PrEP Cascade and Barriers Among Serodifferent Couples in Rural Tanzania: A Prospective Study on Awareness, Uptake, Adherence, and Retention.

Global HIV incidence remains high, particularly in sub-Saharan Africa. Pre-Exposure Prophylaxis (PrEP) prevents HIV transmission in serodifferent couples until the partner with HIV achieves viral suppression on antiretroviral treatment (ART). This study assessed awareness, uptake, and feasibility of a short, 4 month PrEP course alongside the roll-out of dolutegravir-based ART in rural Tanzania. We included serodifferent couples (≥ 15 years), of whom the partner with HIV enrolled in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) and initiated ART between September 2020 and September 2021. Partners without HIV with normal kidney function (eGFR > 60 ml/min) and negative HbsAg were offered PrEP. Both partners completed questionnaires on sexual behavior and adherence. Partners without HIV were tested monthly for HIV. Couples were followed until the partner living with HIV achieved viral suppression (< 200 copies/ml). Among 346 people newly diagnosed with HIV, 184 (53%) reported a sexual partner, 97 (53%) partners were tested and 40 (41%) were HIV negative. PrEP awareness was low (9%). Of 37 eligible seronegative partners, 22 (59%) initiated PrEP, and 9 (41%) completed follow-up. No serious adverse events or HIV seroconversions occurred. 21/22 (96%) of PWH were virally suppressed after 3 months. In our study, partner testing, acceptance and PrEP uptake were low. A 4-month course of PrEP was safe and effectively prevented HIV transmission. These findings highlight gaps in the PrEP care cascade in rural sub-Sahara Africa. Lack of awareness and disclosure of HIV status remain significant barriers to PrEP uptake and HIV prevention among serodifferent couples.