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

Samuel Mwangi Mwaura; Rysper Eve Rajula; Angeline Chepchirchir Kirui

doi:doi:10.11648/j.ijhpebs.20190502.16

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

Samuel Mwangi Mwaura, Rysper Eve Rajula, Angeline Chepchirchir Kirui

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 5, Issue 2)

Received: 27 September 2019 Accepted: 15 October 2019 Published: 24 October 2019

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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.

Published in	International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 5, Issue 2)
DOI	10.11648/j.ijhpebs.20190502.16
Page(s)	115-123
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Pre-exposure Prophylaxis, Adherence, Determinants, Serodiscordant, Heterosexual, Couples, HIV

References

[1]	Unaids. UNAIDS DATA 2018. 2018.
[2]	National AIDS & STI Control Programme (NASCOP). Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV infection in Kenya, 2018 Edition. 2018.
[3]	National AIDS & STI Control Programme M of HK. Pre Exposure Prophylaxis for HIV (Oral PrEP) – NASCOP. NASCOP 2018. https://www.nascop.or.ke/?p=2709 (accessed December 20, 2018).
[4]	World Health Organization (WHO). Consultation on Pre-exposure Prophylaxis (PrEP). Meeting Report. Miami, USA 2014. Available from: https://www.who.int/hiv/pub/prep/consultation-prep-adherence/en/
[5]	McMahon JM, Myers JE, Kurth AE, Cohen SE, Mannheimer SB, Simmons J, et al. Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges. AIDS Patient Care and STDs 2014; 28: 462–74. doi: 10.1089/apc.2013.0302.
[6]	Zheng Z, Li Y, Jiang Y, Liang X, Qin S, Nehl EJ. Population HIV transmission risk for serodiscordant couples in Guangxi, Southern China: A cohort study. Medicine 2018; 97: e12077. doi: 10.1097/MD.0000000000012077.
[7]	Desai M, Field N, Grant R, McCormack S. Recent advances in pre-exposure prophylaxis for HIV. BMJ (Clinical Research Ed) 2017; 359: j5011. doi: 10.1136/bmj.j5011.
[8]	Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure Prophylaxis for HIV Infection among African Women. New England Journal of Medicine 2012; 367: 411–22. doi: 10.1056/NEJMoa1202614.
[9]	Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-Based Preexposure Prophylaxis for HIV Infection among African Women. New England Journal of Medicine 2015; 372: 509–18. doi: 10.1056/NEJMoa1402269.
[10]	Curran K, Baeten JM, Coates TJ, Kurth A, Mugo NR, Celum C. HIV-1 prevention for HIV-1 serodiscordant couples. Current HIV/AIDS Reports 2012; 9: 160–70. doi: 10.1007/s11904-012-0114-z.
[11]	Tobin SC. VOICE reveals the need to improve adherence in PrEP trials. AIDS 2015; 29: N9. doi: 10.1097/QAD.0000000000000693.
[12]	Haberer JE. Current concepts for PrEP adherence in the PrEP revolution: from clinical trials to routine practice. Current Opinion in HIV and AIDS 2016; 11: 10–7. doi: 10.1097/COH.0000000000000220.
[13]	Mugo PM, Sanders EJ, Mutua G, van der Elst E, Anzala O, Barin B, et al. Understanding Adherence to Daily and Intermittent Regimens of Oral HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in Kenya. AIDS and Behavior 2015; 19: 794–801. doi: 10.1007/s10461-014-0958-x.
[14]	Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine 2013; 35: 121–6. doi: 10.4103/0253-7176.116232.
[15]	Heffron R, Ngure K, Mugo N, Celum C, Kurth A, Curran K, et al. Willingness of Kenyan HIV-1 serodiscordant couples to use antiretroviral based HIV-1 prevention strategies. Journal of Acquired Immune Deficiency Syndromes (2012) 61 (1) 116-119 n.d. doi: 10.1097/QAI.0b013e31825da73f.

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Samuel Mwangi Mwaura, Rysper Eve Rajula, Angeline Chepchirchir Kirui. (2019). Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 5(2), 115-123. https://doi.org/10.11648/j.ijhpebs.20190502.16

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Samuel Mwangi Mwaura; Rysper Eve Rajula; Angeline Chepchirchir Kirui. Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2019, 5(2), 115-123. doi: 10.11648/j.ijhpebs.20190502.16

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AMA Style

Samuel Mwangi Mwaura, Rysper Eve Rajula, Angeline Chepchirchir Kirui. Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships. Int J HIV/AIDS Prev Educ Behav Sci. 2019;5(2):115-123. doi: 10.11648/j.ijhpebs.20190502.16

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@article{10.11648/j.ijhpebs.20190502.16,
  author = {Samuel Mwangi Mwaura and Rysper Eve Rajula and Angeline Chepchirchir Kirui},
  title = {Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {5},
  number = {2},
  pages = {115-123},
  doi = {10.11648/j.ijhpebs.20190502.16},
  url = {https://doi.org/10.11648/j.ijhpebs.20190502.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20190502.16},
  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.},
 year = {2019}
}

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TY  - JOUR
T1  - Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships
AU  - Samuel Mwangi Mwaura
AU  - Rysper Eve Rajula
AU  - Angeline Chepchirchir Kirui
Y1  - 2019/10/24
PY  - 2019
N1  - https://doi.org/10.11648/j.ijhpebs.20190502.16
DO  - 10.11648/j.ijhpebs.20190502.16
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 115
EP  - 123
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20190502.16
AB  - 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.
VL  - 5
IS  - 2
ER  -

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Author Information

Samuel Mwangi Mwaura

Department of Medical Surgical Nursing, University of Nairobi, Nairobi, Kenya
Rysper Eve Rajula

Department of Community Health Nursing, University of Nairobi, Nairobi, Kenya
Angeline Chepchirchir Kirui

Department of Medical Surgical Nursing, University of Nairobi, Nairobi, Kenya

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APA Style

Samuel Mwangi Mwaura, Rysper Eve Rajula, Angeline Chepchirchir Kirui. (2019). Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 5(2), 115-123. https://doi.org/10.11648/j.ijhpebs.20190502.16

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ACS Style

Samuel Mwangi Mwaura; Rysper Eve Rajula; Angeline Chepchirchir Kirui. Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2019, 5(2), 115-123. doi: 10.11648/j.ijhpebs.20190502.16

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AMA Style

Samuel Mwangi Mwaura, Rysper Eve Rajula, Angeline Chepchirchir Kirui. Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships. Int J HIV/AIDS Prev Educ Behav Sci. 2019;5(2):115-123. doi: 10.11648/j.ijhpebs.20190502.16

Copy | Download

@article{10.11648/j.ijhpebs.20190502.16,
  author = {Samuel Mwangi Mwaura and Rysper Eve Rajula and Angeline Chepchirchir Kirui},
  title = {Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {5},
  number = {2},
  pages = {115-123},
  doi = {10.11648/j.ijhpebs.20190502.16},
  url = {https://doi.org/10.11648/j.ijhpebs.20190502.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20190502.16},
  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.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Determinants of Adherence Levels to Oral Pre-exposure Prophylaxis among Seronegative Partners in HIV Discordant Heterosexual Relationships
AU  - Samuel Mwangi Mwaura
AU  - Rysper Eve Rajula
AU  - Angeline Chepchirchir Kirui
Y1  - 2019/10/24
PY  - 2019
N1  - https://doi.org/10.11648/j.ijhpebs.20190502.16
DO  - 10.11648/j.ijhpebs.20190502.16
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 115
EP  - 123
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20190502.16
AB  - 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.
VL  - 5
IS  - 2
ER  -

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