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

Abstract

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 preexposure 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.

Preventing HIV Infection in Women

“…Despite documentation of variable adherence,[45], [46] PrEP's acceptability has generally been high when studied among trial participants, such as female sex workers in Kenya[50] and women in Uganda, South Africa, and the US. [51] Other studies of hypothetical use among people not participating in trials have reported willingness to use oral PrEP among young urban African American men and women,[52] although a substantial proportion (40%) of male and female emergency room patients in two New York City hospitals indicated that they were unlikely to use it.…”

Perspectives on use of oral and vaginal antiretrovirals for HIV prevention: the VOICE‐C qualitative study in Johannesburg, South Africa

“…In Kenya, stigma was reported to negatively affect participants’ ability to adhere to an oral PrEP regimen [11]. Similarly, Thai participants in another oral PrEP trial feared being mistakenly identified as HIV positive and experienced stigma and relationship stress [14].…”

Getting PrEPared for HIV Prevention Navigation: Young Black Gay Men Talk About HIV Prevention in the Biomedical Era

“…23 Another study in Kenya also found fear of stigma and susceptibility to local slander or gossip among high-risk HIV negative populations. 24 In a study of African-American young adults, participants expressed apprehension about sharing their use of PrEP within their networks for fear of being mistakenly labeled as HIV-positive or as sexually indiscriminate. 19 Liu and colleagues found that in addition to fear of being stigmatized by family and peers, potential PrEP users sensed judgment and resistance from medical providers providing PrEP.…”