Barriers and facilitators to pre-exposure prophylaxis among African migrants in high income countries: a systematic review

Mwaturura, Chido; Traeger, Michael W; Lemoh, Chris; Stoové, Mark; Price, Brian; Coelho, Alison; Mikola, Masha; Ryan, Kathleen E.; Wright, Edwina

doi:10.1071/sh20175

Cited by 14 publications

(7 citation statements)

References 30 publications

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“…The common reports of stigma hindering uptake of PrEP among our study participants were similar to the findings from other studies [11,31]. For example, research on uptake of PrEP has reported that stigma associated with being labelled as HIV-infected and being suspected of infidelity or promiscuity, was a barrier to uptake of PrEP [11,32,33].…”

Section: Plos Onesupporting

confidence: 86%

Assessing acceptability of pre-exposure prophylaxis (PrEP) among participants in an HIV vaccine preparedness study in southwestern Uganda

Nakamanya

Kawuma²,

Kibuuka³

et al. 2022

PLoS ONE

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Background Daily oral pre-exposure prophylaxis (PrEP) use is highly effective against HIV infection. However, the uptake of PrEP among individuals at high-risk of HIV acquisition in sub-Saharan Africa varies because of availability and acceptability. We assessed the acceptability of PrEP among participants in a prospective HIV vaccine preparedness study in Masaka, southwestern Uganda. Methods From November 2018 to August 2019, 20 participants (10 female) were purposively selected for in-depth interviews (IDIs) at 3 and 9 months’ post-enrolment in the vaccine preparedness study. Four focus group discussions (FGD) (two among men) were conducted with 29 individuals categorized as: younger (18–24 years) men, younger (18–24 years) women, older (≥30 years) men, and older (≥30 years) women. Apart from IDI specific questions on recent life history including work experience, relationship history and places lived, topics for IDIs and FGDs included knowledge of HIV, perceptions of HIV risk (including own risk), knowledge of and use of PrEP. The Theoretical Framework of Acceptability was used to structure a thematic framework approach for data analysis. Results Participants understood that PrEP was an oral pill taken daily by HIV negative individuals to prevent acquisition of HIV. Overall, interest in and acceptability of PrEP was high, more than half expressed positivity towards PrEP but were not ready to initiate taking it citing the burden of daily oral pill taking, related side effects, stigma and distrust of PrEP. Fourteen participants (from IDI and FGD) initiated PrEP, although some (one FGD and two IDI participants) stopped taking it due to side effects or perceived reduced risk. Conclusion We observed a keen interest in PrEP initiation among our study participants. However, a limited understanding of PrEP and associated concerns impeded uptake and sustained use. Hence, interventions are needed to address end-user challenges to increase uptake and support adherence.

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Section: Plos Onesupporting

confidence: 86%

Assessing acceptability of pre-exposure prophylaxis (PrEP) among participants in an HIV vaccine preparedness study in southwestern Uganda

Nakamanya

Kawuma²,

Kibuuka³

et al. 2022

PLoS ONE

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“…In Uganda, PrEP was initially offered in a few accredited antiretroviral therapy (ART) sites with the capacity to provide a complete package. It has not yet been rolled out to all health facilities in the country [ 12 , 13 ]. The Ugandan ministry of health (MoH) started the national PrEP rollout for HIV prevention in 2017 and this scale-up began with serodiscordant couples (SDC) and has since expanded to other MARPs [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to oral PrEP uptake among high-risk men after HIV testing at workplaces in Uganda: a qualitative study

