Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up

Apondi, Rose; Bunnell, Rebecca; Ekwaru, John Paul; Moore, David; Bechange, Stevens; Khana, Kenneth; King, Rachel; Campbell, James D.; Tappero, Jordan W.; Mermin, Jonathan

doi:10.1097/qad.0b013e328347f775

Cited by 55 publications

(67 citation statements)

References 28 publications

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“…These differing approaches may be driven by evidence that treatment of the HIV-infected partner in a serodiscordant relationship significantly decreases the risk of HIV transmission. 28,29 Variability was also noted in frequency of follow up-visits: clinicians often preferred more frequent follow-up than is suggested by the guidance. Our findings are consistent with a prior study of HIV healthcare providers which found departure from the CDC guidance recommendations in testing for HIV infection, confirming high risk for acquiring HIV infection, screening/treatment for STIs, and screening for Hepatitis B.…”

Section: Discussionmentioning

confidence: 99%

Clinician Attitudes Toward CDC Interim Pre-Exposure Prophylaxis (PrEP) Guidance and Operationalizing PrEP for Adolescents

Mullins

Lally

Zimet

et al. 2015

AIDS Patient Care and STDs

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Prior to issuing formal HIV pre-exposure prophylaxis (PrEP) clinical practice guidelines in 2014, the US Centers for Disease Control and Prevention (CDC) had released interim guidance for oral PrEP use among adults. Because oral PrEP may be used off-label for youth and may soon be indicated for minor adolescents, we examined the potential adoption of the interim guidance among clinicians who care for HIV-infected and at-risk youth. Individual, semi-structured interviews were conducted with 15 US clinicians who were recruited through an adolescent HIV research network. The theory-driven interview guide, consisting primarily of openended questions, assessed demographics, familiarity with the guidance, attitudes toward the guidance, and attitudes toward the use of the guidance for adult and adolescent patients. Transcripts were analyzed using framework analysis. Most clinicians (11/15) reported that the guidance was compatible with their practice, although several reported that some aspects, particularly frequency of follow-up visits, needed to be tailored to meet their patients' needs. We found variability in clinician reported characteristics of appropriate PrEP candidates (e.g., youth with substance use and mental health issues were noted to be both suitable and unsuitable PrEP candidates) and PrEP use in serodiscordant couples (e.g., whether PrEP would be recommended to a patient whose HIV-infected partner is virally suppressed). Clinician reported steps for initiation, monitoring, and discontinuing PrEP were largely consistent with the guidance. The observed variability in clinician practice with regard to oral PrEP may be reduced through interventions to educate clinicians about the content and rationale for guideline recommendations.

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Section: Discussionmentioning

confidence: 99%

Clinician Attitudes Toward CDC Interim Pre-Exposure Prophylaxis (PrEP) Guidance and Operationalizing PrEP for Adolescents

Mullins

Lally

Zimet

et al. 2015

AIDS Patient Care and STDs

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“…This provides some insight into how people manage their social relationships, particularly managing new sexual partnerships while on treatment. 18 However, the strategies people use in resource-limited settings to complete the tasks of living with ART, have not been covered in depth. 19 This article aims to describe self-management tasks experienced and strategies used by people living with ART in central Uganda.…”

Section: Introductionmentioning

confidence: 99%

Tasks and Strategies of Self-Management of Living with Antiretroviral Therapy in Uganda

Martin

Kiwanuka

Kawuma

et al. 2013

AIDS Patient Care and STDs

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There is increasing interest in promoting and supporting self-management of HIV and antiretroviral treatment (ART), including in resource-limited settings. Although the impact of HIV and ART on people in Uganda has been explored, little attention has been paid to how people self-manage. This qualitative study collected data from 20 participants on ART in Wakiso district, Uganda, using in-depth interviews, life histories, and observations to explore the tasks and strategies of living with ART. The identified strategies were compared to two existing self-management frameworks. Results highlighted a range of tasks including obtaining, taking, and adhering to ART medication, monitoring their condition, living with stigma and managing disclosure, maintaining general health, and adjusting to new roles. Participants described a range of strategies or behaviors to manage, which they actively created and used, tailored to their needs and environment. Comparison with existing frameworks revealed many similarities, with some local differences in enactment, and greater emphasis in our sample on obtaining the medication. Interventions to support people with self-management in Uganda, and possibly other resource-limited settings, require careful adaptation to local settings. The degree to which each of these strategies may improve health and quality of life requires further investigation.

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“…14 The studies conducted to date on heterosexual serodiscordant couples indicate that the small number of documented HIV transmissions occurred from individuals who had recently started therapy and in whom it is unlikely that undetectable viral load was achieved. 13,14,18 Our previous study, 12 together with two others, 8,19 have been identified 20 as the only ones in which full viral suppression was confirmed in the index cases under HAART. Pooled transmission rate for these studies was zero per 100 person-years (95% CI: 0-0.05).…”

Section: Discussionmentioning

confidence: 94%

Absence of transmission from HIV-infected individuals with HAART to their heterosexual serodiscordant partners

Romero

Río

Castilla

et al. 2015

Enfermedades Infecciosas y Microbiología Clínica

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Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up

Abstract: Despite increased sexual activity among HIV-infected Ugandans over 3 years on ART, risky sex and estimated risk of HIV transmission remained lower than baseline levels. Integrated prevention programs could reduce HIV transmission in Africa.

Cited by 55 publications

References 28 publications

Clinician Attitudes Toward CDC Interim Pre-Exposure Prophylaxis (PrEP) Guidance and Operationalizing PrEP for Adolescents

Clinician Attitudes Toward CDC Interim Pre-Exposure Prophylaxis (PrEP) Guidance and Operationalizing PrEP for Adolescents

Tasks and Strategies of Self-Management of Living with Antiretroviral Therapy in Uganda

Absence of transmission from HIV-infected individuals with HAART to their heterosexual serodiscordant partners

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