Serodiscordant Couples Research Articles

Effectiveness of Frequent Viral Load Testing Plus Additional Interventions to Prevent HIV Transmission in Heterosexual, Serodiscordant Couples - Yunnan Province, China, 2019-2021.

HIV transmission among serodiscordant couples remains a persistent issue in China. However, the practice of combining counseling with antiretroviral therapies (ART) to enhance ART adherence is not widely implemented or recommended in Chinese health guidelines. This randomized controlled trial suggests that increased follow-up, counseling, and awareness of HIV risk can enhance ART compliance, thereby maximizing treatment efficacy. Early testing and counseling of serodiscordant couples, following the identification of a human immunodeficiency virus (HIV) positive spouse, is crucial for initiating ART and reducing the risk of seroconversion in the uninfected partner. Implementing a combination of ART and adjunct counseling in China is advisable.

Barriers and facilitators to uptake and persistence on prep among key populations in Southern Province, Zambia: a thematic analysis

BackgroundEspecially in high HIV prevalence contexts, such as Zambia, effective biomedical prevention tools are needed for priority populations (PPs), including key populations (KPs), who are at higher risk. HIV pre-exposure prophylaxis (PrEP) has been scaled up nationally in Zambia, but little is known about barriers to PrEP use among specific PPs to date.MethodsTo understand barriers and facilitators to PrEP use in Zambia, we conducted a qualitative case study of PrEP services to PPs including sero-discordant couples (SDCs), female sex workers (FSWs), and men who have sex with men (MSM) in Livingstone. The study conducted in 2021 included in-depth interviews (n = 43) guided by the socio-ecological model, and focus group discussions (n = 4) with clinic and community-based providers and PrEP-eligible clients including users and non-users across PP groups. We used thematic analysis to analyze data using codes derived both deductively and inductively.ResultsWe found multilevel barriers and facilitators to PrEP use. Cross-cutting barriers shared across PP groups included amplifying effects of PrEP being mistaken for antiretroviral drugs used to treat HIV, including anticipated stigma, and concerns about side-effects based on both misinformation and experience. In addition, stigmatized identities, particularly that of MSM, served as a barrier to PrEP use. The fear of being mislabeled as having HIV was of greatest concern for FSWs. Facilitators to PrEP use primarily included the importance of confidential, KP-sensitive services, and the role of informed, supportive family, friends, and peers. Participants across all PP groups urged expanded education efforts to increase awareness of PrEP within the general population toward mitigating concerns of being mislabeled as living with HIV.ConclusionTo our knowledge, this is the first qualitative study of the PrEP cascade among multiple PPs in Zambia. This study provides important explanation for the low rates of PrEP continuation found in earlier demonstration trials among KPs in Zambia. The study also offers recommendations for programming efforts going forward such as inclusive PrEP awareness campaigns, expanded KP sensitivity training, and related efforts to thwart PrEP stigma while expanding access.

Semen Washing and Intrauterine Insemination for Reducing the Risk of Human Immunodeficiency Virus Transmission in Serodiscordant Couples: A Cross-sectional Study.

Antiretroviral therapy has helped human immunodeficiency virus (HIV)-infected people live an enhanced quality of life and attempt for a pregnancy, without placing their partner at risk. Although periconceptional pre-exposure prophylaxis for the uninfected partner and consistent antiretroviral therapy for the HIV-infected partner are important to prevent HIV transmission, semen washing could be a great option to further reduce the semen viral load. The aim of this study were as follows: to determine if semen washing with intrauterine insemination provides an added safety net to HIV-serodiscordant couples when the male partner is HIV-infected and virally suppressed and to determine if the U = U concept (undetectable = untransmittable) holds true in virally suppressed HIV-infected males. This was an observational study conducted in seropositive HIV men under treatment with highly active antiretroviral therapy (HAART) in collaboration with Metropolis Laboratory, a CAP recognised private Healthcare Laboratory in Mumbai, India. Blood and semen samples were collected from a total of 110 adult HIV-1-infected males virally suppressed on HAART. These samples were processed to assess the viral load in plasma as well as raw and processed semen fractions. Descriptive statistics were used to analyse the data. Only men with plasma viral loads < 1000 copies were selected in our study. Out of the 110 HIV-infected individuals, 102 (92.73%) patients had undetectable (<20 copies/ml) plasma viral load while 8 (7.27%) patients had a detectable (>20 copies/ml) viral load, who were excluded from the study. In the virally suppressed 102 men, the raw semen samples of 100 men showed an undetectable viral load, while 2 samples showed detectable contamination, even though their plasma samples from the blood showed a viral load of <20 copies/ml. The semen was then separated into the sperm and the seminal plasma samples. The seminal plasma had <20 copies/ml in 95 samples (93.14%) but a detectable viral load in 7 (6.86%) samples. After subjecting all the 102 processed (post-wash) sperm samples to quantitative analysis, an undetectable viral load of <20 copies/ml was found in all the samples. Thus, the raw sample (prewashed),seminal plasma and processed (postwash) samples were evaluated. The post-wash sperm sample showing zero contamination was frozen for intrauterine insemination (IUI) in the uninfected female partner. Semen washing with IUI should be advocated as a safe, efficacious way to increase the safety net and to further reduce the minimal risk of HIV transmission in serodiscordant couples in addition to the U = U concept.

