Willingness to use short-term oral pre-exposure prophylaxis (PrEP) by migrant miners and female partners of migrant miners in Mozambique

Falcão, Joana; Ahoua, Laurence; Zerbe, Allison; Mattei, Pietro di; Baggaley, Rachel; Chivurre, Victor; Mulondo, Prince; Ramiro, Isaías; Dalal, Shona; Morales, Fernando; O’Reilly, Kevin; El‐Sadr, Wafaa

doi:10.1080/13691058.2017.1316424

Cited by 14 publications

(17 citation statements)

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“…Side effects, or fear of potential side effects, were common in both efficacy and implementation studies. Initial side effects among female partners of migrant mine workers in Mozambique dissipated over time but were tolerated because they took the side effects to mean that PrEP was working . Concerns about side effects during discussions of theoretical acceptability were common among women in one study, including partners in serodiscordant couples, adolescent girls and young women (AGYW), and sex workers .…”

Section: Resultsmentioning

confidence: 99%

“…However, male and female sex workers overall were supportive of the idea of PrEP providing "added protection" even in the context of aspirations to always use condoms [27]. Additionally, three other papers noted that risk behaviour did not change over time among participants actually using PrEP including migrant workers and female partners, MSM, FSW and serodiscordant couples [36,42,43]. It should also be noted that two systematic reviews also have shown no significant changes in behaviour among PrEP users [1,17].…”

Section: Realities and Compensationmentioning

confidence: 97%

“…Negative clinic experiences directly deterred PrEP use [21,33], whereas good quality care was highly valued and increased clinic attendance [33,58]. In the FEM-PrEP study, repeated HIV-negative tests (even if on placebo) reinforced the notion that PrEP worked [32,33], although in another study it was noted that having to test often for HIV could be a barrier to continued PrEP use [36].…”

Section: Practical Considerations For Prep Usementioning

confidence: 99%

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Understanding user perspectives of and preferences for oral PrEPforHIVprevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa

2019

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Introduction Oral pre‐exposure prophylaxis (Pr EP ) for HIV prevention has been proven to significantly reduce new HIV infections yet scale‐up has been slow. As contexts continue to adjust to make space for Pr EP , it is crucial to understand the perspectives and experiences of potential end‐users. In order to inform Pr EP and demand creation interventions, this paper examines personal perspectives on adopting and using Pr EP among HIV at‐risk populations in sub‐Saharan Africa. Methods Using the principles of a scoping review in July 2018, we explored the extent, range, and nature of published literature regarding Pr EP uptake and use among; men who have sex with men, HIV serodiscordant couples, adolescent girls and young women, pregnant and breastfeeding women, women partners of migrant workers; and people who use drugs. Steps included: identification of the research question; identification of relevant studies; study selection; charting the data; and collation – summarizing and reporting results. PubMed and PsycInfo were searched for papers relating to Pr EP uptake and use in sub‐Saharan Africa. Resulting papers were reviewed with data extracted and compiled in Excel for analysis. A broad content analysis was conducted and organized into high‐level themes. Results and discussion Thirty‐five papers were included in this review. There was little opposition in general to oral Pr EP ; however, there were significant nuances in its broader acceptability, applicability, and usability. We identified five themes within which these are discussed. These relate to balancing complexities of personal empowerment and stigma; navigating complex risk environments; influences of relationships and partners; efficacy and side effects; and practicalities of use. This body of research suggests that while product attributes and the logistics of Pr EP delivery and use are important topics, it is vital to consider stigma, the interactions of Pr EP use with relationships, and the need for broader understanding of ARV s for prevention versus treatment. Conclusions Planning for, programming and promoting the adoption of oral Pr EP necessitates a deeper understanding of end‐user priorities in order to ensure successful interventions. This review illustrates the nuances facilitating or deterring Pr EP use that may affect the larger effort of Pr EP scale‐up.

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Section: Resultsmentioning

confidence: 99%

Section: Realities and Compensationmentioning

confidence: 97%

Section: Practical Considerations For Prep Usementioning

confidence: 99%

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Understanding user perspectives of and preferences for oral PrEPforHIVprevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa

