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Counseling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention.
J Acquir Immune Defic Syndr. 2017 01 01; 74 Suppl 1:S15-S22.JA

Abstract

BACKGROUND

For HIV-serodiscordant couples, integrated delivery of antiretroviral therapy (ART) for HIV-positive partners and time-limited pre-exposure prophylaxis (PrEP) for negative partners virtually eliminates HIV transmission. Standardized messaging, sensitive to the barriers and motivators to HIV treatment and prevention, is needed for widespread scale-up of this approach.

METHODS

Within the Partners Demonstration Project, a prospective interventional project among 1013 serodiscordant couples in Kenya and Uganda, we offered ART to eligible HIV-positive partners and PrEP to HIV-negative partners before ART initiation and through the HIV-positive partner's first 6 months of ART use. We conducted individual and group discussions with counseling staff to elicit the health communication framework and key messages about ART and PrEP that were delivered to couples.

RESULTS

Counseling sessions for serodiscordant couples about PrEP and ART included discussions of HIV serodiscordance, PrEP and ART initiation and integrated use, and PrEP discontinuation. ART messages emphasized daily, lifelong use for treatment and prevention, adherence, viral suppression, resistance, side effects, and safety of ART during pregnancy. PrEP messages emphasized daily dosing, time-limited PrEP use until the HIV-positive partner sustained 6 months of high adherence to ART, adherence, safety during conception, side effects, and other risks for HIV.

CONCLUSIONS

Counseling messages for HIV-serodiscordant couples are integral to the delivery of time-limited PrEP as a "bridge" to ART-driven viral suppression. Their incorporation into programmatic scale-up will maximize intervention impact on the global epidemic.

Authors+Show Affiliations

Departments of *Global Health; †Epidemiology; ‡Medicine, University of Washington, Seattle, WA; §Centres for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; ‖Infectious Disease Institute, Makerere University, Kampala, Uganda; ¶Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; #Kabwohe Clinical Research Center, Kabwohe, Uganda; **Department of Public and Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; and ††Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27930607

Citation

Morton, Jennifer F., et al. "Counseling Framework for HIV-Serodiscordant Couples On the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention." Journal of Acquired Immune Deficiency Syndromes (1999), vol. 74 Suppl 1, 2017, pp. S15-S22.
Morton JF, Celum C, Njoroge J, et al. Counseling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention. J Acquir Immune Defic Syndr. 2017;74 Suppl 1:S15-S22.
Morton, J. F., Celum, C., Njoroge, J., Nakyanzi, A., Wakhungu, I., Tindimwebwa, E., Ongachi, S., Sedah, E., Okwero, E., Ngure, K., Odoyo, J., Bulya, N., Haberer, J. E., Baeten, J. M., & Heffron, R. (2017). Counseling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention. Journal of Acquired Immune Deficiency Syndromes (1999), 74 Suppl 1, S15-S22.
Morton JF, et al. Counseling Framework for HIV-Serodiscordant Couples On the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention. J Acquir Immune Defic Syndr. 2017 01 1;74 Suppl 1:S15-S22. PubMed PMID: 27930607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Counseling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention. AU - Morton,Jennifer F, AU - Celum,Connie, AU - Njoroge,John, AU - Nakyanzi,Agnes, AU - Wakhungu,Imeldah, AU - Tindimwebwa,Edna, AU - Ongachi,Snaidah, AU - Sedah,Eric, AU - Okwero,Emmanuel, AU - Ngure,Kenneth, AU - Odoyo,Josephine, AU - Bulya,Nulu, AU - Haberer,Jessica E, AU - Baeten,Jared M, AU - Heffron,Renee, AU - ,, PY - 2016/12/9/entrez PY - 2016/12/9/pubmed PY - 2017/8/12/medline SP - S15 EP - S22 JF - Journal of acquired immune deficiency syndromes (1999) JO - J. Acquir. Immune Defic. Syndr. VL - 74 Suppl 1 N2 - BACKGROUND: For HIV-serodiscordant couples, integrated delivery of antiretroviral therapy (ART) for HIV-positive partners and time-limited pre-exposure prophylaxis (PrEP) for negative partners virtually eliminates HIV transmission. Standardized messaging, sensitive to the barriers and motivators to HIV treatment and prevention, is needed for widespread scale-up of this approach. METHODS: Within the Partners Demonstration Project, a prospective interventional project among 1013 serodiscordant couples in Kenya and Uganda, we offered ART to eligible HIV-positive partners and PrEP to HIV-negative partners before ART initiation and through the HIV-positive partner's first 6 months of ART use. We conducted individual and group discussions with counseling staff to elicit the health communication framework and key messages about ART and PrEP that were delivered to couples. RESULTS: Counseling sessions for serodiscordant couples about PrEP and ART included discussions of HIV serodiscordance, PrEP and ART initiation and integrated use, and PrEP discontinuation. ART messages emphasized daily, lifelong use for treatment and prevention, adherence, viral suppression, resistance, side effects, and safety of ART during pregnancy. PrEP messages emphasized daily dosing, time-limited PrEP use until the HIV-positive partner sustained 6 months of high adherence to ART, adherence, safety during conception, side effects, and other risks for HIV. CONCLUSIONS: Counseling messages for HIV-serodiscordant couples are integral to the delivery of time-limited PrEP as a "bridge" to ART-driven viral suppression. Their incorporation into programmatic scale-up will maximize intervention impact on the global epidemic. SN - 1944-7884 UR - https://www.unboundmedicine.com/medline/citation/27930607/Counseling_Framework_for_HIV_Serodiscordant_Couples_on_the_Integrated_Use_of_Antiretroviral_Therapy_and_Pre_exposure_Prophylaxis_for_HIV_Prevention_ L2 - http://dx.doi.org/10.1097/QAI.0000000000001210 DB - PRIME DP - Unbound Medicine ER -