The year 2011 marked a turning point in the three-decade search for effective HIV prevention interventions. In 2011, both early antiretroviral therapy (ART) in HIV-infected individuals and oral antiretroviral pre-exposure prophylaxis (PrEP) in uninfected individuals demonstrated high efficacy for protection against HIV transmission when used by members of HIV-1 serodiscordant couples in sub-Saharan Africa. ART and PrEP for prevention are now considered among the most promising strategies for reducing the spread of HIV. Attention is now turning to development of approaches to delivering these new prevention tools. The Partners Demonstration Project is the first-ever demonstration to deliver ART/PrEP for prevention to HIV-1 serodiscordant couples in Africa. The demonstration uses a "bridging strategy" of delivery in which ART is offered to HIV-infected partners eligible for treatment, and PrEP is offered to HIV-uninfected partners as a "bridge" to ART initiation. We propose a qualitative evaluation of the bridging strategy, to inform future global implementation and scale- up of ART/PrEP for prevention in Africa. The project takes place in Kampala, Uganda. The evaluation draws upon multiple participant groups and data collection methods for in-depth investigation. We will carry out multiple qualitative interviews with 48 couples purposefully sampled to represent various bridging strategy experiences. Interviews will be joint (partners together) and individual (partners separately), and linked to key bridging strategy transitions. Forty interviews with Demonstration Project providers and 40 observations of Project activities of care will also be conducted. An inductive, content-focused, comparative analytic approach will allow us to characterize couples'experiences of the bridging strategy and responses to ART/PrEP for prevention (Aim 1), couples'relationship dynamics (Aim 2), provider challenges (Aim 3), and broader social, cultural and economic contextual influences (Aim 4).
Antiretroviral (ARV)-based HIV-1 prevention interventions are now considered among the most promising strategies for reducing the spread of HIV. Maximum public health impact from ART and PrEP for prevention requires effective delivery strategies. Understanding what constitutes delivery will come from comprehensive evaluation of demonstration projects. The Partners Demonstration Project marks the first attempt to deliver ART/PrEP for prevention to African serodiscordant couples outside an efficacy trial. Building on our prior research, we propose a systematic and thorough qualitative evaluation of the Partners Demonstration Project, grounded in a systematically derived, original conceptual framework. This study will inform future global implementation and scale up of ART/PrEP for prevention.