Prevalence and Factors Associated with Sharing of Human Immunodeficiency Seropositivity Status among Serodiscordant Couples in the City of Parakou (Benin)

Prevalence and Factors Associated with Sharing of Human Immunodeficiency Seropositivity Status among Serodiscordant Couples in the City of Parakou (Benin)

The Prevalence and Correlates of Sexually Transmitted Infections (STIs) among Heterosexual HIV-1 Sero-Discordant Couples Enrolled into HIV Prevention Clinical Trial in Western Kenya

The Prevalence and Correlates of Sexually Transmitted Infections (STIs) among Heterosexual HIV-1 Sero-Discordant Couples Enrolled into HIV Prevention Clinical Trial in Western Kenya

Local Pathways of “Serodiscordant Couples”: Unpacking a Global HIV Population Category in Papua New Guinea

ABSTRACT HIV prevention programs focus on global “key populations” and more localized “priority populations” to ensure effective targeting of interventions. These HIV population categories have been subject to considerable scholarly scrutiny, particularly key populations, with less attention given to critically unpacking priority populations at local levels, for example “serodiscordant couples” (one partner has HIV, but not the other). We examine this population in the context of Papua New Guinea to consider how local configurations, relational pathways, and lived realities of serodiscordant relationships strain the boundaries of this population category and raise intriguing questions about its intersection with contemporary biomedical agendas.

Common Dyadic Coping Mediates the Associations Between We-Disease Appraisal and Relationship Satisfaction and Quality of Life in HIV Serodiscordant Couples: The Common Fate Mediation Model.

Since HIV has evolved into a lifelong but manageable condition, improving the quality of life (QoL) of persons living with HIV (PLWHs) has become increasingly important. Living with HIV is life-altering and poses substantial challenges for both PLWHs and their partners, so identifying how HIV serodiscordant couples cope with HIV together is crucial. Here, Bodenmann's Systemic Transaction Model highlights common dyadic coping (CDC), which refers to both partners working together to alleviate the negative effects of stress. We examined the mediating role of CDC in linking we-disease appraisal with relationship satisfaction and QoL. We recruited a convenience sample of 231 HIV serodiscordant couples via local grassroots organizations between June and October 2022. Participants completed measures of we-disease appraisal, CDC, relationship satisfaction, and QoL. We examined the mediation effect of CDC on the association between we-disease appraisal and outcomes using the common fate mediation model. The mean age of PLWHs was 32.18 years (standard deviation = 8.61 years), and that of their partners was 32.55 years (standard deviation = 9.24 years). The average time since HIV diagnosis was 4.18 years. Most couples were same-sex male couples. We found that CDC mediated the effect of we-disease appraisal on relationship satisfaction. Moreover, CDC significantly mediated the effect of we-disease appraisal on the QoL of PLWHs and their partners. Our findings highlight the importance of CDC in dyadic illness management among Chinese HIV serodiscordant couples.

