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Patterns of Oral PrEP Adherence and HIV Risk Among Eastern African Women in HIV Serodiscordant Partnerships

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Abstract

Understanding how women use PrEP is important for developing successful implementation programs. We hypothesized there are distinct patterns of adherence, related to HIV risk and other factors. We identified patterns of PrEP adherence and HIV risk behavior over the first 6 months of PrEP use, using data from 233 HIV-uninfected women in high-risk serodiscordant couples in a demonstration project in Kenya & Uganda. We modeled PrEP adherence, assessed by daily electronic monitoring, and HIV risk behavior using group-based trajectory models. We tested baseline covariates and risk behavior group as predictors of adherence patterns. There were four distinct adherence patterns: high steady adherence (55% of population), moderate steady (29%), late declining (8%), and early declining (9%). No baseline characteristics significantly differed between adherence patterns. Adherence patterns differed in average weekly doses (6.7 vs 5.4 vs 4.1 vs 1.5, respectively). Two risk behavior groups were identified: steady HIV risk (78% of population) and declining (22%). Compared to women with declining HIV risk behavior, women with steady risk behavior were more likely to have high steady adherence (61% vs 35%) and less likely to have early (6% vs 17%) or late (4% vs 19%) declining adherence. Women’s use of PrEP was associated with concurrent HIV risk behavior; higher risk was associated with higher, sustained adherence.

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Acknowledgements

We thank the couples who participated in this study. Jared Baeten (protocol chair), Connie Celum (protocol co-chair), Renee Heffron (project director), Deborah Donnell (statistician), Ruanne Barnabas, Jessica Haberer, Harald Haugen, Craig Hendrix, Lara Kidoguchi, Mark Marzinke, Susan Morrison, Jennifer Morton, Norma Ware, Monique Wyatt. Project sites: Kabwohe, Uganda (Kabwohe Clinical Research Centre): Stephen Asiimwe, Edna Tindimwebwa. Kampala, Uganda (Makerere University): Elly Katabira, Nulu Bulya. Kisumu, Kenya (Kenya Medical Research Institute): Elizabeth Bukusi, Josephine Odoyo. Thika, Kenya (Kenya Medical Research Institute, University of Washington): Nelly Rwamba Mugo, Kenneth Ngure. Data Management was provided by DF/Net Research, Inc. (Seattle, WA). PrEP medication was donated by Gilead Sciences.

Funding

The Partners Demonstration Project was funded by the National Institute of Mental Health of the US National Institutes of Health (R01 MH095507), the Bill & Melinda Gates Foundation (OPP1056051), and the US Agency for International Development (AID-OAA-A-12-00023). Additional funding for the present analysis came from the National Institute of Mental Health (R01 MH098744). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, NIH, or the United States Government.

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Washington, Seattle, USA

    Maria Pyra, Renee Heffron, Connie Celum & Jared M. Baeten

  2. Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359927, Seattle, WA, 98104, USA

    Maria Pyra, Renee Heffron, Connie Celum, Elizabeth A. Bukusi, Nelly R. Mugo, Jared M. Baeten, Jared Baeten, Connie Celum, Renee Heffron, Deborah Donnell, Ruanne Barnabas, Jessica Haberer, Harald Haugen, Craig Hendrix, Lara Kidoguchi, Mark Marzinke, Susan Morrison, Jennifer Morton, Norma Ware & Monique Wyatt

  3. Department of Biostatistics, University of Washington, Seattle, USA

    Elizabeth R. Brown

  4. Department of Obstetrics and Gynecology, University of Washington, Seattle, USA

    Elizabeth A. Bukusi

  5. Department of Medicine, University of Washington, Seattle, USA

    Connie Celum & Jared M. Baeten

  6. Vaccine and Infection Diseases and Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, USA

    Elizabeth R. Brown

  7. Massachusetts General Hospital Global Health, Boston, USA

    Jessica E. Haberer

  8. Department of Medicine, Harvard Medical School, Boston, USA

    Jessica E. Haberer

  9. Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

    Elizabeth A. Bukusi, Nelly R. Mugo, Jared Baeten, Connie Celum, Renee Heffron, Deborah Donnell, Ruanne Barnabas, Jessica Haberer, Harald Haugen, Craig Hendrix, Lara Kidoguchi, Mark Marzinke, Susan Morrison, Jennifer Morton, Norma Ware & Monique Wyatt

  10. Kabwohe Clinical Research Center, Kabwohe, Uganda

    Stephen Asiimwe

  11. Infectious Disease Institute, Makerere University, Kampala, Uganda

    Elly Katabira

Authors
  1. Maria Pyra
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Consortia

for the Partners Demonstration Project Team

  • Jared Baeten
  • , Connie Celum
  • , Renee Heffron
  • , Deborah Donnell
  • , Ruanne Barnabas
  • , Jessica Haberer
  • , Harald Haugen
  • , Craig Hendrix
  • , Lara Kidoguchi
  • , Mark Marzinke
  • , Susan Morrison
  • , Jennifer Morton
  • , Norma Ware
  •  & Monique Wyatt

Corresponding author

Correspondence to Jared M. Baeten.

Ethics declarations

Conflict of interest

JMB has led studies with pre-exposure prophylaxis medication donated by Gilead Sciences and served on an advisory committee.

Ethical Approval and Informed Consent

The University of Washington Human Subjects Division and ethics review committees at each site (the National HIV/AIDS Research Committee of the Uganda National Council for Science and Technology or the Ethics Review Committee of the Kenya Medical Research Institute) approved the protocol. All participants provided written informed consent in their preferred language in accordance with the Declaration of Helsinki.

Additional information

Collaborators of the Partners Demonstration Project Team and Coordinating Center (University of Washington) and collaborating investigators (Harvard Medical School, Johns Hopkins University, Massachusetts General Hospital) are listed in “Acknowledgement”.

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Pyra, M., Brown, E.R., Haberer, J.E. et al. Patterns of Oral PrEP Adherence and HIV Risk Among Eastern African Women in HIV Serodiscordant Partnerships. AIDS Behav 22, 3718–3725 (2018). https://doi.org/10.1007/s10461-018-2221-3

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