The Confronting violence in intimate relationships is associated with an increased risk of poor adherence to pre-exposure prophylaxis (PrEP) among women in serodiscordant relationships in sub-Saharan Africa, this is the online edition ofJournal of Acquired Immunodeficiency Syndrome. Overall, 16% of women who have experienced intimate partner violence (IPV) and this determined a use sub-optimal PrEP grip around 50%, when adhesion is evaluated by any method of counting pills or plasma concentrations of tenofovir .
"This is the first study to examine the association between IPV and PrEP adherence, the authors write. "Women who reported IPV last 3 months had an increased risk of low adherence PrEP."
PrEP has been shown to reduce the risk of infection with HIV in a variety of populations, including gay men, heterosexual men and women and injecting drug users. We recommend, therefore PrEP as part of comprehensive HIV prevention programs aimed at high-risk populations.
The efficacy of PrEP is related to accession. Violence in intimate relationships has been linked to a higher incidence of HIV, reduced the use of condoms and suboptimal adherence to antiretroviral therapy. It is therefore possible that violence in intimate relationships can also affect adherence to PrEP.
Recent researchers Partners in PrEP study therefore analyzed data obtained from 1785 HIV negative women in serodiscordant relationships included in the study. face to face monthly interviews, women were asked to report their experiences of verbal behavior, physical or economic in the face of violence in intimate relationships.
The researchers assessed the relationship between partner abuse and a sub-optimal adherence to PrEP. Two measures were used to evaluate adhesion: pills count (80% less than the doses set low adhesion) and measuring plasma levels of tenofovir (defined as low adhesion levels below 40 ng / ml). In-depth interviews with a subset of women from insights into how the violence in intimate relationships affected adherence and individual intention to maintain PrEP as well as the strategies used to maintain adherence to PrEP in the context of "violent relationships."
Participants had a mean age of 33 years 70% had obtained an income in the last three months prior. The vast majority (99%) were married. The average relationship duration was 13 years and women had declared in serodiscordant relationships in an average of 1,4 years.
During 35 months of follow-up, 288 women (16%) reported violence in intimate relationships in 437 study visits (0,7% of the total). Of these women, 69% reported violence in intimate relationships on a visit, 20% in two visits, 7% in three visits and 5% in four or more visits. The most common form of violence in intimate relationships reported was verbal, followed by physical and economic. Women reporting violence in intimate relationships last month were less likely to report abuse than women with abuse report that had sexual intercourse having had sex with any partner in his comparative study of recent partners (69% versus 81%), but more likely linked to unprotected sexual activity report (22% versus 13%). They were also the ones that have reported more sex with partners who reported sex with another partner (20% versus 15%).
These reports of violence in intimate relationships were similar in most respects to women who did not report the respective partner violence.
The adherence assessed by pill count was high (95%) among most women, regardless of reported violence in intimate relationships. The pill counts suggested the membership below 80% to 7% of study visits and 32% of tenofovir plasma measurements were below optimal levels.
In general, women were 50% more likely to have inadequate adherence to PrEP had experienced violence in intimate relationships in the previous three months. This association was consistent regardless of membership be measured by pill count (RAR, 1,51 CI 95%, 1,17-1,89, p = 0,001) or plasma concentrations of tenofovir (RAR, 1,51 CI 95%, 1,06-2,15, p = 0,02).
However, the impact of violence in intimate relationships on the accession was no longer significant after three months.
When "types" of violence in intimate relationships were considered separately, the researchers found a significant relationship between inadequate adhesion and verbal abuse (ARR = 1,65 CI 95%, 1,17-2,33, p = 0,005) and low grip when there was abuse of power economic by the partner who committed violence (ARR = 1,48, 95% CI, 1,14-1,92, p = 0,003). The relationship between low adherence and physically violent partner was not significant, but the higher frequency of physical abuse of a partner was associated with lower adherence to treatment (p <0,001).
There were a total of 48 new HIV infections among women. However, living under violence in intimate relationships did not significantly increase the risk of seroconversion. Seven women discussed the violence in intimate relationships during interviews with staff. Reasons for the form of abuse by the partners concerned affecting adherence included stress and forgetfulness, daily routine running, skipping doses and medication partners wasting medicines.
Strategies to overcome these challenges and maintain high adherence include sending children to recover pills that had been thrown away, or explain events to the clinic staff, who were able to offer replacement therapy.
"Efforts to target women with IPV PrEP should recognize the low risk of adherence, and interventions should be evaluated to promote adherence to PrEP in the context of violence, the authors conclude. "Some women in our study reported strategies to maintain grip in the face of IPV and the lessons these examples of resilience could help in the development of successful interventions. Such interventions could increase the benefit of PrEP by promoting effective use in a population at high risk for HIV infection. "
Translated by Original Claudio Souza in Women in HIV serodiscordant relationships less Likely to take PrEP consistently If They experience intimate partner violence. Reviewed by Mara Macedo.
ST Roberts et al.Violence in intimate relationships and adherence to pre-exposure prophylaxis (PrEP) in African women in HIV serodiscordant relationships: a prospective cohort. J Adquiriraâ AOA Defic immune Synr, online edition. DOI: 10.1097 / QAI.0000000000001093, 2016.