Wairimu Njeri, Ngure Kenneth, Ogello Vallery, Owidi Emmah, Mwangi Paul, Etyang Lydia, Waituika Winnie, Mwangi Margaret, Githuku Dominic M, Maina Simon, Irungu Elizabeth, Mugo Nelly, Mugwanya Kenneth K
Partners in Health Research and Development, Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
PLOS Glob Public Health. 2025 Apr 28;5(4):e0004493. doi: 10.1371/journal.pgph.0004493. eCollection 2025.
Adherence to oral HIV pre-exposure prophylaxis (PrEP) is crucial for its effectiveness, however, studies have shown that PrEP use wanes within the first six months. We sought to understand reasons for discontinuation among individuals previously accessing PrEP from HIV clinics. Between November 2020 - January 2023, we conducted a mixed methods sub-study within a programmatic study to improve the efficiency of PrEP delivery in four public HIV clinics in Kenya (ClinicalTrials.gov number NCT04424524). We used random simple stratification to select individuals who had discontinued PrEP and completed surveys; we purposively sampled a subset of participants for in-depth interviews. Quantitative data were analyzed descriptively; qualitative data were analyzed thematically guided by the socio-ecological model. Overall, 300 participants completed surveys; median age was 35 years (interquartile range 28-43), 61% were female and 57% were married/cohabiting. Majority (76%) discontinued PrEP because of low perceived risk of HIV acquisition. Nearly half (43.7%) reported not being at risk, 23% had separated from their partners or had partners who were virally suppressed (6%), 3.3% were discontinued by healthcare providers. Other reasons for discontinuation were PrEP use concerns (15.6%) including concerns about side effects (8.7%) and daily pill burden (6%). Accessibility challenges (4%), and opportunity costs such as fear of missing/losing work (1%) were reported less frequently. Similarly in qualitative interviews, participants (n=30) reported PrEP discontinuation was mainly driven by perceived low HIV risk due to changes in relationship dynamics (separation/partner relocation), partner achieving viral suppression for those in serodifferent partnerships and reduced sexual activity (individual and interpersonal factors). Other themes included perceived HIV/PrEP stigma (community factors), frequency of clinic visits and long wait times (structural/institutional factors). PrEP discontinuation was mainly associated with perceived low HIV risk in this study population. Prevention-effective adherence counselling is essential in supporting individuals to correctly assess HIV risk to inform appropriate discontinuation.
坚持口服艾滋病毒暴露前预防（PrEP）对其有效性至关重要，然而，研究表明，PrEP的使用在头六个月内就会减少。我们试图了解以前从艾滋病毒诊所获取PrEP的个体停药的原因。在2020年11月至2023年1月期间，我们在一项旨在提高肯尼亚四家公共艾滋病毒诊所PrEP给药效率的项目研究中进行了一项混合方法子研究（ClinicalTrials.gov编号NCT04424524）。我们使用随机简单分层法选择已停用PrEP并完成调查的个体；我们有目的地抽取了一部分参与者进行深入访谈。定量数据进行描述性分析；定性数据在社会生态模型的指导下进行主题分析。总体而言，300名参与者完成了调查；中位年龄为35岁（四分位间距28 - 43岁），61%为女性，57%已婚/同居。大多数（76%）停用PrEP是因为认为感染艾滋病毒的风险较低。近一半（43.7%）报告没有风险，23%与伴侣分居或伴侣病毒载量得到抑制（6%），3.3%是由医疗服务提供者停用的。其他停药原因是对PrEP使用的担忧（15.6%），包括对副作用的担忧（8.7%）和每日服药负担（6%）。可及性挑战（4%）以及诸如担心错过/失去工作等机会成本（1%）的报告较少。同样，在定性访谈中，参与者（n = 30）报告PrEP停药主要是由于关系动态变化（分居/伴侣搬迁）、血清学不同伴侣关系中伴侣实现病毒载量抑制以及性活动减少（个体和人际因素）导致认为艾滋病毒风险较低。其他主题包括感知到的艾滋病毒/PrEP污名（社区因素）、就诊频率和长时间等待（结构/机构因素）。在该研究人群中，PrEP停药主要与认为艾滋病毒风险较低有关。有效的预防依从性咨询对于支持个体正确评估艾滋病毒风险以指导适当停药至关重要。