et al. 2023

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Background Men in Uganda contribute significantly to new HIV infections annually yet PrEP uptake among them is low and those initiated are likely to discontinue usage. We explored the barriers and facilitators to PrEP uptake among high-risk men employed in private security services with negative HIV results after testing at workplaces in Uganda. Methods An explorative qualitative study comprising in-depth participant interviews. Data were collected via telephone calls and manually analyzed by inductive content analysis. Results Fifty-six (56) men participated, 27(48.21%) had heard about PrEP, and 29(51.79%) were willing to initiate it. Four categories emerged for the facilitators of PrEP uptake including the perceived need for HIV prevention, awareness creation, availability, and sexual freedom. Six categories emerged for the barriers to PrEP uptake. These were: Inaccessibility of PrEP services, Misinformation, Knowledge deficit, Medication-related barriers, Potential for increased risky sexual behavior, and Perceptions about PrEP use. Conclusion The findings suggest the need for healthcare providers to offer information regarding PrEP and HIV prevention services and mass sensitization campaigns to facilitate uptake. Participants recommend mass roll-out of PrEP to lower-level facilities and accessible pick-up points for men such as workplaces. The men also suggested the use of longer-acting PrEP modalities such as an injectable option or an option that is utilized specifically by the female partner. Finally, the stigma surrounding PrEP use could be reduced by the separation of PrEP and ART services at health facilities, or special pick-up days to reduce waiting times.

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“…The prescription of these prevention tools, which are reimbursed by social security, is recommended by the French health authorities in populations most vulnerable to HIV acquisition, mainly men who have sex with men (MSM) and people born in sub-Saharan Africa [ 10 ]. However, to date, limited research has been conducted to assess the state of knowledge of these treatments among immigrants from sub-Saharan Africa, both in France and in other Western countries [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Low knowledge of antiretroviral treatments for the prevention of HIV among precarious immigrants from sub-Saharan Africa living in the greater Paris area: Results from the Makasi project

Coulibaly¹,

Gosselin²,

Carillon³

et al. 2023

PLoS ONE

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Introduction In France, combination prevention tools, particularly antiretroviral treatment for HIV prevention has been available for several years. We described the knowledge of these antiretroviral treatments among immigrants from sub-Saharan Africa, who are particularly affected by HIV, and the factors associated with this knowledge. Methods The data come from the Makasi study, which was conducted between 2019 and 2020 among precarious immigrants from sub-Saharan Africa recruited through a community-based outreach approach in the greater Paris area (n = 601). We described levels of knowledge of HIV treatment effectiveness (HTE), treatment as prevention (TasP), post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (PrEP), by sex with chi2 test. We investigated factors associated with their knowledge with logistic regressions adjusted for sociodemographic characteristics, living conditions and sexual behaviors (p≤0.2). Results Respondents were mostly men (76%), from West Africa (61%), in precarious situation: 69% were unemployed, 74% were undocumented and 46% had no health coverage. Among this population, knowledge of HIV preventive treatments was heterogeneous. While HTE was well known (84%); TasP was known by only half of the respondents (46%), and PEP and PrEP were hardly known: 6% and 5%, respectively. Multivariate regressions models showed that these antiretroviral treatments for the prevention of HIV was better known by people with a higher level of education (PEP: aOR = 3.33 [1.09–10.20], p = 0.03; HTE: aOR = 4.33 [1.87–10.04], p<0.001), those who had a social network in France (TasP: aOR = 1.90, [1.33–2.73], p<0.001), those who had access to the health system and those who were exposed to sexual risks (TasP: aOR = 3.17, [1.03–9.69], p = 0.04; PrEP: aOR = 2.60 [0.72–9.34], p = 0.14). Conclusions There is a need for specific communication on antiretroviral treatment for HIV prevention that targets sub-Saharan immigrants, particularly those who have no access to the health-care system and those who are less educated.

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Barriers and facilitators to pre-exposure prophylaxis among African migrants in high income countries: a systematic review

Cited by 14 publications

References 30 publications

Assessing acceptability of pre-exposure prophylaxis (PrEP) among participants in an HIV vaccine preparedness study in southwestern Uganda

Assessing acceptability of pre-exposure prophylaxis (PrEP) among participants in an HIV vaccine preparedness study in southwestern Uganda

Barriers and facilitators to oral PrEP uptake among high-risk men after HIV testing at workplaces in Uganda: a qualitative study

Low knowledge of antiretroviral treatments for the prevention of HIV among precarious immigrants from sub-Saharan Africa living in the greater Paris area: Results from the Makasi project

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