High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.
This paper used qualitative methods to explore experiences of men who have sex with men and female sex workers in Nairobi and Mtwapa, Kenya, who used oral pre-exposure prophylaxis (PrEP) for HIV prevention as part of a four-month trial of safety, acceptability and adherence. Fifty-one of 72 volunteers who took part in a randomized, placebo-controlled, blinded trial that compared daily and intermittent dosage of PrEP underwent qualitative assessments after completing the trial. Analyses identified three themes: (i) acceptability of PrEP was high, i.e. side effects were experienced early in the study but diminished over time, however characteristics of pills could improve comfort and use; (ii) social impacts such as stigma, rumors, and relationship difficulties due to being perceived as HIV positive were prevalent; (iii) adherence was challenged by complexities of daily life, in particular post-coital dosing adherence suffered from alcohol use around time of sex, mobile populations, and transactional sex work. These themes resonated across dosing regimens and gender, and while most participants favored the intermittent dosing schedule, those in the intermittent group noted particular challenges in adhering to the post-coital dose. Culturally appropriate and consistent counseling addressing these issues may be critical for PrEP effectiveness.
Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, P.O. Box 230, Kilifi, Kenya. EvanderElst@kemri-wellcome.org
Elisabeth Maria
EM
Van der Elst
Judie
J
Mbogua
Don
D
Operario
Gaudensia
G
Mutua
Caroline
C
Kuo
Peter
P
Mugo
Jennifer
J
Kanungi
Sagri
S
Singh
Jessica
J
Haberer
Frances
F
Priddy
Eduard Joachim
EJ
Sanders
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D004338:Drug Combinations; D000069480:Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D007630:Kenya; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009943:Organophosphorus Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D060386:Sex Workers / Q000523:psychology; D013240:Stereotyping; D055815:Young Adult; D016903:Drug Monitoring
D019380:Anti-HIV Agents; D004338:Drug Combinations; D000069480:Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; D009943:Organophosphorus Compounds; D003841:Deoxycytidine