title: Counseling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention.
abstract: For HIV-serodiscordant couples, integrated delivery of antiretroviral therapy (ART) for HIV-positive partners and time-limited pre-exposure prophylaxis (PrEP) for negative partners virtually eliminates HIV transmission. Standardized messaging, sensitive to the barriers and motivators to HIV treatment and prevention, is needed for widespread scale-up of this approach.
  
  
  
  Within the Partners Demonstration Project, a prospective interventional project among 1013 serodiscordant couples in Kenya and Uganda, we offered ART to eligible HIV-positive partners and PrEP to HIV-negative partners before ART initiation and through the HIV-positive partner's first 6 months of ART use. We conducted individual and group discussions with counseling staff to elicit the health communication framework and key messages about ART and PrEP that were delivered to couples.
  
  
  
  Counseling sessions for serodiscordant couples about PrEP and ART included discussions of HIV serodiscordance, PrEP and ART initiation and integrated use, and PrEP discontinuation. ART messages emphasized daily, lifelong use for treatment and prevention, adherence, viral suppression, resistance, side effects, and safety of ART during pregnancy. PrEP messages emphasized daily dosing, time-limited PrEP use until the HIV-positive partner sustained 6 months of high adherence to ART, adherence, safety during conception, side effects, and other risks for HIV.
  
  
  
  Counseling messages for HIV-serodiscordant couples are integral to the delivery of time-limited PrEP as a "bridge" to ART-driven viral suppression. Their incorporation into programmatic scale-up will maximize intervention impact on the global epidemic.
authors.affiliation: Departments of *Global Health; †Epidemiology; ‡Medicine, University of Washington, Seattle, WA; §Centres for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; ‖Infectious Disease Institute, Makerere University, Kampala, Uganda; ¶Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; #Kabwohe Clinical Research Center, Kabwohe, Uganda; **Department of Public and Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; and ††Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Morton
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.forename: John
authors.initials: J
authors.lastname: Njoroge
authors.forename: Agnes
authors.initials: A
authors.lastname: Nakyanzi
authors.forename: Imeldah
authors.initials: I
authors.lastname: Wakhungu
authors.forename: Edna
authors.initials: E
authors.lastname: Tindimwebwa
authors.forename: Snaidah
authors.initials: S
authors.lastname: Ongachi
authors.forename: Eric
authors.initials: E
authors.lastname: Sedah
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Okwero
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ngure
authors.forename: Josephine
authors.initials: J
authors.lastname: Odoyo
authors.forename: Nulu
authors.initials: N
authors.lastname: Bulya
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D017048:Health Care Costs; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010349:Patient Compliance; D065129:Pre-Exposure Prophylaxis; D011247:Pregnancy; D011446:Prospective Studies; D012747:Sexual Partners; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents