{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:48:38Z","timestamp":1793317718305,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T00:00:00Z","timestamp":1500940800000},"content-version":"vor","delay-in-days":205,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1056051"],"award-info":[{"award-number":["OPP1056051"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Introduction:<\/jats:bold> Adherence is essential for pre\u2010exposure prophylaxis (PrEP) to protect against HIV acquisition, but PrEP use need not be life\u2010long. PrEP is most efficient when its use is aligned with periods of risk \u2013 a concept termed prevention\u2010effective adherence. The objective of this paper is to describe prevention\u2010effective adherence and predictors of adherence within an open\u2010label delivery project of integrated PrEP and antiretroviral therapy (ART) among HIV serodiscordant couples in Kenya and Uganda (the Partners Demonstration Project).<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: We offered PrEP to HIV\u2010uninfected participants until the partner living with HIV had taken ART for \u22656 months (a strategy known as \u201cPrEP as a bridge to ART\u201d). The level of adherence sufficient to protect against HIV was estimated in two ways: \u22654 and \u22656 doses\/week (per electronic monitoring). Risk for HIV acquisition was considered <jats:italic>high<\/jats:italic> if the couple reported sex with &lt;100% condom use before six months of ART, <jats:italic>low<\/jats:italic> if they reported sex but had 100% condom use and\/or six months of ART and <jats:italic>very low<\/jats:italic> if no sex was reported. We assessed prevention\u2010effective adherence by cross\u2010tabulating PrEP use with HIV risk and used multivariable regression models to assess predictors of \u22654 and \u22656 doses\/week.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: A total of 985 HIV\u2010uninfected participants initiated PrEP; 67% were male, median age was twenty\u2010nine years, and 67% reported condomless sex in the month before enrolment. An average of \u22654 doses and \u22656 doses\/week were taken in 81% and 67% of participant\u2010visits, respectively. Adherence sufficient to protect against HIV acquisition was achieved in 75\u201388% of participant\u2010visits with high HIV risk. The strongest predictor of achieving sufficient adherence was reporting sex with the study partner who was living with HIV; other statistically significant predictors included no concerns about daily PrEP, pregnancy or pregnancy intention, females aged <jats:styled-content>&gt;<\/jats:styled-content>25 years, older male partners and desire for relationship success. Predictors of not achieving sufficient adherence were no longer being a couple, delayed PrEP initiation, &gt;6 months\u00a0 of follow\u2010up, ART use <jats:styled-content>&gt;<\/jats:styled-content>6 months\u00a0 by the partner living with HIV and problem alcohol use.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Over three\u2010quarters of participant\u2010visits by HIV\u2010uninfected partners in serodiscordant couples achieved prevention\u2010effective adherence with PrEP. Greater adherence was observed during months with HIV risk and the strongest predictor of achieving sufficient adherence was sexual activity.<\/jats:p>","DOI":"10.7448\/ias.20.1.21842","type":"journal-article","created":{"date-parts":[[2017,7,22]],"date-time":"2017-07-22T18:08:14Z","timestamp":1500746894000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Alignment of adherence and risk for HIV acquisition in a demonstration project of pre\u2010exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention\u2010effective adherence"],"prefix":"10.1002","volume":"20","author":[{"given":"Jessica E.","family":"Haberer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Kidoguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Heffron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelly","family":"Mugo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Bukusi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elly","family":"Katabira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Asiimwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine K.","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Celum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"for the Pa","given":"Jared M.","family":"Baeten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000220"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000172"},{"key":"e_1_2_12_4_1","unstructured":"AndersonP LamaJ BuchbinderS GuaniraJ MontoyaO CasapiaM et al.Expanded case\u2010control analysis of drug detection in the global iPrEx trial.Presented at: 6th IAS Conf HIV Pathogenesis Treatment Prevention; 2011 July 17\u201320; Rome Italy."},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3004006"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiw077"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002099"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.4683"},{"key":"e_1_2_12_9_1","unstructured":"BekkerL\u2010GGrantRHughesJRouxS AmicoR HendrixC. 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