Counsel PrEP and ART Strategies in HIV-Serodiscordant Couples
Experts agree that integrated antiretroviral therapy (ART) for HIV-positive partners and time-limited pre-exposure prophylaxis (PrEP) for negative partners almost eliminates HIV transmission.
In the United States, estimates indicate that approximately 50% of women with HIV are in serodiscordant partnerships. To prevent HIV transmission, clinicians need to consider HIV serodiscordant couples' reproductive intentions. Experts agree that integrated antiretroviral therapy (ART) for HIV-positive partners and time-limited pre-exposure prophylaxis (PrEP) for negative partners almost eliminates HIV transmission.
An international team of researchers reports that standardized messaging is required for widespread uptake of appropriate measures in serodiscordant couples. They stress that such information must consider individuals' motivators and barriers as they consider HIV treatment and prevention.
The standardized messaging project was conducted in Kenya and Uganda, but the approach and message applies globally. Using data from the Partners Demonstration Project, the research team structured a prospective interventional project enrolling 1013 serodiscordant couples and offering ART to eligible HIV-positive partners. PrEP was recommended to HIV-negative partners before the positive partner began ART and for 6 months thereafter. Counseling staff were interviewed individually and in groups to identify a health communication framework and key messages to provide in counseling sessions accompanying PrEP and ART delivery.
Counselors offered education about HIV serodiscordance, PrEP, and ART initiation and integrated use, and PrEP discontinuation. Counselors also highlighted the need for daily, lifelong ART use for treatment and prevention. They emphasized and explained adherence, viral suppression, resistance, side effects, and ART safety during pregnancy.
PrEP counseling included information on daily dosing, PrEP continuation until the HIV-positive partner was completely adherent to ART for 6 months, adherence, safety during conception, side effects, and other risks.
Structured in this way, counseling helped patients and their partners understand PrEP as a bridge to effective ART use in the HIV-positive partner, according to the researchers. It encouraged both partners to become confident that viral suppression prevents HIV effectively, and prepared them for PrEP discontinuation.
This counseling framework presents time-limited PrEP as a bridge to ART-driven viral suppression. Counseling staff can provide key messages to HIV-serodiscordant couples to encourage PrEP use, and the importance of PrEP and ART strategies in prevention and treatment.
This study appears in the January 2017 issue of the Journal of Acquired Immune Deficiency Syndrome.
Morton JF, Celum C, Njoroge J, et al. Partners Demonstration Project Team. 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; Jan 1;74 Suppl 1:S15-S22.