Exploring Perceived Barriers and Facilitators of PrEP Uptake among Young People in Uganda, Zimbabwe, and South Africa

Muhumuza, Richard; Ssemata, Andrew Sentoogo; Kakande, Ayoub; Ahmed, Nadia; Atujuna, Millicent; Mangxilana, Nomvuyo; Bekker, Linda‐Gail; Dietrich, Janan; Tshabalala, Gugulethu; Hornschuh, Stefanie; Maluadzi, Mamakiri; Chibanda-Stranix, Lynda; Nematadzira, Teacler; Weiss, Helen A.; Nash, Stephen; Fox, Julie; Seeley, Janet

doi:10.1007/s10508-020-01880-y

Cited by 71 publications

(76 citation statements)

References 36 publications

(48 reference statements)

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“…Relationships built with other PrEP users, through virtual platforms or physical meetings, could also provide long-term social support. A high proportion of participants reported that PrEP use was facilitated by support from friends and family, in line with qualitative research done in three sub-Saharan contexts where youth perceived peer influence and social support as potential facilitators to PrEP uptake [45]. This also suggests that most participants told at least some friends and family members about PrEP.…”

Section: Discussionsupporting

confidence: 77%

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

et al. 2021

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Daily oral pre-exposure prophylaxis (PrEP) is a key tool in addressing high HIV incidence among young women, and breaking the cycle of transmission. From 2017 to 2020, Médecins Sans Frontières (MSF) offered PrEP, in conjunction with contraception and risk-reduction counselling, to women aged 18–25, in a government-run clinic in Khayelitsha, a low income high HIV prevalence area in South Africa. Drawing on clinical, quantitative, and qualitative interview data, we describe participants’ experiences and engagement with the PrEP program, participant adherence (measured by TFV-DP levels in dried blood spots) over time, and the indirect benefits of the PrEP program. Of 224 screened and eligible participants, 164 (73.2%) initiated PrEP, with no large differences between those who initiated and those who did not. Overall, 47 (29%) completed 18 months follow-up, with 15 (9.1%) attending all visits. 76 (46.9%) participants were lost to follow-up, 15 (9.1%) exited when leaving the area, and 28.7% of exits happened in the first month of the study. We identified two different trajectories of PrEP adherence: 67% of participants had, on average, consistently low TFV-DP levels, with the remaining 33% having sustained high adherence. Few baseline characteristics predicted good adherence. The main reported barrier to taking PrEP was forgetting to take or travel with the pills. Encouragement from others declined as a reported facilitator from month 6 to 18 (family: 93.1% vs 77.6%, p = 0.016, friends: 77.6% vs 41.4%, p ≤ 0.001, partners: 62.1% vs 46.6%, p = 0.096, other PrEP users: 89.7% vs 74.1%, p = 0.020). Disclosure to friends and family in some cases opened dialogue around sex, and helped to educate others about PrEP. Self-reported sex with more than one partner, and sex without a condom, decreased significantly after enrolment (p < 0.001, p = 0.063). In the individual interviews, participants credited their PrEP experience with changing their behaviour. Recognising the challenges with, but overall benefits from a package of care that includes the option of PrEP, lessons drawn from this study can help maximise persistence on PrEP within resource constraints. PrEP providers need to address participants’ need for both convenience and social support.

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Section: Discussionsupporting

confidence: 77%

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

et al. 2021

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“…One major challenge to acceptability of PrEP in this study, as has been noted elsewhere ( Kawuma et al, 2021 ; Muhumuza et al, 2021 ), was taking pills which are similar to those taken by people living with HIV. Hence participants preferred on-demand PrEP, largely because it would shelter them from being seen “taking pills daily".…”

Section: Discussionmentioning

confidence: 74%

“…Community-based studies of daily oral PrEP implementation in East Africa also indicate lower uptake among people younger than 25 years old ( Mugwanya et al, 2019 ; Koss et al, 2020 ). In addition, recent findings from the Combined HIV Adolescent PrEP and Prevention study (CHAPS) conducted in Uganda, Zimbabwe and South Africa indicate that even though young people were willing to use PrEP, there are barriers at individual, interpersonal, community, institutional and structural levels that require multi-level interventions to promote PrEP use ( Muhumuza et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“I prefer to take pills when I plan to have sex”: Perceptions of on-demand versus daily oral pre-exposure prophylaxis among adolescents in Kampala, Uganda

