Facilitators and barriers affecting PrEP adherence among Thai men who have sex with men (MSM) in the HPTN 067/ADAPT Study

Abstract

The HPTN 067/ADAPT Study evaluated the feasibility, acceptability and patterns of adherence and coverage for three randomly assigned oral FTC/TDF pre-exposure prophylaxis (PrEP) dosing regimens to prevent HIV infection: daily, time-driven (twice a week with a post-sex dose), and event-driven (pre/post-sex dosing). Using qualitative methods, we explored facilitators and barriers for each regimen among a subset of men who have sex with men (MSM) participants in Bangkok, Thailand. Between August 2013 and March 2014, 32 (of 179) HPTN 067/ADAPT participants joined in six focus group discussions, and six attended key-informant interviews -two per each study regimen. Facilitators of PrEP adherence included use of strategies to have PrEP available when needed and constructing convenient dosing regimens, simplicity in regimen requirements with recognition that more complex regimens may take some time to master, ability to plan for sex (non-daily regimens), receipt of social and technology support, ability to use a PrEP regimen that best matches to one's own patterns of sex, and experiences with PrEP as a part of health and wellbeing. Challenges to PrEP adherence included perceptions of no or low HIV risk, difficulties following regimens when drinking (intoxicated), concerns about short or long-term side-effects of PrEP, experience of HIV stigma (fears of being misidentified as HIV positive), inability to forecast sex events for non-daily regimens, and affordability of PrEP outside of study context influencing uptake and use in the community. Preferences for regimens varied, suggesting that multiple PrEP

Exploring nurse‐led HIV Pre‐Exposure Prophylaxis in a community health care clinic

“…This may suggest that individuals who perceive themselves at risk are more likely to keep accessing PrEP. This is consistent with previous research that concluded that PrEP use is driven by risk perceptions for HIV (Chemnasiri et al., 2020; Gombe et al., 2020; Liu et al., 2014). Regular STI testing is recommended as a key component of PrEP care and could lead to faster diagnoses of STIs among high‐risk groups (Werner et al., 2018).…”

“…These include fear of needles stopping patients from getting requisite bloodwork to start and continue on PrEP and stigma in disclosing accurate sexual health history (though because a large proportion came to the clinic seeking PrEP these concerns were not necessarily observed in our sample). Combatting stigma is an ongoing issue in PrEP uptake and delivery (Chemnasiri et al., 2020; Knight et al., 2016; Liu et al., 2014; St. Vil et al, 2019). Stigma has been identified as one factor in decreased ART adherence for younger gbMSM (Tanner et al., 2016) as well as precarious employment, housing instability, substance abuse, and sexual identity issues (Eastwood & Birnbaum, 2007), which may help explain the significance of age in PrEP discontinuation in this study and others (Dolbecki‐Lewis et al, 2016).…”

“…These include fear of needles stopping patients from getting requisite bloodwork to start and continue on PrEP and stigma in disclosing accurate sexual health history (though because a large proportion came to the clinic seeking PrEP these concerns were not necessarily observed in our sample). Combatting stigma is an ongoing issue in PrEP uptake and delivery (Chemnasiri et al, 2020;Knight et al, 2016;Liu et al, 2014;St. Vil et al, 2019).…”

Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study

“…In our sample, only two items were related to intention and willingness to use PrEP: the degree of difficulty in taking the medication and attending the monitoring appointment. This finding conveyed the significance of adherence to treatment and access to healthcare as facilitators of PrEP use [ 22 , 23 ]. This is not a surprising result, as access to treatments, care, and HIV prevention in Colombia is fragmented, limited, and problematic due to the organization of its health system [ 24 , 25 ].…”

Adaptation of a Theory-Based Social Networking and Gamified App-Based Intervention to Improve Pre-Exposure Prophylaxis Adherence Among Young Men Who Have Sex With Men in Bangkok, Thailand: Qualitative Study

“…The individual, societal, and systemic level facilitators and barriers to PrEP adherence among Thai YMSM identified in this study have also been reported in other studies of MSM and YMSM in the United States, Thailand, and other countries. Consistent with other studies [ 7 , 41 - 45 ], adherence facilitators included awareness of HIV risk and desire to protect themselves, concerns related to sexual partners, support from friends, sexual partners, family members, and adolescent-friendly providers, and PrEP affordability (PrEP is provided free of charge through universal health coverage for key populations in Thailand). Key barriers, also identified in other studies [ 41 - 44 , 46 - 49 ], included sexuality, HIV and PrEP stigma, attending regular PrEP medical appointments, forgetting to take PrEP daily or while intoxicated, not having PrEP with them at certain times, running out of PrEP, side effects, and low HIV risk perception.…”