Cargando…

Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda

A strategy of pre-exposure prophylaxis (PrEP) transitioning to treatment as prevention is highly efficacious and cost effective for prevention of HIV transmission within HIV serodiscordant couples. We assessed whether couples who adopted this strategy experienced changes in sexual behaviors after HI...

Descripción completa

Detalles Bibliográficos
Autores principales: Stalter, Randy, Mugwanya, Kenneth, Thomas, Katherine, Donnell, Deborah, Mujugira, Andrew, Ngure, Kenneth, Celum, Connie, Kidoguchi, Lara, Bukusi, Elizabeth, Baeten, Jared, Heffron, Renee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JAIDS Journal of Acquired Immune Deficiency Syndromes 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495981/
https://www.ncbi.nlm.nih.gov/pubmed/32658130
http://dx.doi.org/10.1097/QAI.0000000000002434
_version_ 1783582996904804352
author Stalter, Randy
Mugwanya, Kenneth
Thomas, Katherine
Donnell, Deborah
Mujugira, Andrew
Ngure, Kenneth
Celum, Connie
Kidoguchi, Lara
Bukusi, Elizabeth
Baeten, Jared
Heffron, Renee
author_facet Stalter, Randy
Mugwanya, Kenneth
Thomas, Katherine
Donnell, Deborah
Mujugira, Andrew
Ngure, Kenneth
Celum, Connie
Kidoguchi, Lara
Bukusi, Elizabeth
Baeten, Jared
Heffron, Renee
author_sort Stalter, Randy
collection PubMed
description A strategy of pre-exposure prophylaxis (PrEP) transitioning to treatment as prevention is highly efficacious and cost effective for prevention of HIV transmission within HIV serodiscordant couples. We assessed whether couples who adopted this strategy experienced changes in sexual behaviors after HIV-negative partners discontinued PrEP and transitioned to rely primarily on their partner's adherence to antiretroviral therapy (ART) for prevention. SETTING: Kenya and Uganda. METHODS: Data are from the Partners Demonstration Project, a prospective, open-label evaluation of PrEP and ART use for HIV prevention. Using zero-inflated negative binomial models, we assessed changes in the level (ie, intercept) and trend over time (ie, slope) in total and condomless sex acts reported after PrEP discontinuation by HIV-negative partners. We conducted subgroup analyses based on HIV-negative partners' age and sex. RESULTS: We included 567 couples where the HIV-negative partner discontinued PrEP because of their partner with HIV using ART for ≥6 months. HIV-negative partners were women in 32.6% of couples and had a median age of 30 years. We observed no change in the level or trend over time in total sex acts [level adjusted rate ratio (aRR) = 0.95, 95% confidence interval (CI): 0.87 to 1.04; trend aRR = 1.00, 95% CI: 0.99 to 1.01] or condomless sex acts (level aRR = 0.97, 95% CI: 0.81 to 1.17; trend aRR = 1.00, 95% CI: 0.98 to 1.03) reported after PrEP discontinuation versus prediscontinuation. No significant changes in behaviors were observed in age and sex subgroups. CONCLUSIONS: PrEP discontinuation seems to result in no significant changes in couples' sexual behaviors. These data further support a strategy of time-limited PrEP use by serodiscordant couples.
format Online
Article
Text
id pubmed-7495981
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher JAIDS Journal of Acquired Immune Deficiency Syndromes
record_format MEDLINE/PubMed
spelling pubmed-74959812020-09-24 Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda Stalter, Randy Mugwanya, Kenneth Thomas, Katherine Donnell, Deborah Mujugira, Andrew Ngure, Kenneth Celum, Connie Kidoguchi, Lara Bukusi, Elizabeth Baeten, Jared Heffron, Renee J Acquir Immune Defic Syndr Prevention Research A strategy of pre-exposure prophylaxis (PrEP) transitioning to treatment as prevention is highly efficacious and cost effective for prevention of HIV transmission within HIV serodiscordant couples. We assessed whether couples who adopted this strategy experienced changes in sexual behaviors after HIV-negative partners discontinued PrEP and transitioned to rely primarily on their partner's adherence to antiretroviral therapy (ART) for prevention. SETTING: Kenya and Uganda. METHODS: Data are from the Partners Demonstration Project, a prospective, open-label evaluation of PrEP and ART use for HIV prevention. Using zero-inflated negative binomial models, we assessed changes in the level (ie, intercept) and trend over time (ie, slope) in total and condomless sex acts reported after PrEP discontinuation by HIV-negative partners. We conducted subgroup analyses based on HIV-negative partners' age and sex. RESULTS: We included 567 couples where the HIV-negative partner discontinued PrEP because of their partner with HIV using ART for ≥6 months. HIV-negative partners were women in 32.6% of couples and had a median age of 30 years. We observed no change in the level or trend over time in total sex acts [level adjusted rate ratio (aRR) = 0.95, 95% confidence interval (CI): 0.87 to 1.04; trend aRR = 1.00, 95% CI: 0.99 to 1.01] or condomless sex acts (level aRR = 0.97, 95% CI: 0.81 to 1.17; trend aRR = 1.00, 95% CI: 0.98 to 1.03) reported after PrEP discontinuation versus prediscontinuation. No significant changes in behaviors were observed in age and sex subgroups. CONCLUSIONS: PrEP discontinuation seems to result in no significant changes in couples' sexual behaviors. These data further support a strategy of time-limited PrEP use by serodiscordant couples. JAIDS Journal of Acquired Immune Deficiency Syndromes 2020-10-01 2020-07-13 /pmc/articles/PMC7495981/ /pubmed/32658130 http://dx.doi.org/10.1097/QAI.0000000000002434 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Prevention Research
Stalter, Randy
Mugwanya, Kenneth
Thomas, Katherine
Donnell, Deborah
Mujugira, Andrew
Ngure, Kenneth
Celum, Connie
Kidoguchi, Lara
Bukusi, Elizabeth
Baeten, Jared
Heffron, Renee
Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda
title Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda
title_full Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda
title_fullStr Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda
title_full_unstemmed Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda
title_short Sexual Behaviors After PrEP Discontinuation Among HIV Serodiscordant Couples in Kenya and Uganda
title_sort sexual behaviors after prep discontinuation among hiv serodiscordant couples in kenya and uganda
topic Prevention Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495981/
https://www.ncbi.nlm.nih.gov/pubmed/32658130
http://dx.doi.org/10.1097/QAI.0000000000002434
work_keys_str_mv AT stalterrandy sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT mugwanyakenneth sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT thomaskatherine sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT donnelldeborah sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT mujugiraandrew sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT ngurekenneth sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT celumconnie sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT kidoguchilara sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT bukusielizabeth sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT baetenjared sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda
AT heffronrenee sexualbehaviorsafterprepdiscontinuationamonghivserodiscordantcouplesinkenyaanduganda