2019

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“…Much qualitative research on antiretrovirals for prevention in Africa reports user perspectivesattitudes, knowledge, preferences, and influences on the use of PrEP and immediate ART [16][17][18][19][20][21][22][23][24][25][26]. Qualitative methods have also been used to shed light on reasons underlying suboptimal PrEP adherence in the VOICE and FEM-PrEP clinical trials [27][28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Integrated delivery of antiretroviral treatment and pre‐exposure prophylaxis toHIV‐1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda

et al. 2018

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IntroductionSerodiscordant couples are a priority population for delivery of new HIV prevention interventions in Africa. An integrated strategy of delivering time‐limited, oral pre‐exposure prophylaxis (PrEP) to uninfected partners in serodiscordant couples as a bridge to long‐term antiretroviral treatment (ART) for infected partners has been implemented in East Africa, nearly eliminating new infections. We conducted a qualitative evaluation of the integrated strategy in Uganda, to better understand its success.MethodsData collection consisted of 274 in‐depth interviews with 93 participating couples, and 55 observations of clinical encounters between couples and healthcare providers. An inductive content analytic approach aimed at understanding and interpreting couples’ experiences of the integrated strategy was used to examine the data. Analysis sought to characterize: (1) key aspects of services provided; (2) what the services meant to recipients; and (3) how couples managed the integrated strategy. Themes were identified in each domain, and represented as descriptive categories. Categories were grouped inductively into more general propositions based on shared content. Propositions were linked and interpreted to explain “why the integrated strategy worked.”ResultsCouples found “couples‐focused” services provided through the integrated strategy strengthened partnered relationships threatened by the discovery of serodiscordance. They saw in services hope for “getting help” to stay together, turned joint visits to clinic into opportunities for mutual support, and experienced counselling as bringing them closer together.Couples adopted a “couples orientation” to the integrated strategy, considering the health of partners as they made decisions about initiating ART or accepting PrEP, and devising joint approaches to adherence. A couples orientation to services, grounded in strengthened partnerships, may have translated to greater success in using antiretrovirals to prevent HIV transmission.ConclusionsVarious strategies for delivering antiretrovirals for HIV prevention are being evaluated. Understanding how and why these strategies work will improve evaluation processes and strengthen implementation platforms. We highlight the role of service organization in shaping couples’ experiences of and responses to ART and PrEP in the context of the integrated strategy. Organizing services to promote positive care experiences will strengthen delivery and contribute to positive outcomes as antiretrovirals for prevention are rolled out.

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“…The high acceptability and uptake are consistent with findings from our previous qualitative study in this population. 16 …”

Section: Discussionmentioning

confidence: 99%

Feasibility, Acceptability, and Adherence with Short-Term HIV Preexposure Prophylaxis in Female Sexual Partners of Migrant Miners in Mozambique

Lahuerta

Zerbe

Baggaley

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Preexposure prophylaxis (PrEP) offers protection from HIV acquisition if taken as prescribed. We evaluated the feasibility, acceptability, and adherence with short-term PrEP among female sexual partners of migrant miners in Mozambique.Methods:HIV-negative female sexual partners of migrant miners were offered daily tenofovir/emtricitabine (TDF/FTC) for 6 weeks concurrent with miners' return home. Study visits occurred at baseline, week 4, 6, and 8. Dried blood spots (DBSs) were collected at week 4 and 6.Results:Seventy-four women (median age: 42 years) were enrolled, 95% reported having 1 sexual partner and 80% reported never or rarely using condoms. At baseline, 41% had never tested for HIV; 65% were unaware of partners' HIV status. Of all women, 72 (97%) initiated PrEP, 7 (9%) discontinued PrEP before week 6; only 1 due to adverse events. Missed doses in the last week were self-reported by 8% and 3% of women at week 4 and 6, respectively. Of 66 (89%) women with DBS at week 4, 79% had detectable tenofovir diphosphate (TFV-DP) and 44% had levels consistent with ≥4 pills/wk (≥700 fmol/punch). Of 63 (88%) women with DBS at week 6, 76% had detectable TFV-DP and 42% had levels consistent with ≥4 pills/wk.Conclusions:In this first study assessing the use of short-term PrEP, a high percent of female partners of migrant workers initiated PrEP and had detectable DP levels during follow-up. Further efforts are needed to enhance adherence to ensure protection from HIV acquisition. Short-term PrEP offers promise for populations who are at high risk of HIV during specific periods of time.

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Willingness to use short-term oral pre-exposure prophylaxis (PrEP) by migrant miners and female partners of migrant miners in Mozambique

Cited by 14 publications

References 17 publications

Understanding user perspectives of and preferences for oral PrEPforHIVprevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa

Understanding user perspectives of and preferences for oral PrEPforHIVprevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa

Integrated delivery of antiretroviral treatment and pre‐exposure prophylaxis toHIV‐1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda

Feasibility, Acceptability, and Adherence with Short-Term HIV Preexposure Prophylaxis in Female Sexual Partners of Migrant Miners in Mozambique

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