Abstract:
Background: Intimate partner violence (IPV) is associated with
higher HIV incidence, reduced condom use, and poor adherence to
antiretroviral therapy and other medications. IPV may also affect
adherence to pre-exposure prophylaxis (PrEP).
Methods: We analyzed data from 1785 HIV-uninfected women
enrolled in a clinical trial of PrEP among African HIV serodiscordant
couples. Experience of verbal, physical, or economic IPV was
assessed at monthly visits by face-to-face interviews. Low PrEP
adherence was defined as clinic-based pill count coverage ,80% or plasma tenofovir levels ,40 ng/mL. The association between IPV and
low adherence was analyzed using generalized estimating equations,
adjusting for potential confounders. In-depth interview transcripts
were examined to explain how IPV could impact adherence.
Results: Sixteen percent of women reported IPV during a median
of 34.8 months of follow-up (interquartile range 27.0–35.0). Overall,
7% of visits had pill count coverage ,80%, and 32% had plasma
tenofovir ,40 ng/mL. Women reporting IPV in the past 3 months
had increased risk of low adherence by pill count (adjusted risk ratio
1.49, 95% confidence interval: 1.17 to 1.89) and by plasma tenofovir
(adjusted risk ratio 1.51, 95% confidence interval: 1.06 to 2.15).
Verbal, economic, and physical IPV were all associated with low
adherence. However, the impact of IPV diminished and was not
statistically significant 3 months after the reported exposure. In
qualitative interviews, women identified several ways in which IPV
affected adherence, including stress and forgetting, leaving home
without pills, and partners throwing pills away.
Conclusions: Women who reported recent IPV in the Partners
PrEP Study were at increased risk of low PrEP adherence. Strategies
to mitigate PrEP nonadherence in the context of IPV should
be evaluated.
