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

Abstract

Background: Adherence to PrEP medication is key for its efficacy in prevention of HIV infection acquisition by uninfected partner during high risk periods of HIV exposure. Some studies have demonstrated adherence to oral PrEP may be determined by lifestyle changes like excess alcohol intake, multiple sexual partners, frequent travels and frequency of sex. Other determinants of adherence to intake of PrEP includes employment, side effects of PrEP drugs, condom use and clinic accessibility. Objective: The study was 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 CCC. Methodology: This was a cross-sectional design that applied two data collection methods: semi structured questionnaires guided interview and a checklist that was used during review of respondents’ medical records. Both qualitative and quantitative data were collected. Convenience sampling method was used to get a sample size of 51 participants from about 60 HIV negative partners in serodiscordant heterosexual relationships who were taking oral PrEP. Data was analyzed using SPSS IBM statistics version 24 software. Both descriptive and inferential analysis were done. Descriptive analysis included the following; frequencies, percentages, means and standard deviations which were displayed in charts and frequency tables. Inferential analysis included binomial logistic regression and chi square statistical tests with a P value of ≤ 0.05 set as significant. Results: 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. Maturity and higher education were associated with increased overall adherence to PrEP. (p=0.01). Longer period of being in HIV discordant relationship was associated with increased adherence to PrEP. (p=0.04). Use of condom after PrEP break was associated with increased intake of oral PrEP. (p=0.04). Those who engaged their partners in adherence support (80%) and had a plan of remembering to take their PrEP e.g. an alarm (58%) were found to have good adherence to intake of PrEP pills. (p=0.04). Increase in frequency of doing a HIV test was associated with increased adherence to intake of oral PrEP. (p=0.04). Majority (58.3%) reported side effects for the first two weeks after PrEP initiation, and presence of side effects was associated with reduced adherence to intake of PrEP pills. (p=0.003). Majority (98%) demonstrated good knowledge and understanding on use of PrEP which was associated with good overall adherence to PrEP. The respondents who engaged in extra marital sex (11.8%) (p=0.04) and those that used alcohol (19.6%) (p=0.05) were shown to have reduced adherence to intake of PrEP pills. Conclusion and recommendations: The overall adherence for the different levels (intake, timing, appointments) was over 70%. The key determinants of the adherence observed were being male, being older in age, higher education, longer period of being in discordant status, partners support and higher frequency of HIV testing. However side effects of treatment, alcohol use and extra marital sex were associated with low adherence across all levels. 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.