Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England

Abstract

PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.

Barriers and facilitators to HIV Pre‐Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum

“…Lack of PrEP knowledge was the most studied barrier (Figure 3): it was investigated in 19 of the studies [10, 24, 25, 27, 33–35, 41, 44, 46, 48, 51, 53, 56, 58, 59, 61, 62, 65]. One study found that 44% of survey respondents listed lack of PrEP knowledge as a direct barrier to PrEP use [56].…”

“…Lack of self‐perception of HIV risk was the least studied barrier at the PrEP contemplation step ( n = 12, Figure 3) [10, 24, 34–36, 41, 44, 46, 53, 59, 62, 65]. In Wales, a majority (57%) of those who declined PrEP did so because they did not perceive themselves as at risk of HIV acquisition [10].…”

“…Peer support was the only factor assessed as belonging to two separate PCC steps PrEP contemplation and PrEP maintenance (Figure 4, Table 3) and was reported in five qualitative studies [24, 46, 48, 53, 66]. Community and social networks were important across populations: peer support was key to reducing concerns about PrEP and associated stigma [46], promoting PrEP knowledge [53, 66], encouraging PrEP uptake [46], and facilitating adherence (some PrEP users were reminded to take PrEP by a partner or peer) [24, 46]. This was due to a preference to accessing essential PrEP knowledge from peers as it was otherwise difficult to access care (Appendix S3) [48], and shared experiences were key to building trust [53, 66].…”

“…The MEDLINE, Embase, Global Health, EU Clinical Trials and WHO International Clinical Trials Registry Platform databases were initially searched on 24 March 2021 (updated on 28 March 2022) using six search terms: HIV, PrEP, barriers, facilitators, underserved populations, and UK (Appendix S2). The British Association for Sexual Health and HIV, British HIV Association, Conference on Retroviruses and Opportunistic Infections, and International AIDS Conference conference databases were searched manually using the terms PrEP, pre-exposure prophylaxis, and pre-exposure prophylaxis.…”

“…In fact, another study found that MSM who had such concerns were 99% less likely to be willing to use PrEP than those without concerns [35]. This was reflected in qualitative findings [24,44], whereby MSM tended to associate PrEP with earlier-generation ARVs and their side effects [51]. • Representation.…”