Delayed initiation of antiretroviral therapy among HIV-discordant couples in Kenya

Abstract

Timely initiation of antiretroviral therapy (ART) is particularly important for HIV-discordant couples because viral suppression greatly reduces the risk of transmission to the uninfected partner. To identify issues and concerns related to ART initiation among HIV-discordant couples, we recruited a subset of discordant couples participating in a longitudinal study in Nairobi to participate in in-depth interviews and focus group discussions about ART. Our results suggest that partners in HIV-discordant relationships discuss starting ART, yet most are not aware that ART can decrease the risk of HIV transmission. In addition, their concerns about ART initiation include side effects, sustaining an appropriate level of drug treatment, HIV/AIDS-related stigma, medical/biological issues, psychological barriers, misconceptions about the medications, the inconvenience of being on therapy, and lack of social support. Understanding and addressing these barriers to ART initiation among discordant couples is critical to advancing the HIV “treatment as prevention” agenda.

Keywords:

• HIV/AIDS
• serodiscordant couples
• serodiscordant
• antiretroviral therapy
• Africa

Acknowledgements

The authors would like to thank the study subjects for their willingness to participate in this project and share their personal experiences. We would also like to thank the University of Nairobi focus group leaders and interviewers, including Beth Njeri Njiru, Mark Ouma Anam, Dominic Murumbutsa, Michael Gitonga, and Caroline Nafula Khisa, as well as the Couples Against Transmission team. Funding for this study was provided by NIH research grant R01 AI068431 and NIH training grant TL1 RR025016.