Contribution of Nested PCR for the Diagnosis of the Immunodeficiency Virus and the Detection of Endogenization of the Provirus in Serodiscordant Couples in Kinshasa, Democratic Republic of the Congo: A Preliminary Diagnostic Study

Contribution of Nested PCR for the Diagnosis of the Immunodeficiency Virus and the Detection of Endogenization of the Provirus in Serodiscordant Couples in Kinshasa, Democratic Republic of the Congo: A Preliminary Diagnostic Study

Sociodemographic, Clinical and Therapeutic Characteristics of Serodiscordant Couples for the Human Immunodeficiency Virus Followed in Kinshasa: A Case of CH Monkole and Saint Anne Health Center

Sociodemographic, Clinical and Therapeutic Characteristics of Serodiscordant Couples for the Human Immunodeficiency Virus Followed in Kinshasa: A Case of CH Monkole and Saint Anne Health Center

Sexual behaviours of HIV sero-discordant couples in the context of art: a systematic review of studies from Sub-Saharan Africa

The impact of the use of antiretroviral therapy (ART) on the sexual behaviours of serodiscordant couples (SDC) is not well documented. This systematic review attempts to examine the strength of evidence from primary studies on the impact of ART on the sexual behaviours of serodiscordant couples in SSA. In this study, 16 studies that fit the inclusion criteria were identified. Nine were cohort studies, six cross-sectional and one randomised controlled trial. Risky sexual behaviours generally declined on several indicators used to assess them. Five within individual studies reported a decrease in unprotected sex from baseline to follow-up, while of the four that said consistent condom use, they observed a significant increase in condom use from baseline to follow-up. For the between-individual studies, one study posited that ART is significantly associated with inconsistent condom use, whereas reporting multiple and concurrent partners and self-reported symptoms of sexually transmitted infections (STIs) were associated with not being on ART. Overall, there was evidence of lower-risk sexual behaviours with ART among SDC in sub-Saharan Africa. However, this relationship was not established to be causal. Further research is required to fully explore and validate the impact of ART on the sexual practices of these couples. Behavioural programmes should be strengthened and targeted towards couple-based counselling and testing with disclosure of status and continue encouraging consistent condom use among steady couples.

Pattern of Lipid Profile Levels in HIV Serodiscordant Couples in Jos Plataeu State, Nigeria

This was a cross sectional study designed to determine the pattern of lipid profile levels in HIV serodiscordant couples in Jos, Nigeria. A total of 20 discordant HIV couples (40 patients) and 20 controls (40 non HIV couples) aged between 18 and 49 years were included in the study. 5ml of fasting venous blood sample was collected from each participant into plain containers for the evaluation of lipid profile. Total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), very low density lipoprotein cholesterol (VLDL-C) and low density lipoprotein cholesterol (LDL-C) were assayed using standard methods. The results showed that HIV discordant test group had significantly higher mean serum TG, VLDL-C, and LDL-C levels whereas HDL-C values were significantly lower than in the control (p&lt;0.05). There was no significant difference in TC levels in groups when compared to the control (p&gt;0.05). The male HIV discordant test group had higher TG and VLDL-C values (p=0.001; 0.002) and lower HDL-C (p=0.000) than in the male control group (p=0.001) while the female HIV discordant test group had significantly higher LDL-C and lower HDL-C levels (p=0.001; 0.000) than in female control group. Male HIV-exposed seronegative partners had significantly higher TG and VLDL-C with lower HDL-C levels (p&lt;0.05) compared to male control while female exposed seronegatives had significantly lower HDL-C level (p=0.000) than in the female control. Furthermore, female HIV positives had significantly higher LDL-C and lower HDL-C levels than in the female control (p&lt;0.05). This study revealed significant alterations in lipid profile levels in the HIV serodiscordant couples which warrant further studies.

Alloimmunity to Class 2 Human Leucocyte Antigens May Reduce HIV-1 Acquisition - A Nested Case-Control Study in HIV-1 Serodiscordant Couples.

