Partner violence and self-reported pre-exposure prophylaxis (PrEP) interruptions among HIV negative partners in HIV serodiscordant couples in Kenya and Uganda.

Abstract

Abstract: Background: Pre-exposure prophylaxis (PrEP) is effective for HIV prevention among diverse populations and studies of PrEP delivery are investigating ways to deliver PrEP with high adherence. In many settings with high HIV burden, where PrEP is an important intervention, intimate partner violence (IPV) is reported often. We examined the role of IPV to influence interruptions in PrEP use. Methods: We analyzed data from 1,013 serodiscordant heterosexual couples enrolled in a large PrEP demonstration project in Kenya and Uganda, the Partners Demonstration Project. At quarterly study visits, HIV negative participants receiving PrEP self-reported interruptions in their PrEP use and experiences with IPV. The association of IPV and PrEP interruptions was analyzed using multivariate generalized estimating equations. Results: Of 1,013 HIV negative people who used PrEP during the study, 67% were male and the median age was 30 (interquartile range [IQR] 26-36). Interruptions in PrEP use were reported at 328 visits (7.1% of all visits). The median length of PrEP interruption was 28 days (interquartile range [IQR]: 7-45). At baseline and follow up there were 53 reports of abuse by HIV negative partners, including physical, economic, verbal, or other types of abuse. The frequency of PrEP interruption among people who experienced IPV was 23.8% and those without IPV was 6.9%. The crude odds ratio for PrEP interruption was 3.83 (95% CI 1.8-8.0) and remained significant after adjustment for age, and frequency of intercourse (aOR=2.64, 95% CI 1.17-6.00). Conclusion: IPV was more likely to be reported at visits when PrEP interruptions were also reported, which may have implications for successful adherence to PrEP. Within PrEP delivery, there may be opportunities to assess and intervene on IPV in order to bolster adherence.