Knowledge, attitude and uptake of antiretroviral therapy for HIV prevention among discordant couples: Pumwani maternity Hospital cohort

Abstract

Background: The consistent use of a combination of antiretroviral drugs referred to as Highly Active Antiretroviral Therapy (HAART) has been shown to reduce the viral load in body fluids especially in blood and genital secretions.This has great implications as the HIV virus is spread mainly through sexual contacts. In discordant couples where one partner is HIV seropositive, the HIV negative partner is constantly exposed through sex and hence at a high risk of HIV acquisition. However, early initiation of HAART on the HIV infected partner could be beneficial to the HIV negative individual in the discordant relationship. This could be achieved through the adoption of Treatment as prevention(TaSP), a strategy whose aim is to initiate use of antiretroviral drugs as early as possible regardless of the CD4+ count. This concept aims at treating the HIV positive partner at the point of diagnosis regardless of the disease stage. Objectives:The objective of this study was to assess the knowledge, attitudes and practices regarding the uptake of treatment as prevention in a cohort of discordant couples.The study seeked to examine the participants knowledge in terms of HIV transmission methods and HIV preventive measures. We also assessed the couples attitudes towards high risk behaviours, determined their sexual practices and finally the reasons for/ or against the use of antiretrovirals for HIV prevention. Methodology: This was a cross sectional study that focussed on the knowledge, attitudes and practices among the discordant couples enrolled at the Pumwani cohort, Nairobi. Standardized questionnaires were used to collect data from the Pumwani discordant couples cohort until the sample size for the study was reached. Focus group discussions were also utilized to gather qualitative information on use of HAART for treatment as prevention from randomly selected discordant couples. Collected data was then enterered into a secured database, cleaned and then exported into SPSS Version 2.0 for analysis. Results: A total of 338 participants who were in a discordant relationship were enrolled into the study. Most of the participants, 320 (95.2%) knew about the availability of antiretroviral drugs while 16 (4.8%) had not heard of them . However, only 94(27.7%) could correctly name an antiretroviral drug. Majority of them, about 245(72.27%) could not name any drug. About 119 (40.9%) of them reported 350 CD4+ cells/ml as the best level to initiateantiretroviral treatment.. Most of the respondents 291(87.4%) reported antiretroviral drugs as being safe for use but 136(40.2%) of the participants noted that the drugs had intolerable side effects. Majority 289 (87%) of them affirmed that they would be able to use the drugs regularly and consistently. More than half of the respondents, 192(56.8%) had not heard of the treatment as prevention therapy while 178(54.4%) had not heard of the pre-exposure prophylaxis. Interestingly175 (53.2%) knew about Post Exposure Prophylaxis therapy. Majority of the respondents, 289(85.5%) reported that they would use the drugs for Treatment as Prevention if initiated on treatment. Conclusion: Majority of discordant couples in this study knew about the existence of antiretrovirals though only a few of them were able to name the specific drugs. Howeverless than half knew about t Treatment as Prevention concept and this could explain the poor uptake of this HIV prevention strategy at the Pumwani and Baba Dogo health facilities. Besides majority of those in discordant relationship did not perceive themselves at high risk of HIV acquisition Greater efforts should therefore be put into education on HIV risk perception in addition to demand creation for treatment as prevention as a novel strategy and a priority among discordant couples