Citation

Roberts ST, Haberer JE, Celum C, Mugo N, Ware NC, Cohen CR, Tappero JW, Kiarie J, Ronald A, Mujugira A, Tumwesigye E, Were E, Irungu E, Baeten JM. J. Acquir. Immune Defic. Syndr. (LWW) 2016; 73(3): 313-322.

Affiliation

1Department of Epidemiology, University of Washington, Seattle, WA, USA; 2Department of Medicine and Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; 3Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; 4Department of Global Health, University of Washington, Seattle, WA, USA; 5Department of Medicine, University of Washington, Seattle, WA, USA; 6Kenya Medical Research Institute, Nairobi, Kenya; 7Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; 8Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA; 9Centers for Disease Control and Prevention, Atlanta, GA, USA; 10Department of Obstetrics and Gynaecology University of Nairobi, Nairobi, Kenya; 11Department of Medicine, University of Manitoba, Winnipeg, Canada; 12Kabwohe Clinical Research Center, Kabwohe, Uganda; 13Department of Reproductive Health Moi University, Eldoret, Kenya; 14Kenyatta National Hospital, Nairobi, Kenya; *Members of the Partners PrEP Study Team listed in the Acknowledgements section.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/QAI.0000000000001093

PMID

27243900

Abstract

BACKGROUND: Intimate partner violence (IPV) is associated with higher HIV incidence, reduced condom use, and poor adherence to antiretroviral therapy and other medications. IPV may also affect adherence to pre-exposure prophylaxis (PrEP).

METHODS: We analyzed data from 1785 HIV-uninfected women enrolled in a clinical trial of PrEP among African HIV-serodiscordant couples. Experience of verbal, physical, or economic IPV was assessed at monthly visits by face-to-face interviews. Low PrEP adherence was defined as clinic-based pill count coverage <80% or plasma tenofovir levels <40 ng/mL. The association between IPV and low adherence was analyzed using generalized estimating equations, adjusting for potential confounders. In-depth interview transcripts were examined to explain how IPV could impact adherence.

RESULTS: 16% of women reported IPV during a median of 34.8 months of follow-up (IQR 27.0 - 35.0). Overall, 7% of visits had pill count coverage <80% and 32% had plasma tenofovir <40 ng/mL. Women reporting IPV in the past 3 months had increased risk of low adherence by pill count (adjusted RR 1.49, 95% CI 1.17-1.89) and by plasma tenofovir (adjusted RR 1.51, 95% CI 1.06-2.15). Verbal, economic, and physical IPV were all associated with low adherence. However, the impact of IPV diminished and was not statistically significant 3 months after the reported exposure. In qualitative interviews, women identified several ways in which IPV affected adherence, including stress and forgetting, leaving home without pills, and partners throwing pills away.

CONCLUSION: Women who reported recent IPV in the Partners PrEP Study were at increased risk of low PrEP adherence. Strategies to mitigate PrEP non-adherence in the context of IPV should be evaluated.

Language: en