title: What's love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis for HIV-serodiscordant couples.
abstract: OBJECTIVE
  Adherence may be the "Achilles heel" of pre-exposure prophylaxis (PrEP), a promising biomedical approach to HIV prevention. This article presents an explanation of PrEP adherence for African serodiscordant couples derived from qualitative data.
  
  
  METHODS
  Explaining quantitative findings is one way qualitative investigation contributes to research in medicine and public health. This qualitative interview study was nested in the Partners PrEP Study, a phase III randomized trial evaluating oral tenofovir and emtricitabine/tenofovir PrEP to prevent HIV acquisition by HIV-uninfected partners in serodiscordant heterosexual couples.
  
  
  METHODS
  In-depth qualitative interviews were provided by 60 Partners PrEP Study participants in Uganda. Interviews used open-ended questions eliciting information on adherence experiences, barriers, and facilitators. An inductive approach informed by grounded theory methodology was used to analyze study data.
  
  
  RESULTS
  The proposed explanation may be summarized as follows. Serodiscordance destabilizes couples, as the HIV-negative partner reacts with anger, fear, and sadness to the implication of infidelity represented by HIV infection. A "discordance dilemma" ensues, as the desire to avoid acquiring HIV and the advantages of preserving the relationship become competing priorities. PrEP is seen as a solution-a means of safeguarding health without ending the relationship. PrEP users benefit from the support of partners, who reinforce adherence. Where discord in the relationship persists, adherence suffers.
  
  
  CONCLUSIONS
  PrEP adherence in serodiscordant couples may be understood as a function of the desire to reduce risk although preserving a partnered relationship. PrEP use in stable couples may be associated with improved adherence and thus, greater effectiveness.
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA. norma_ware@hms.harvard.edu
authors.forename: Norma C
authors.initials: NC
authors.lastname: Ware
authors.forename: Monique A
authors.initials: MA
authors.lastname: Wyatt
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Alexander
authors.initials: A
authors.lastname: Kintu
authors.forename: Christina
authors.initials: C
authors.lastname: Psaros
authors.forename: Steven
authors.initials: S
authors.lastname: Safren
authors.forename: Elioda
authors.initials: E
authors.lastname: Tumwesigye
authors.forename: Connie L
authors.initials: CL
authors.lastname: Celum
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000284:Administration, Oral; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001294:Attitude to Health; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000068679:Emtricitabine; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000523:psychology / Q000635:transmission; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage; D012747:Sexual Partners / Q000523:psychology; D000068698:Tenofovir; D014454:Uganda; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D003841:Deoxycytidine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine