What's love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis for HIV-serodiscordant couples

J Acquir Immune Defic Syndr. 2012 Apr 15;59(5):463-8. doi: 10.1097/QAI.0b013e31824a060b.

Abstract

Objective: Adherence may be the "Achilles heel" of pre-exposure prophylaxis (PrEP), a promising biomedical approach to HIV prevention. This article presents an explanation of PrEP adherence for African serodiscordant couples derived from qualitative data.

Design: Explaining quantitative findings is one way qualitative investigation contributes to research in medicine and public health. This qualitative interview study was nested in the Partners PrEP Study, a phase III randomized trial evaluating oral tenofovir and emtricitabine/tenofovir PrEP to prevent HIV acquisition by HIV-uninfected partners in serodiscordant heterosexual couples.

Methods: In-depth qualitative interviews were provided by 60 Partners PrEP Study participants in Uganda. Interviews used open-ended questions eliciting information on adherence experiences, barriers, and facilitators. An inductive approach informed by grounded theory methodology was used to analyze study data.

Results: The proposed explanation may be summarized as follows. Serodiscordance destabilizes couples, as the HIV-negative partner reacts with anger, fear, and sadness to the implication of infidelity represented by HIV infection. A "discordance dilemma" ensues, as the desire to avoid acquiring HIV and the advantages of preserving the relationship become competing priorities. PrEP is seen as a solution-a means of safeguarding health without ending the relationship. PrEP users benefit from the support of partners, who reinforce adherence. Where discord in the relationship persists, adherence suffers.

Conclusions: PrEP adherence in serodiscordant couples may be understood as a function of the desire to reduce risk although preserving a partnered relationship. PrEP use in stable couples may be associated with improved adherence and thus, greater effectiveness.

Publication types

  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenine / administration & dosage
  • Adenine / analogs & derivatives
  • Administration, Oral
  • Adult
  • Anti-HIV Agents / administration & dosage*
  • Attitude to Health
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Emtricitabine
  • Female
  • HIV Infections / prevention & control*
  • HIV Infections / psychology
  • HIV Seronegativity*
  • HIV Seropositivity / drug therapy*
  • HIV Seropositivity / psychology
  • HIV Seropositivity / transmission
  • Humans
  • Interpersonal Relations
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Organophosphonates / administration & dosage
  • Sexual Partners / psychology
  • Tenofovir
  • Uganda
  • Young Adult

Substances

  • Anti-HIV Agents
  • Organophosphonates
  • Deoxycytidine
  • Tenofovir
  • Emtricitabine
  • Adenine