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Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda.
J Int AIDS Soc. 2018 05; 21(5):e25113.JI

Abstract

INTRODUCTION

Serodiscordant couples are a priority population for delivery of new HIV prevention interventions in Africa. An integrated strategy of delivering time-limited, oral pre-exposure prophylaxis (PrEP) to uninfected partners in serodiscordant couples as a bridge to long-term antiretroviral treatment (ART) for infected partners has been implemented in East Africa, nearly eliminating new infections. We conducted a qualitative evaluation of the integrated strategy in Uganda, to better understand its success.

METHODS

Data collection consisted of 274 in-depth interviews with 93 participating couples, and 55 observations of clinical encounters between couples and healthcare providers. An inductive content analytic approach aimed at understanding and interpreting couples' experiences of the integrated strategy was used to examine the data. Analysis sought to characterize: (1) key aspects of services provided; (2) what the services meant to recipients; and (3) how couples managed the integrated strategy. Themes were identified in each domain, and represented as descriptive categories. Categories were grouped inductively into more general propositions based on shared content. Propositions were linked and interpreted to explain "why the integrated strategy worked."

RESULTS

Couples found "couples-focused" services provided through the integrated strategy strengthened partnered relationships threatened by the discovery of serodiscordance. They saw in services hope for "getting help" to stay together, turned joint visits to clinic into opportunities for mutual support, and experienced counselling as bringing them closer together. Couples adopted a "couples orientation" to the integrated strategy, considering the health of partners as they made decisions about initiating ART or accepting PrEP, and devising joint approaches to adherence. A couples orientation to services, grounded in strengthened partnerships, may have translated to greater success in using antiretrovirals to prevent HIV transmission.

CONCLUSIONS

Various strategies for delivering antiretrovirals for HIV prevention are being evaluated. Understanding how and why these strategies work will improve evaluation processes and strengthen implementation platforms. We highlight the role of service organization in shaping couples' experiences of and responses to ART and PrEP in the context of the integrated strategy. Organizing services to promote positive care experiences will strengthen delivery and contribute to positive outcomes as antiretrovirals for prevention are rolled out.

Authors+Show Affiliations

Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda. STD Clinic/Ward 12, Mulago Hospital, Kampala, Uganda.Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. Harvard Global, Cambridge, MA, USA.Infectious Diseases Institute, Makerere University, Kampala, Uganda.Kabwohe Clinical Research Centre, Kabwohe, Uganda.Kabwohe Clinical Research Centre, Kabwohe, Uganda.Department of Global Health, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA.Department of Medicine, Makerere University, Kampala, Uganda.

Pub Type(s)

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

Language

eng

PubMed ID

29851436

Citation

Ware, Norma C., et al. "Integrated Delivery of Antiretroviral Treatment and Pre-exposure Prophylaxis to HIV-1 Serodiscordant Couples in East Africa: a Qualitative Evaluation Study in Uganda." Journal of the International AIDS Society, vol. 21, no. 5, 2018, pp. e25113.
Ware NC, Pisarski EE, Nakku-Joloba E, et al. Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda. J Int AIDS Soc. 2018;21(5):e25113.
Ware, N. C., Pisarski, E. E., Nakku-Joloba, E., Wyatt, M. A., Muwonge, T. R., Turyameeba, B., Asiimwe, S. B., Heffron, R. A., Baeten, J. M., Celum, C. L., & Katabira, E. T. (2018). Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda. Journal of the International AIDS Society, 21(5), e25113. https://doi.org/10.1002/jia2.25113
Ware NC, et al. Integrated Delivery of Antiretroviral Treatment and Pre-exposure Prophylaxis to HIV-1 Serodiscordant Couples in East Africa: a Qualitative Evaluation Study in Uganda. J Int AIDS Soc. 2018;21(5):e25113. PubMed PMID: 29851436.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda. AU - Ware,Norma C, AU - Pisarski,Emily E, AU - Nakku-Joloba,Edith, AU - Wyatt,Monique A, AU - Muwonge,Timothy R, AU - Turyameeba,Bosco, AU - Asiimwe,Stephen B, AU - Heffron,Renee A, AU - Baeten,Jared M, AU - Celum,Connie L, AU - Katabira,Elly T, PY - 2017/08/31/received PY - 2018/05/04/accepted PY - 2018/6/1/entrez PY - 2018/6/1/pubmed PY - 2019/5/14/medline KW - HIV prevention KW - Uganda KW - antiretroviral treatment (ART) KW - evaluation KW - implementation KW - mechanism of effect KW - pre-exposure prophylaxis (PrEP) KW - service delivery SP - e25113 EP - e25113 JF - Journal of the International AIDS Society JO - J Int AIDS Soc VL - 21 IS - 5 N2 - INTRODUCTION: Serodiscordant couples are a priority population for delivery of new HIV prevention interventions in Africa. An integrated strategy of delivering time-limited, oral pre-exposure prophylaxis (PrEP) to uninfected partners in serodiscordant couples as a bridge to long-term antiretroviral treatment (ART) for infected partners has been implemented in East Africa, nearly eliminating new infections. We conducted a qualitative evaluation of the integrated strategy in Uganda, to better understand its success. METHODS: Data collection consisted of 274 in-depth interviews with 93 participating couples, and 55 observations of clinical encounters between couples and healthcare providers. An inductive content analytic approach aimed at understanding and interpreting couples' experiences of the integrated strategy was used to examine the data. Analysis sought to characterize: (1) key aspects of services provided; (2) what the services meant to recipients; and (3) how couples managed the integrated strategy. Themes were identified in each domain, and represented as descriptive categories. Categories were grouped inductively into more general propositions based on shared content. Propositions were linked and interpreted to explain "why the integrated strategy worked." RESULTS: Couples found "couples-focused" services provided through the integrated strategy strengthened partnered relationships threatened by the discovery of serodiscordance. They saw in services hope for "getting help" to stay together, turned joint visits to clinic into opportunities for mutual support, and experienced counselling as bringing them closer together. Couples adopted a "couples orientation" to the integrated strategy, considering the health of partners as they made decisions about initiating ART or accepting PrEP, and devising joint approaches to adherence. A couples orientation to services, grounded in strengthened partnerships, may have translated to greater success in using antiretrovirals to prevent HIV transmission. CONCLUSIONS: Various strategies for delivering antiretrovirals for HIV prevention are being evaluated. Understanding how and why these strategies work will improve evaluation processes and strengthen implementation platforms. We highlight the role of service organization in shaping couples' experiences of and responses to ART and PrEP in the context of the integrated strategy. Organizing services to promote positive care experiences will strengthen delivery and contribute to positive outcomes as antiretrovirals for prevention are rolled out. SN - 1758-2652 UR - https://www.unboundmedicine.com/medline/citation/29851436/Integrated_delivery_of_antiretroviral_treatment_and_pre_exposure_prophylaxis_to_HIV_1_serodiscordant_couples_in_East_Africa:_a_qualitative_evaluation_study_in_Uganda_ L2 - https://doi.org/10.1002/jia2.25113 DB - PRIME DP - Unbound Medicine ER -