Pre-exposure prophylaxis use among HIV serodiscordant couples: a qualitative study in Mozambique

Abstract

Background: Pre-exposure prophylaxis (PrEP) has the potential to reduce HIV transmission and stem the HIV epidemic. Unfortunately, PrEP uptake in rural sub-Saharan Africa has been slow and medication adherence has been suboptimal. Objective: To explore the perspectives, attitudes, and experiences of HIV serodiscordant partners taking PrEP and develop a messaging campaign to improve PrEP uptake in rural Mozambique to reduce HIV transmission among serodiscordant partners. Methods: In this qualitative study, we interviewed 20 people in serodiscordant relationships using PrEP at a rural health center in Zambézia province, Mozambique and employed inductive and deductive coding to elicit their perspectives, attitudes, and experiences related to learning their partner's HIV status, barriers to PrEP uptake, obstacles to PrEP adherence, and decisions to disclose their PrEP use with family and friends using thematic analysis. Results: Our analysis generated nine themes across various levels of the socioecological model. Participants reported a strong desire to stay in the discordant relationship and highlighted the importance of working together to ensure PrEP and antiretroviral therapy adherence, with the majority skeptical that adherence could be achieved without both partners' support (individual and interpersonal). Although most participants were reticent about sharing their serodiscordant status with family and friends (individual and interpersonal), those who did found their family and friends supportive (interpersonal). Participants suggested increasing community health agent availability to help people navigate HIV prevention and treatment (organizational). We then created three oral stories, using themes from the interviews, with examples from various levels of the socioecological model that will be used to generate support for PrEP use among community members. Conclusions: Our findings informed oral template stories that will be used to emphasize how couples can work together to improve PrEP uptake and reduce incident HIV infections in serodiscordant couples elsewhere in rural Mozambique.

Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review

“…Several studies explored factors that influence PrEP initiation, non-initiation and discontinuation in individuals who received PrEP through the different SDMs 24 25 42–44 52. Motivators to initiate PrEP included: perception of high risk, preference of PrEP over other HIV prevention methods, protection from unwanted/forced sexual encounters, love for one’s partner, knowledge about PrEP and the belief it is effective, partner support belief that PrEP supported life goals and a positive clinical encounter 24 25 42–44 52 53. Females preferred a product that was delivered at a health clinic over accessing it at a pharmacy 54.…”

“…Females preferred a product that was delivered at a health clinic over accessing it at a pharmacy 54. Barriers to PrEP initiation included daily pill burden, side effects, mixed dosing messaging, living with parents or attending school, partners consent or partners reaction to use and HIV-related stigma 24 25 42–44 52 53…”

Experiences of oral pre‐exposure prophylaxis use among heterosexual men accessing sexual and reproductive health services in South Africa: a qualitative study

“…Participants perceived themselves to be vulnerable to HIV based on their sexual behaviour, which included having multiple sexual partners, being in serodifferent relationships, having unplanned sexual intercourse, and having condomless sex and challenges with condom use, particularly when using alcohol. For some participants, motivation to initiate PrEP centred on protecting partners and maintaining relationships, similar to a study among serodifferent couples [ 21 ]. In this study, PrEP was seen as a preferred HIV prevention method compared to consistent condom use, which was perceived to make sex less pleasurable and was challenging when sex occurred under the influence of alcohol; PrEP counselling should highlight the importance of condom use in addition to PrEP use to enhance protection against HIV and other sexually transmitted infections.…”

HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross‐sectional study in the Democratic Republic of Congo

“…The primary outcome of interest was depressive symptoms, screened with the PHQ-9, a brief instrument based on the nine diagnostic criteria of the DSM-IV for major depressive disorder [24]. The PHQ-9 total score ranges from 0 to 27 with five severity categories: minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19) and severe (20)(21)(22)(23)(24)(25)(26)(27). The country research team in our previous study in DRC translated the PHQ-9 from French to Lingala, back-translated from Lingala to French and field tested the Lingala version [25].…”

“…For people in stable partnerships, disclosure of one's HIV status and knowledge of a permanent partner's status can be critical for maintaining their relationship and staying in care, particularly for serodiscordant couples who can benefit from the use of pre-exposure prophylaxis (PrEP) [20,21]. A qualitative study among serodiscordant couples in Mozambique found that participants had a strong desire to stay in the discordant relationship and emphasized the need to work together and support each other to ensure PrEP and ART adherence [22].…”