Sexual Relationships Outside Primary Partnerships and Abstinence Are Associated With Lower Adherence and Adherence Gaps: Data From the Partners PrEP Ancillary Adherence Study.
OBJECTIVE
To assess the role of sexual relationships on levels and patterns of adherence to medication for pre-exposure prophylaxis against HIV.


METHODS
We enrolled 1147 HIV-negative individuals in long-term serodiscordant relationships at 3 sites in Uganda from the Partners Pre-exposure Prophylaxis Study, a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir. We used generalized estimation equations to assess the effects of sexual relationships on low adherence (<80%) and on gaps in adherence.


RESULTS
Fifty-three percent were male, 51% were 18-34 years and 24% were polygamous. Participants who reported sex in the past month with someone other than their primary partner and with <100% condom use were more than twice as likely to have low adherence [adjusted odds ratio (aOR) = 2.48, 95% CI: 1.70 to 3.62] compared with those who had sex with only their primary partners and 100% condom use. Using the same reference group, those who abstained from sex in the previous month had 30% increased odds of low adherence (aOR = 1.30, 95% CI: 1.05 to 1.62) and participants in nonpolygamous marriages who reported sex with both their primary and other partners and <100% condom use were almost twice as likely to be low adherers (aOR = 1.76, 95% CI: 1.01 to 3.08). At least one 72-hour gap in adherence was seen in 598 participants (54.7%); 23.2% had at least one 1-week gap.


CONCLUSIONS
Risk of low overall adherence was higher in participants who reported sex outside primary partnerships and suboptimal condom use, as well as in those who abstained from sex. Adherence gaps were common, potentially creating risk for HIV acquisition.
*Department of Global Health and Population, Harvard School of Public Health, Boston, MA; †Kabwohe Clinical Research Center, Sheema, Uganda; ‡Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA; §Center for Global Health, Massachusetts General Hospital, Boston, MA; ‖Department of Medicine, Harvard Medical School, Boston, MA; ¶Ragon Institute of MGH, MIT and Harvard, Boston, MA; and #Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Alexander
A
Kintu
Susan E
SE
Hankinson
Raji
R
Balasubramanian
Karen
K
Ertel
Elioda
E
Tumwesigye
David R
DR
Bangsberg
Jessica E
JE
Haberer
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000068679:Emtricitabine; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D012746:Sexual Abstinence; D012747:Sexual Partners; D000068698:Tenofovir; D014454:Uganda; D055815:Young Adult
D019380:Anti-HIV Agents; D063065:Organophosphonates; D003841:Deoxycytidine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine