Background: 

A strategy of pre-exposure prophylaxis (PrEP) transitioning to treatment as prevention is highly efficacious and cost effective for prevention of HIV transmission within HIV serodiscordant couples. We assessed whether couples who adopted this strategy experienced changes in sexual behaviors after HIV-negative partners discontinued PrEP and transitioned to rely primarily on their partner's adherence to antiretroviral therapy (ART) for prevention.

Setting: 

Kenya and Uganda.

Methods: 

Data are from the Partners Demonstration Project, a prospective, open-label evaluation of PrEP and ART use for HIV prevention. Using zero-inflated negative binomial models, we assessed changes in the level (ie, intercept) and trend over time (ie, slope) in total and condomless sex acts reported after PrEP discontinuation by HIV-negative partners. We conducted subgroup analyses based on HIV-negative partners' age and sex.

Results: 

We included 567 couples where the HIV-negative partner discontinued PrEP because of their partner with HIV using ART for ≥6 months. HIV-negative partners were women in 32.6% of couples and had a median age of 30 years. We observed no change in the level or trend over time in total sex acts [level adjusted rate ratio (aRR) = 0.95, 95% confidence interval (CI): 0.87 to 1.04; trend aRR = 1.00, 95% CI: 0.99 to 1.01] or condomless sex acts (level aRR = 0.97, 95% CI: 0.81 to 1.17; trend aRR = 1.00, 95% CI: 0.98 to 1.03) reported after PrEP discontinuation versus prediscontinuation. No significant changes in behaviors were observed in age and sex subgroups.

Conclusions: 

PrEP discontinuation seems to result in no significant changes in couples' sexual behaviors. These data further support a strategy of time-limited PrEP use by serodiscordant couples.

中文翻译：

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在肯尼亚和乌干达，HIV血清恶性夫妇中PrEP停药后的性行为

背景： 

的策略预曝光预防转变到治疗如（PREP）预防是高度有效的和成本有效的预防的HIV内的传输HIV 血清不一致夫妻。我们评估了采用这种策略的夫妇在HIV阴性伴侣终止PrEP并过渡为主要依靠伴侣坚持抗逆转录病毒疗法（ART）预防后是否发生性行为变化。

设置： 

肯尼亚和乌干达。

方法： 

数据来自合作伙伴示范项目，这是对PrEP和ART用于预防HIV 的前瞻性开放标签评估。使用零膨胀负二项式模型，我们评估了HIV阴性伴侣终止PrEP后报告的全部和无避孕套性行为的水平（即截距）和趋势随时间（即斜率）的变化。我们根据艾滋病毒阴性伴侣的年龄和性别进行了亚组分析。

结果： 

我们纳入了567对夫妇，其中HIV阴性伴侣因为他们的HIV伴侣使用ART≥6个月而终止了PrEP 。艾滋病毒阴性伴侣是女性，占夫妇的32.6％，中位年龄为30岁。我们观察到总性行为的水平或趋势没有随时间变化[水平调整比率（aRR）= 0.95，95％置信区间（CI）：0.87至1.04；PrEP停用与停用前发生性行为的趋势aRR = 1.00，95％CI：0.99至1.01]或无避孕套性行为（水平aRR = 0.97，95％CI：0.81至1.17；趋势aRR = 1.00，95％CI：0.98至1.03）。在年龄和性别亚组中没有观察到行为的显着变化。

结论： 

PrEP停用似乎不会导致夫妻的性行为发生重大变化。这些数据进一步支持了血清皂苷夫妇使用限时PrEP的策略。