behav 18, 1701–1711 (2014). https://doi.org/10.1007/s10461-014-0804-1

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