Thesis:

Assessing the pre-exposure prophylaxis adherence among HIV sero-discordant couples in Homabay county, Kenya.

HIV sero-discordance is a condition in which one partner is HIV-positive while the other is HIV-negative. The seronegative partner is at great risk of infection. The majority of discordant couples are of reproductive age hence, safe conception interventions is key. Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that is used to prevent infection ofthe seronegative partners. This strategy involves antiretroviral drugs that are used before a person gets exposed to the risk of infection with HIV. For complete protection against HIV transmission among the sero-discordant couples, daily adherence to oral intake of PrEP is required. However, adherence to the daily intake of Pre-exposure prophylaxis has been noted to be irregular among the sero-discordant couples hence, endangering the safety of the seronegative partner. The specific objectives were to assess the current adherence status to PrEP, to assess the effect of socio-demographic characteristic on adherence to PrEP, to assess the effect of knowledge gap on PrEP and to identify healthcare provider related barriers affecting the adherence to PrEP among discordant couples in Homabay County. The 167 Sero-discordant couples attending monthly clinic at the Comprehensive Care Center at the Homabay County Referral Hospital constituted the target population. Yamane formula was used to calculate the sample size which was 125. This study adopted the use of exploratory sequential design for collection of data. Kobo toolbox was used to collect quantitative data among 105 respondents while audio recordings of Focus Group Discussion was used to collect qualitative. The study was piloted at Marindi Sub-County Hospital. SPSS (version 27) was used to analyze quantitative data while MSQDA software was used in the analysis of qualitative data. The average awareness of PrEP among the respondents was 0.99 with a standard deviation of 0.098. Most of the respondents (51%) had used PrEP for between 1 and 5 years, while 48.6% had used it for less than one year. The coefficients of age (β = 0.001, t = 0.063, Sig. = 0.950), occupation (β = -0.011, t = -0.283, Sig. = 0.778), and level of education (β = 0.017, t = 0.489, Sig. = 0.626) were not statistically significant, indicating these socio-demographic factors, have no significant effect on adherence status to PrEP. The coefficient of knowledge on PrEP (β = -0.030, t = -0.12, Sig. = 0.905) was not statistically significant. Showing no significant association between PrEP awareness and adherence status. Two coefficients of healthcare provider related barriers; provider’s willingness PrEP (β = -0.098, t = -0.391, Sig. = 0.697), and whether education of clients (β = -0.120, t = -0.467, Sig. = 0.642) were not statistically significant, hence healthcare provider related barriers did not affect the adherence to PrEP. The study found a high adherence, socio-demographic factors, knowledge and healthcare related barriers didn’t have effect on PrEP adherence. The study recommended the authorities and other stakeholders to formulate and implement policies for PrEP adherence and initiate programs to fight stigmatization.