Enveloped viruses, including the Human Immunodeficiency Virus-1 (HIV), incorporate host proteins such as human leucocyte antigens (HLA) into their envelope. Pre-existing antibodies against HLA, termed HLA antibodies, may bind to these surface proteins and reduce viral infectivity. Related evidence includes macaque studies which suggest that xenoimmunization with HLA antigens may protect against simian immunodeficiency virus infection. Since HIV gp120 shows homology with class 2 HLA, including shared affinity for binding to CD4, class 2 HLA antibodies may influence HIV acquisition via binding to gp120 on the viral envelope. We conducted a nested case-control study on HIV serodiscordant couples, comparing the frequency of HLA antibodies among highly exposed persistently seronegative controls with those who went on to acquire HIV (HIV-seroconverters). We first performed low resolution HLA typing on 143 individuals who were HIV-infected at enrollment (index partners) and their corresponding sexual partners (115 highly exposed persistently seronegative individuals and 28 HIV-seroconverters). We then measured HLA class 1 and 2 antibodies in the highly exposed persistently seronegative individuals and HIV-seroconverters at early and late timepoints. We analyzed whether such antibodies were directed at HLA specificities of their HIV-infected index partners, and whether autoantibodies or complement-fixing class 2 HLA antibodies were present. Seventy-nine percent of highly exposed persistently seronegative individuals had HLA antibodies; 56% against class 1 and 50% against class 2 alleles. Half of the group of highly exposed persistently seronegative individuals, prior to seroconversion, expressed class 2 HLA antibodies, compared with only 29% of controls (p=0.05). HIV infection was a sensitizing event leading to de novo development of antibodies against HLA-A and HLA-B loci, but not against class 2 loci. HLA autoantibodies were present in 27% of highly exposed persistently seronegative individuals. Complement-fixing class 2 HLA antibodies did not differ significantly between highly exposed persistently seronegative individuals and seroconverters. In multivariable regression, presence of class 2 HLA antibodies at early timepoints was associated with reduced odds of HIV acquisition (odds ratio 0.330, confidence interval 0.112-0.976, p=0.045). These epidemiological data suggest that pre-existing class 2 HLA antibodies were associated with reduced odds of HIV acquisition.

HIV testing frequency and associated factors among five key populations in ten cities of China: a cross-sectional study

BackgroundRegular HIV testing is the best way to detect people living with HIV promptly, yet not much is known about the characteristics of frequent, voluntary testers. This study explores factors related to HIV testing frequency among five key populations in China including men who have sex with men (MSM), female sex workers (FSWs), people who use drugs (PWUD), men who have casual sex with women (MCSW) and sero-negative partners among sero-discordant couples (SNPs).MethodsWe conducted a cross-sectional study in ten cities of China from November 2018 to September 2019 using convenience sampling to recruit participants. Univariate and multivariate partial proportional odds models were adopted to compare socio-behavioral factors associated with HIV testing frequencies among the five key populations.ResultsAmong the 2022 recruited participants, 36.6% reported not testing for HIV in the past year, whereas 37.0% tested once and 26.4% tested twice. Compared with MSM, FSWs (AOR = 1.97, 95% CI: 1.36–2.86) and SNPs (AOR = 3.63, 95% CI: 2.40–5.49) were more likely to test for HIV, but MCSW (AOR = 0.23, 95% CI: 0.17–0.32) were less likely. Additionally, SNPs (AOR = 4.02, 95% CI: 2.78–5.83) were more likely to be frequent HIV testers, while FSWs (AOR = 0.49, 95% CI: 0.32–0.76) and MCSW (AOR = 0.29, 95% CI: 0.20–0.41) were less likely to be frequent testers. Factors identified as barriers to HIV testing include the following: higher education level and > 5000 CNY monthly income for FSWs; elder age and a married/cohabitating status for PWUD; reported alcohol use for MCSW; and non-Han ethnicity and non-local household for SNPs. Facilitators to frequent testing included the following: higher education level for MSM and SNPs; higher AIDS knowledge score for MSM and PWUD; > 5000 CNY monthly income for FSWs and PWUD; and reporting high-risk sexual behaviors for MSM, FSW and PWUD.ConclusionsHIV testing frequencies and associated factors were not equivalent across the five key populations in China. Public health officials should take heed of the identified high-risk populations reporting high testing rates, perhaps with intensive and tailored behavioral interventions or biochemical prophylaxis.

Sharing Medical Adherence Responsibilities Together: An Approach for Promoting Responsibility and Solidarity in Human Immunodeficiency Virus Serodiscordant Couples.

Sharing Medical Adherence Responsibilities Together: An Approach for Promoting Responsibility and Solidarity in Human Immunodeficiency Virus Serodiscordant Couples.

Untapped Potential for Safer Conception Messaging to Transform PrEP Rollout and Promote Service Engagement Among Serodiscordant Couples.

Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa's initial rollout, revealing the need for more effective promotion strategies. In Uganda, we explored potential benefits and challenges of integrating safer conception messaging to promote PrEP among serodiscordant couples. In-depth interviews were conducted with clients and personnel at three clinics and analyzed thematically. Participants (n = 58) valued PrEP as a safer conception method (SCM) but described lack of integration of safer conception and PrEP services as well as inconsistent practices in prescribing PrEP to couples pursuing conception. Participants reported that the wider population remains largely unaware of PrEP and SCM or harbors misconceptions that PrEP is primarily for highly stigmatized groups like sex workers. Participants further described how heterosexual couples can still be reluctant to test for HIV, unaware of tools like PrEP and SCM that would allow them to continue their relationship and/or pursuit of childbearing. Overall, findings suggest that integrating PrEP and SCM in messaging and services targeting serodiscordant couples holds untapped benefits throughout the HIV prevention cascade.

Prevalence of Consistent Condom Use and Associated Factors among Serodiscordant Couples in Ethiopia, 2020: A Mixed-Method Study.

Background Heterosexual transmission within serodiscordant relationships is the core source of new HIV infections. Although consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples, it has not been extensively studied in Ethiopia. Consequently, the current study looked at the proportion of serodiscordant couples in Ethiopia who used condoms consistently and the factors associated with that. Methods A cross-sectional was conducted from October 2019 to June 2020. For the quantitative findings to be more robust and reliable, a qualitative design was incorporated. An interviewer-administered questionnaire was used to collect the data. Qualitative data were collected using gender-matched four focus group discussions. Multivariable logistic regression was conducted to identify factors associated with consistent condom use. The statistical significance of the variables was declared at a P value of less than 0.05. Results This study confirmed that the proportion of consistent condom use was 58.4% [95% CI: 53.1-63.1%]. After controlling for all other variables, unmarried partners, adjusted odds ratio (AOR) = 0.44 [95% CI: 0.229-0.877] and students and employees, AOR = 0.33 [95% CI: 0.130-0.846] and AOR = 0.39 [95% CI: 0.165-0.939], respectively, were less likely consistently use condoms, whereas couples living together, AOR = 1.86 [95% CI: 1.197-2.195], receiving counseling about condom use, AOR = 1.90 [95% CI: 1.182-3.076], and having more knowledge about HIV, AOR = 1.61 [95% CI: 1.031-2.525] were more likely to use condoms consistently. Conclusion Despite its importance, the proportion of consistent condom use among serodiscordant couples was significantly low. To improve condom use consistently, planners, policymakers, and health care practitioners should consider the factors listed above when making decisions. There should be an increased focus on student and employee intervention as well.

Protective Effect of the Combination of Wild-Type Genotypes (G/G and G/G) of CCR2-64V and SDF1-3A' Genes in Serodiscordant Couples in Yaounde-Cameroon.

There is growing evidence that polymorphisms in chemokine and chemokine receptor genes influence susceptibility to HIV infection and disease progression. However, not much is documented about the influence of these polymorphisms in HIV serodiscordant couples in Cameroon. The objective of this study therefore was to determine the prevalence and the effect of the polymorphisms of CCR5-Δ32, CCR5 promoter 59029 A/G, CCR2-64I and SDF1-3'A gene in HIV serodiscordant couples in comparison to HIV negative seroconcordant and HIV positive seroconcordant couples in Yaoundé-Cameroon. A total of 96 couples were recruited from five hospitals, of which 60 couples were HIV serodiscordant (test group), 18 HIV negative seroconcordant and 18 HIV positive seroconcordant couples were used as controls. Their genotypes for CCR5-Δ32, CCR5 promoter, CCR2 and SDF1 were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism. The allelic frequencies of these genes in the studied population were: 0%, 26.30%, 15.30% and 1.62% respectively for CCR5-Δ32, CCR5 promoter, CCR2 and SDF1. The frequency of the combination of CCR5 promoter and SDF1- (A/A+ G/G) wild-type genotype was higher in HIV-infected partners (82.92%) compared to uninfected partners (56.1%) in HIV serodiscordant couples (p= 0.0001). The combination of wild-type CCR2 and SDF1 genotypes (G/G + G/G) was higher among uninfected partners (80.48%) in HIV serodiscordant couples compared to the infected partners (60.97) (p= 0.005). HIV negative partner protection against HIV/AIDS infection may be attributed to the combination of wild-type genotypes (G/G and G/G) of CCR2 and SDF1 genes in HIV serodiscordant couples.

