HIV pre-exposure prophylaxis uptake and associated factors among HIV serodiscordant heterosexual couples in Nairobi City County, Kenya

HIV antiretroviral drugs used as pre-exposure prophylaxis (PrEP) are effective for HIV prevention. This study evaluated determinants of PrEP uptake among HIV-negative spouses in HIV-serodiscordant heterosexual relationships in Nairobi City County, Kenya. Of the 424 participants, 114 reported current PrEP use, resulting in a PrEP uptake of 27% (23-31%). The top reason for current PrEP use was to achieve pregnancy (<i>n</i> = 69; 61%). Of the 424 participants, 209 (49%) had never used PrEP, and the leading reasons for never using PrEP were lack of PrEP information (38%) and self-perceived low risk for HIV (36%). Factors associated with decreased likelihood of PrEP use included: low level of education (<i>p</i> = 0.026), self-perception of being at low-to-no risk for HIV (<i>p</i> = 0.021), lack of desire for more children (<i>p</i> = 0.005) and lack of knowledge that PrEP is offered free (<i>p</i> = 0.004). Female sex (aOR = 2.3; 95% CI: 1.4-4.0) and lack of condom use (aOR = 2.5; 95% CI: 1.4-4.5) were associated with increased odds of taking PrEP. Uptake of PrEP among HIV-serodiscordant couples in Nairobi City County was low, and PrEP use was driven by desire to fulfill pregnancy intentions. Aggressive educational campaigns to address self-HIV-risk perceptions and increase PrEP knowledge are necessary for increased PrEP demand.