Title

Low awareness of pre-exposure prophylaxis (PrEP) for protection against HIV transmission among HIV-infected women in HIV-serodiscordant couples in Kenya: Results from a nationwide survey

Presenter

Jillian Pintye

Authors

J. Pintye¹, P. Oluoch², D. Achwoka², A. Langat², B. Singa³, J. Kinuthia^1,4, A. Katana², L. Nganga², C. McGrath¹, G. John-Stewart⁵, A. Drake¹

Institutions

¹University of Washington, Department of Global Health, Seattle, United States, ²Centers for Disease Control and Prevention, Nairobi, Kenya, ³Kenya Medical Research Institute, Nairobi, Kenya, ⁴Kenyatta National Hospital, Nairobi, Kenya, ⁵University of Washington, Departments of Global Health, Epidemiology and Medicine, Seattle, United States

Background: PrEP for HIV-serodiscordant couples is being scaled-up through HIV care programs in high burden settings. HIV-infected partners'' awareness of PrEP as a method for protection against transmission will influence effective PrEP utilization among HIV-uninfected partners. We evaluated PrEP awareness among HIV-infected women in HIV treatment programs in Kenya.
Methods: Data from a cross-sectional survey of HIV-infected women enrolled at 109 HIV care programs with ≥1000 antiretroviral therapy (ART) clients across Kenya were analyzed to evaluate PrEP awareness. Data were collected from June-September 2016 by mobile teams. Participants were aged 15-49 years, not currently pregnant and had vaginal intercourse within the last 6 months. Clinical characteristics and male partner status were determined by women''s self-report. PrEP awareness was ascertained by asking participants to list methods they had heard of to protect their HIV-uninfected partners from acquiring HIV. Correlates of PrEP awareness were determined by logistic regression analysis adjusted for facility-level clustering.
Results: Among 4805 HIV-infected women surveyed, 938 (28%) had a known HIV-uninfected male partner. Of these 938 women in HIV-serodiscordant couples, 67% were married, median age was 34 years (interquartile range, IQR [29-40]), and median education was 9 years (IQR 8-12). Overall, 96% of HIV-infected women in HIV-serodiscordant couples were on ART for a median of 5 years (IQR 2-8). Most (96%) had disclosed their HIV status to their partner and 29% reported inconsistent condom use within the last month. Only 6% were aware of PrEP as a method for protecting HIV-uninfected partners from acquiring HIV. Compared to women unaware of PrEP, women with PrEP awareness were more likely to have completed >12 years of education (odds ratio [OR]=4.45, 95% CI 2.36-8.41, p< 0.001); there were no differences in age or employment between groups. Few (< 1%) women reported that their HIV-uninfected partners had ever used PrEP, though 51% believed their partner could take a daily pill to prevent HIV, if available.
Conclusions: PrEP awareness was low in this large survey of HIV-infected women in HIV-serodiscordant couples, but belief that partners could use PrEP was high. Sensitizing HIV-care clients in HIV-serodiscordant couples about PrEP may enhance awareness and utilization in this high-risk population.