Kawuma

Nabalwanyi

Seeley

et al. 2022

African Journal of AIDS Research

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There is limited information about the use of on-demand and daily pre-exposure prophylaxis (PrEP) among adolescents and young people (AYP) in sub-Saharan Africa. We explored perceptions of both regimens among 14- to 19-year-olds perceived to be at high risk of HIV infection in Kampala, Uganda, using qualitative data collection methods. Data were analysed by theme and interpreted based on constructs from the framework of acceptability. Although there were no noticeable gender differences in preferences for a particular regimen, acceptability of PrEP depended on individual AYP sexual behaviour at the time of the study. Those who perceived themselves to be at increased risk of acquiring HIV preferred using daily PrEP, citing the consistency that comes from taking a pill daily and which they considered to be efficacious and safe. AYP who had less frequent sex preferred on-demand PrEP because it would enable them to “plan for sex”. However, both groups perceived taking daily PrEP to be a burden, which was an impediment to acceptance of this form of PrEP. AYP anticipated that daily pill taking would be very stressful, requiring a lot of effort and would interrupt their daily routine. Therefore, while both on-demand and daily PrEP were acceptable and beneficial to these AYP, preferences for either regimen depended on self-perceived risk. Thus, oral PrEP use should be tailored to end-user preferences and risk profiles.

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“…In Uganda, anticipated stockouts have also been reported as a barrier to PrEP uptake. 54 If not addressed, stockouts will continue to act as a primary barrier to PrEP scale-up in Cameroon. Sustainable funding, effective supply chain management, and inventory monitoring need to be strengthened to support effective PrEP implementation.…”

Section: Discussionmentioning

confidence: 99%

HIV Pre-exposure Prophylaxis Uptake and Continuation Among Key Populations in Cameroon: Lessons Learned From the CHAMP Program

Ndenkeh

Bowring

Njindam

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: Pre-exposure prophylaxis (PrEP) is proven to be a highly effective HIV prevention method for key populations. However, its scale-up in resource-limited settings remains suboptimal. This paper seeks to describe PrEP initiation and continuation among key populations in Cameroon.Methodology: From June 2019 through October 2020, we collected routine program data on PrEP uptake and continuation among female sex workers (FSWs) and men who have sex with men (MSM) in the Continuum of prevention, care and treatment of HIV/AIDS with Most-at-risk Populations (CHAMP) program in Cameroon. PrEP was offered to clients who tested negative for HIV and were assessed to potentially benefit from PrEP. Using survival analysis, we identified factors associated with PrEP discontinuation over time with significance set at 5%.Results: Overall, 27,750 clients were sensitized for PrEP of whom 3,138 persons were eligible to start PrEP and 1,409 (45%; FSW: 691 and MSM: 718) initiated PrEP. The PrEP continuation rate was 37% at 3 months, 28% at 6 months and 19% at 12 months. PrEP discontinuation was significantly higher among FSW than MSM [adjusted hazard ratio (aHR) 1.5 (95% CI: 1.2 to 1.9)] in Yaounde [aHR 1.5 (95% CI: 1.2 to 1.9)] and Bafoussam/Bertoua [aHR 3.1 (2.2-4.5)] relative to Douala. Discontinuation was lower among those with moderate [aHR 0.3 (0.3-0.4)] or good adherence [aHR 0.4 (0.3-0.6)] compared with poor adherence (all P , 0.001). Conclusion:Differentiated approaches to deliver PrEP, create demand, and provide more intensive support for adherence and continuation may support scale-up of PrEP in Cameroon for equitable and prolonged impact on HIV prevention.

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Exploring Perceived Barriers and Facilitators of PrEP Uptake among Young People in Uganda, Zimbabwe, and South Africa

Cited by 71 publications

References 36 publications

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

“I prefer to take pills when I plan to have sex”: Perceptions of on-demand versus daily oral pre-exposure prophylaxis among adolescents in Kampala, Uganda

HIV Pre-exposure Prophylaxis Uptake and Continuation Among Key Populations in Cameroon: Lessons Learned From the CHAMP Program

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