P46.06
Background: Pre-exposure prophylaxis (PrEP) for HIV-uninfected persons is highly efficacious for HIV prevention. Evidence-based social science research is urgently needed to inform PrEP rollout. We used qualitative methods to gather insights into couples' early experiences of using PrEP within a PrEP demonstration study.
Methods: From June-December 2013, we conducted 16 in-depth dyadic interviews with heterosexual HIV discordant couples participating at the Thika, Kenya site of the Partners Demonstration Project, a project evaluating uptake of and adherence to PrEP and ART. PrEP is offered when couples enroll in the study until the HIV-infected partner initiates ART and achieves viral suppression [i.e. as a “bridge”]. We developed and applied deductive and inductive codes and identified key themes related to early experiences of initiation and use of time-limited PrEP.
Results: Of the couples interviewed, all HIV-uninfected partners had initiated PrEP and 7 of the 16 HIV-infected partners interviewed had initiated ART at time of interview. Prior to joining the study, no couples had heard of PrEP. Interviewees often described their decision to take PrEP as “following the doctor's advice,” and believed that “doctor knows best” due to the trust that had been established between the health providers and couples. The friendly environment at the clinic reportedly enabled a majority of the couples to make shared decision to initiate PrEP. Many couples reported that PrEP could reduce the risk of HIV transmission, meet their aspirations for fertility and cope with HIV discordance (i.e. a solution to their discordance challenges). Remaining HIV negative in the follow-up visits reinforced couples' decisions and motivations to continue adhering to PrEP.
Conclusions: Among these early adopters of PrEP for HIV prevention, confidence in provider's advice and patient-friendly services were critical to decisions to initiate PrEP. PrEP responded to couples' values and preferences for reducing their HIV risk.
