Sexual behaviors following PrEP discontinuation among HIV serodiscordant couples in Kenya and Uganda.

BACKGROUND: A strategy of pre-exposure prophylaxis (PrEP) transitioning to treatment as prevention is highly efficacious and cost-effective for prevention of HIV transmission within HIV serodiscordant couples. We assessed whether couples who adopted this strategy experienced changes in sexual behaviors after HIV-negative partners discontinued PrEP and transitioned to rely primarily on their partner's adherence to antiretroviral therapy (ART) for prevention.

SETTING: Kenya and Uganda METHODS:: Data are from the Partners Demonstration Project, a prospective, open-label evaluation of PrEP and ART use for HIV prevention. Using zero-inflated negative binomial models, we assessed changes in the level (i.e., intercept) and trend over time (i.e., slope) in total and condomless sex acts reported after PrEP discontinuation by HIV-negative partners. We conducted subgroup analyses based on HIV-negative partners' age and sex.

RESULTS: We included 567 couples where the HIV-negative partner discontinued PrEP due to their partner with HIV using ART for ≥6 months. HIV-negative partners were female in 32.6% of couples and had a median age of 30. We observed no change in the level or trend over time in total sex acts (level adjusted rate ratio [aRR]=0.95, 95% CI: 0.87-1.04; trend aRR=1.00, 95% CI: 0.99-1.01) or condomless sex acts (level aRR=0.97, 95% CI: 0.81-1.17; trend aRR=1.00, 95% CI: 0.98-1.03) reported after PrEP discontinuation versus pre-discontinuation. No significant changes in behaviors were observed in age and sex subgroups.

CONCLUSION: PrEP discontinuation appears to result in no significant changes in couples' sexual behaviors. These data further support a strategy of time-limited PrEP use by serodiscordant couples.