title: I Knew I Would Be Safer. Experiences of Kenyan HIV Serodiscordant Couples Soon After Pre-Exposure Prophylaxis (PrEP) Initiation.
abstract: Pre-exposure prophylaxis (PrEP) for HIV-uninfected persons is highly efficacious for HIV prevention. Understanding how people at risk for HIV will use PrEP is important to inform PrEP scale-up and implementation. We used qualitative methods to gather insights into couples' early experiences with PrEP use within the Partners Demonstration Project, an open-label implementation study evaluating integrated delivery of PrEP and antiretroviral therapy (ART). PrEP is offered to HIV uninfected partners until the HIV-infected partner initiates and sustains ART use (i.e., PrEP as a "bridge" to ART initiation and viral suppression). From August 2013 to March 2014 we conducted 20 in-depth dyadic interviews (n = 40) with heterosexual HIV serodiscordant couples participating at the Thika, Kenya study site, exploring how couples make decisions about using PrEP for HIV prevention. We developed and applied deductive and inductive codes to identify key themes related to experiences of PrEP initiation and use of time-limited PrEP. Couples reported that PrEP offered them an additional strategy to reduce the risk of HIV transmission, meet their fertility desires, and cope with HIV serodiscordance. Remaining HIV negative at follow-up visits reinforced couples' decisions and motivated continued adherence to PrEP. In addition, confidence in their provider's advice and client-friendly services were critical to their decisions to initiate and continue use of PrEP. Strategies for wide-scale PrEP delivery for HIV serodiscordant couples in low resource settings may include building capacity of health providers to counsel on PrEP adoption while addressing couples' concerns and barriers to adoption and continued use.
authors.affiliation: 1 School of Public Health, Jomo Kenyatta University of Agriculture and Technology , Kenya .|2 Department of Global Health, University of Washington , Seattle, Washington.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ngure
authors.affiliation: 2 Department of Global Health, University of Washington , Seattle, Washington.|3 Department of Epidemiology, University of Washington , Seattle, Washington.
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
authors.affiliation: 2 Department of Global Health, University of Washington , Seattle, Washington.
authors.forename: Kathyrn
authors.initials: K
authors.lastname: Curran
authors.affiliation: 5 Center for Clinical Research, Kenya Medical Research Institute , Kenya .
authors.forename: Sophie
authors.initials: S
authors.lastname: Vusha
authors.affiliation: 5 Center for Clinical Research, Kenya Medical Research Institute , Kenya .
authors.forename: Mariah
authors.initials: M
authors.lastname: Ngutu
authors.affiliation: 2 Department of Global Health, University of Washington , Seattle, Washington.|5 Center for Clinical Research, Kenya Medical Research Institute , Kenya .
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.affiliation: 2 Department of Global Health, University of Washington , Seattle, Washington.|3 Department of Epidemiology, University of Washington , Seattle, Washington.|4 Department of Medicine, University of Washington , Seattle, Washington.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.affiliation: 2 Department of Global Health, University of Washington , Seattle, Washington.|3 Department of Epidemiology, University of Washington , Seattle, Washington.|4 Department of Medicine, University of Washington , Seattle, Washington.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D044383:Black People / Q000523:psychology*; D005191:Family Characteristics; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology* / Q000635:transmission / Q000821:virology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000188:drug therapy / Q000523:psychology / Q000635:transmission; D020010:Heterosexuality; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya / Q000453:epidemiology; D008297:Male; D009042:Motivation; D065129:Pre-Exposure Prophylaxis; D036301:Qualitative Research; D012747:Sexual Partners / Q000523:psychology*
chemical_list: D019380:Anti-HIV Agents
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