Patterns of Oral PrEP Adherence and HIV Risk Among Eastern African Women in HIV Serodiscordant Partnerships
Understanding how women use PrEP is important for developing successful implementation programs. We hypothesized there are distinct patterns of adherence, related to HIV risk and other factors. We identified patterns of PrEP adherence and HIV risk behavior over the first 6 months of PrEP use, using data from 233 HIV-uninfected women in high-risk serodiscordant couples in a demonstration project in Kenya & Uganda. We modeled PrEP adherence, assessed by daily electronic monitoring, and HIV risk behavior using group-based trajectory models. We tested baseline covariates and risk behavior group as predictors of adherence patterns. There were four distinct adherence patterns: high steady adherence (55% of population), moderate steady (29%), late declining (8%), and early declining (9%). No baseline characteristics significantly differed between adherence patterns. Adherence patterns differed in average weekly doses (6.7 vs 5.4 vs 4.1 vs 1.5, respectively). Two risk behavior groups were identified: steady HIV risk (78% of population) and declining (22%). Compared to women with declining HIV risk behavior, women with steady risk behavior were more likely to have high steady adherence (61% vs 35%) and less likely to have early (6% vs 17%) or late (4% vs 19%) declining adherence. Women’s use of PrEP was associated with concurrent HIV risk behavior; higher risk was associated with higher, sustained adherence.
KeywordsPre-exposure prophylaxis HIV Adherence Patterns Women Africa
We thank the couples who participated in this study. Jared Baeten (protocol chair), Connie Celum (protocol co-chair), Renee Heffron (project director), Deborah Donnell (statistician), Ruanne Barnabas, Jessica Haberer, Harald Haugen, Craig Hendrix, Lara Kidoguchi, Mark Marzinke, Susan Morrison, Jennifer Morton, Norma Ware, Monique Wyatt. Project sites: Kabwohe, Uganda (Kabwohe Clinical Research Centre): Stephen Asiimwe, Edna Tindimwebwa. Kampala, Uganda (Makerere University): Elly Katabira, Nulu Bulya. Kisumu, Kenya (Kenya Medical Research Institute): Elizabeth Bukusi, Josephine Odoyo. Thika, Kenya (Kenya Medical Research Institute, University of Washington): Nelly Rwamba Mugo, Kenneth Ngure. Data Management was provided by DF/Net Research, Inc. (Seattle, WA). PrEP medication was donated by Gilead Sciences.
The Partners Demonstration Project was funded by the National Institute of Mental Health of the US National Institutes of Health (R01 MH095507), the Bill & Melinda Gates Foundation (OPP1056051), and the US Agency for International Development (AID-OAA-A-12-00023). Additional funding for the present analysis came from the National Institute of Mental Health (R01 MH098744). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, NIH, or the United States Government.
Compliance with Ethical Standards
Conflict of interest
JMB has led studies with pre-exposure prophylaxis medication donated by Gilead Sciences and served on an advisory committee.
Ethical Approval and Informed Consent
The University of Washington Human Subjects Division and ethics review committees at each site (the National HIV/AIDS Research Committee of the Uganda National Council for Science and Technology or the Ethics Review Committee of the Kenya Medical Research Institute) approved the protocol. All participants provided written informed consent in their preferred language in accordance with the Declaration of Helsinki.
- 1.AIDS by the Numbers. Geneva, Switzerland: UNAIDS; 2016. http://www.unaids.org/sites/default/files/media_asset/AIDS-by-the-numbers-2016_en.pdf. Accessed 29 Nov 2017.
- 2.Prevention Gap Report. Geneva, Switzerland: UNAIDS; 2016. http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf. Accessed 29 Nov 2017.
- 11.Bekker L-G, Roux S, Sebastien E, Yola N, Amico KR, Hughes JP, et al. Daily and non-daily pre-exposure prophylaxis in African women (HPTN 067/ADAPT Cape Town Trial): a randomised, open-label, phase 2 trial. Lancet HIV. 2017. https://doi.org/10.1016/S2352-3018(17)30156-X.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Patel RC, Stanford-Moore G, Odoyo J, Pyra M, Wakhungu I, Anand K, et al. “Since both of us are using antiretrovirals, we have been supportive to each other”: facilitators and barriers of pre-exposure prophylaxis use in heterosexual HIV discordant couples in Kisumu, Kenya. JIAS. 2016;19(1):21134.CrossRefGoogle Scholar
- 15.Haberer JE, Kidoguchi L, Heffron R, Mugo N, Bukusi E, Katabira E, et al. Alignment of adherence and risk for HIV acquisition in a demonstration project of pre-exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention-effective adherence. J Int AIDS Soc. 2017;20:1–9.Google Scholar
- 21.Jones BL. traj: group-based modeling of longitudinal data. Traj Group-Based Model Longitud Data. https://www.andrew.cmu.edu/user/bjones/index.htm. Accessed 25 Apr 2018.
- 26.Blumenthal J, Jain S, Dube M, Sun X, Ellorin E, Hoenigl M, et al. Recent HIV Risk Behavior and Partnership Type predict PrEP adherence in men who have sex with men. San Diego, CA; 2017. https://idsa.confex.com/idsa/2017/viewsessionpdf.cgi. Accessed 8 Dec 2017.