HLA-C: Plasma viral load and antibiotic susceptibility pattern of microbial infection in HIV-1 among serodiscordant couples in Nigeria

Background: The role Human Leucocyte Antigen-C class I play in microbial infections and antibiotic susceptibility among heterosexual HIV-1 serodiscordant couples is not known in Nigeria. Therefore, this study evaluated the association between HLA-C Class I, microbial infection, antibiotic susceptibility in HIV-1 transmission amongst heterosexual serodiscordant couples in Nigeria. Methods and materials: A total of 271 serodiscordant who signed informed consent document were enrolled into this study. Extracted genomic DNA was sequenced on exons 2 and 3 DNA for both high and low resolutions of HLA-C class 1 genotyping using allele-specific primers. Baseline and follow-up HIV-1 RNA (plasma viral load), CD4+ count analysis was done for HIV positive individuals. One hundred and twenty-six (126) High vaginal/endocervical swabs, 11 urethral swabs and 137 early morning urine samples passed through: microscopy, culture, Antibiotics susceptibility test and other identification methods. Results: Participants age ranged from 20 to >50 years with median age of 38 years. Two hundred and eight (208) etiologic agents were isolated and Candida spp. 56 (26.9%), Staphylococcus aureus and Escherichia coli 46 (22.1%) respectively were the most prevalent. Staphylococcus aureus showed more sensitivity to Augmentin (95.4%) and Gentamycin (90.4%) and more resistance to Ceftazidime and Gentamycin (81.4%/72.3%). HLA-C*040101 72 (34.5%)/C*0701 57 (24.2%) and C*040101 106 (39.0%)/C*0701 86 (31.6%) were the most prevalent alleles associated with high plasma viral load at baseline and after 6 months on ARV (p<0.000, p<0.003). Sexually transmitted infections (STIs) and Reproductive tract infections (RTIs) were associated with increased plasma viral load (p < 0.057/p > 0.071). HLA-C*070201 22 (9.0%) was independently associated with HIV-1 susceptibility (p < 0.006) among Serodiscordant Couples. Conclusion: High plasma viral load was significantly associated with STIs and RTIs which was independently associated with resistance to Ceftazidime and Gentamycin. The HLA-C alleles which has increased chances of HIV-1 transmission from HIV positive Index to the recipient Partner is also significantly associated with high plasma viral load. Seriologic HLA-C*070201, was the allele associated with HIV-1 susceptibility based on polymorphism in HLA-C class 1 genetic markers in serodiscordant couples in Nigeria.

Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda.

BackgroundScale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Uganda began with serodiscordant couples (SDC) and has expanded to other most at-risk populations (MARPs). We explored knowledge, acceptability, barriers and facilitators of PrEP use among potential PrEP users in four MARPs (SDC; men who have sex with men [MSM]; female sex workers [FSW], and fisher folk).MethodsWe administered quantitative surveys to potential PrEP users in multiple settings in Central Uganda at baseline and approximately 9 months after healthcare worker (HCW) training on PrEP.ResultsThe survey was completed by 250 potential PrEP users at baseline and 125 after HCW training; 55 completed both surveys. For these 250 participants, mean age was 28.5 years (SD 6.9), 47% were male and 6% were transgender women, with approximately even distribution across MARPs and recruitment locations (urban, peri-urban, and rural). Most (65%) had not heard about PrEP. After HCW training, 24% of those sampled were aware of PrEP, and the proportion of those who accurately described PrEP as “antiretrovirals to be used before HIV exposure” increased from 54% in the baseline survey to 74% in the second survey (p<0.001). The proportion of participants who reported HCW as a source of PrEP information increased after training (59% vs 91%, p<0.001). In both surveys, nearly all participants indicated they were willing to take PrEP if offered. The most common anticipated barriers to PrEP were stigma, transportation, accessibility, busy schedules, and forgetfulness. Closeness to home was a common facilitator for all participant categories.ConclusionsInitial awareness of PrEP was low, but PrEP knowledge and interest increased among diverse MARPs after HCW training. Demand creation and HCW training will be critical for increasing PrEP awareness among key populations, with support to overcome barriers to PrEP use. These findings should encourage the acceleration of PrEP rollout in Uganda.

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 HIV-negative partners discontinued PrEP and transitioned to rely primarily on their partner's adherence to antiretroviral therapy (ART) for prevention. Kenya and Uganda. 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. 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. 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.