Barriers to post exposure prophylaxis use among men who have sex with men in sub-Saharan Africa: An online cross-sectional survey

Isano, Sandra; Wong, Rex; Logan, Jenae; El-Halabi, Soha; El‐Khatib, Ziad

doi:10.1016/j.pmedr.2020.101100

Cited by 11 publications

(13 citation statements)

References 13 publications

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“…However, it has not routinely been integrated in the prevention toolkit in sub‐Saharan Africa (SSA) beyond limited use restricted to occupational risks among healthcare workers, female sex workers and men who have sex with men [3,4]. Some reasons for PEP underutilization include widespread unawareness of this prevention option, fear of misuse limiting offers of PEP, lack of provider training in screening for eligible candidates and stigma and discrimination against high‐risk groups such as sex workers and men who have sex with men [3,5,6,7]. Pre‐exposure prophylaxis (PrEP) is increasing, but not reaching all populations at risk, thus additional prevention measures are needed [8,9].…”

Section: Introductionmentioning

confidence: 99%

Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda

et al. 2021

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Introduction Antiretroviral‐based HIV prevention, including pre‐exposure prophylaxis (PrEP), is expanding in generalized epidemic settings, but additional prevention options are needed for individuals with periodic, high‐risk sexual exposures. Non‐occupational post‐exposure prophylaxis (PEP) is recommended in global guidelines. However, in Africa, awareness of and access to PEP for sexual exposures are limited. We assessed feasibility, acceptability, uptake and adherence in a pilot study of a patient‐centred PEP programme with options for facility‐ or community‐based service delivery. Methods After population‐level HIV testing with universal access to PrEP for persons at elevated HIV risk (SEARCH Trial:NCT01864603), we conducted a pilot PEP study in five rural communities in Kenya and Uganda between December 2018 and May 2019. We assessed barriers to PEP in the population and implemented an intervention to address these barriers, building on existing in‐country PEP protocols. We used community leaders for sensitization. Test kits and medications were acquired through the Ministry of Health supply chain and healthcare providers based at the Ministry of Health clinics were trained on PEP delivery. Additional intervention components were (a)PEP availability seven days/week, (b)PEP hotline staffed by providers and (c)option for out‐of‐facility medication delivery. We assessed implementation using the Proctor framework and measured seroconversions via repeat HIV testing. Successful “PEP completion” was defined as self‐reported adherence over four weeks of therapy with post‐PEP HIV testing. Results Community leaders were able to sensitize and mobilize for PEP. The Ministry of Health supplied test kits and PEP medications; after training, healthcare providers delivered the 28‐day regimen with high completion rates. Among 124 persons who sought PEP, 66% were female, 24% were ≤25 years and 42% were fisherfolk. Of these, 20% reported exposure with a serodifferent partner, 72% with a new or existing relationship and 7% from transactional sex. 12% of all visits were conducted at out‐of‐facility community‐based sites; 35% of participants had ≥1 out‐of‐facility visit. No serious adverse events were reported. Overall, 85% met the definition of PEP completion. There were no HIV seroconversions. Conclusions Among individuals with elevated‐risk exposures in rural East African communities, patient‐centred PEP was feasible, acceptable and provides a promising addition to the current prevention toolkit.

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Section: Introductionmentioning

confidence: 99%

Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda

et al. 2021

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“…IRS-related research is still rare in China, however. MSM are often afraid of being exposed, stigmatized, and discriminated against, [20][21][22] especially in China. 23,24 In traditional Chinese culture, homosexuality is considered a disgrace.…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing the Intention of MSM to Use the PrEP Intelligent Reminder System

Ma¹,

Zhong²,

Lin³

et al. 2021

RMHP

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Purpose Low adherence to medication is an important reason why pre-exposure prophylaxis (PrEP) is not effective at reducing the rate of new human immunodeficiency virus (HIV) infections among men who have sex with men (MSM). The intelligent reminder system (IRS) has been designed to improve user compliance, but the intention of MSM to use the IRS remains unclear. This study establishes a theoretical model to analyze the factors influencing their intention to use the IRS. Patients and Methods Non-probability sampling was used to recruit MSM volunteers in Chongqing and Sichuan, China, and the data were collected from MSM who had used the IRS. A model based on the unified theory of acceptance and use of technology (UTAUT) was established for the data through a structural equation model, and the perceived privacy risk was considered to explore the subjects’ behavior intention. Results A total of 111 volunteers who had used the IRS filled out a questionnaire. Social influence had the greatest impact on behavior intention (β = 0.360, P < 0.001), followed by performance expectancy (β = 0.331, P < 0.001), and perceived privacy risk had a negative impact on behavior intention (β = −0.151, P = 0.040). In addition, social influence had an indirect effect on behavior intention (β = 0.182, P = 0.003) and performance expectancy played a mediating role in this indirect effect. Conclusion Developments in the IRS are required to improve its usefulness and adequately explain its role when recommending it to MSM. It is also important to improve the system’s ability to protect user privacy. Clinical evidence for the effectiveness of the IRS is conducive to its widespread use.

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“…Individual factors Concern about side effects (8) Having been involved in high-risk sexual intercourse (37,39) Lack of PEP information (11,34) Using methamphetamine (11) Having an adequate knowledge about PEP Knowledge where to get PEP (30,36,43)…”

Section: Domains Barriers References Facilitating Factors Referencesmentioning

confidence: 99%

Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

Jin

Sun

et al. 2022

Front. Med.

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Background: The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations.Methods: We conducted a systematic literature search of the PubMed, Web of Science, PsycINFO, and Google Scholar electronic databases. Studies were screened for inclusion, and relevant data were abstracted, assessed for bias, and synthesized. Pooled effect estimates were calculated using random effects meta-analysis, meta-regression and subgroup analysis, and a qualitative review and risk of bias assessment were performed (PROSPERO, CRD42019123815).Results: Twenty eligible studies involving 12,579 MSM were included in the meta-analysis. The pooled estimate of the proportions of MSM who were aware of PEP was modest at 59.9% (95% CI: 50.5~68.7) and that of MSM who previously used PEP was very low at 4.9% (95% CI: 2.4~9.8). PEP awareness showed no clear change over time, while PEP use significantly changed over time. Multiple factors affected awareness, including educational attainment, race/ethnicity, levels of HIV stigma, access to condoms, and so on. Many factors could potentially impede or facilitate the use of PEP, such as income, lack of PEP information, and partnership.Conclusion: We observed that PEP is an underused HIV prevention strategy among MSM and that once MSM become aware of PEP, the majority are willing to use it if they are supported appropriately in terms of a range of individual, social, and structural barriers.Systematic Review Registration: http://www.cdr.york.ac.uk/prospero, PROSPERO [CRD42019123815].

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Barriers to post exposure prophylaxis use among men who have sex with men in sub-Saharan Africa: An online cross-sectional survey

Cited by 11 publications

References 13 publications

Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda

Uptake and outcomes of a novel community‐based HIV post‐exposure prophylaxis (PEP) programme in rural Kenya and Uganda

Factors Influencing the Intention of MSM to Use the PrEP Intelligent Reminder System

Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

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