Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships

Abstract

Adherence to pre-exposure prophylaxis (PrEP) medication is key for its efficacy in prevention of Human Immunodeficiency Virus (HIV) infection acquisition by uninfected partner in HIV discordant couples during high risk periods of HIV exposure. This study aimed at establishing determinants of adherence levels to oral PrEP drugs among seronegative partners in HIV discordant heterosexual relationships attending and registered at Mbagathi Hospital Comprehensive Care Center (CCC). The study adopted a cross-sectional design that applied two data collection methods: semi structured questionnaires guided interview and a checklist that assessed respondents’ medical records. Both qualitative and quantitative data was collected. Convenience sampling method was used to get a sample size of 51 participants in serodiscordant heterosexual relationships taking oral PrEP. Data was analyzed using Statistical Package for the Social Sciences (SPSS) IBM statistics version 24 software. Both descriptive and inferential analysis were done. Level of significance was set at P value of ≤ 0.05. A higher proportion of the respondents were females (52.9%) and male (47.1%). Most were self-employed (56.9%) with primary level of education (39.2%) and between 30-39 years age group (38%). Adherence levels assessed included; adherence to intake of oral PrEP pills (89.4%), adherence to time of taking PrEP (96%) and adherence to scheduled clinic appointments (80%). Male respondents were 1.01 times more likely to adhere to intake of PrEP pills than females. Determinants that positively influenced adherence to PrEP intake included: increase in age and higher education (p=0.01); longer period of being in HIV discordant relationship (p=0.04); use of condom after PrEP break (p=0.04); partners’ adherence support and having a plan of remembering to take PrEP e.g. an alarm (p=0.04); and increase in frequency of doing a HIV test (p=0.04). Determinants that negatively influenced adherence to PrEP intake included: presence of side effects (p=0.003); engaging in extra marital sex (p=0.04) and alcohol use (p=0.05). The positive determinants of good adherence should be upheld and negative determinants should be addressed. In management of these clients there is need to look out for determinants that promote adherence that include maturity in age, level of education, length of being in discordant status and partners support. Programs should be initiated to create awareness on the effect of bad social habits like alcoholism and extra marital affairs. Laboratory services access should be strengthened in monitoring patients’ adherence and side effects to treatment.