Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda

Abstract

Background Scale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Uganda began with serodiscordant couples (SDC) and has expanded to other most at-risk populations (MARPs). We explored knowledge, acceptability, barriers and facilitators of PrEP use among potential PrEP users in four MARPs (SDC; men who have sex with men [MSM]; female sex workers [FSW], and fisher folk). Methods We administered quantitative surveys to potential PrEP users in multiple settings in Central Uganda at baseline and approximately 9 months after healthcare worker (HCW) training on PrEP. Results The survey was completed by 250 potential PrEP users at baseline and 125 after HCW training; 55 completed both surveys. For these 250 participants, mean age was 28.5 years (SD 6.9), 47% were male and 6% were transgender women, with approximately even distribution across MARPs and recruitment locations (urban, peri-urban, and rural). Most (65%) had not heard about PrEP. After HCW training, 24% of those sampled were aware of PrEP, and the proportion of those who accurately described PrEP as “antiretrovirals to be used before HIV exposure” increased from 54% in the baseline survey to 74% in the second survey (p<0.001). The proportion of participants who reported HCW as a source of PrEP information increased after training (59% vs 91%, p<0.001). In both surveys, nearly all participants indicated they were willing to take PrEP if offered. The most common anticipated barriers to PrEP were stigma, transportation, accessibility, busy schedules, and forgetfulness. Closeness to home was a common facilitator for all participant categories. Conclusions Initial awareness of PrEP was low, but PrEP knowledge and interest increased among diverse MARPs after HCW training. Demand creation and HCW training will be critical for increasing PrEP awareness among key populations, with support to overcome barriers to PrEP use. These findings should encourage the acceleration of PrEP rollout in Uganda.

High burden of untreated syphilis, drug resistant Neisseria gonorrhoeae, and other sexually transmitted infections in men with urethral discharge syndrome in Kampala, Uganda

“…To build on the successes of Uganda’s 90–90–90 progress, young men who engage in transactional sex, and other high-risk sexual behaviors should be identified for prevention interventions before they acquire HIV and other STIs or at their first episode of UDS. Behavior change interventions are perennially challenging [ 25 ], but have been shown to be effective [ 26 ] so merit ongoing efforts. In particular interventions to promote consistent condom use with all partners, including transactional and non-transactional partnerships, are required [ 27 ].…”

Health Care Worker Perspectives of HIV Pre-exposure Prophylaxis Service Delivery in Central Uganda

“…We previously reported that potential PrEP users primarily received information about HIV prevention from HCWs ( 16 ). This reliance on HCWs for information and the need for accurate knowledge to provide high-quality care highlight the importance of ongoing training as PrEP is scaled up in Uganda and elsewhere.…”

“…The Barriers Study was a mixed-methods study designed to assess knowledge of PrEP and identify potential barriers and facilitators of PrEP uptake and adherence among potential PrEP users, as well as to determine HCW knowledge of PrEP and perceptions regarding preparedness and willingness to deliver PrEP services in Central Uganda. Findings on potential PrEP users are described elsewhere ( 16 ); this paper focuses on the impact of HCW training. All activities associated with HCWs occurred in English (the official language used in provision of medical care in Uganda).…”

“…Educational methods included both didactic sessions and role-plays. Training modules included: (1) PrEP basics (e.g., what is PrEP, differentiating PrEP from post-exposure prophylaxis (PEP) and antiretroviral therapy (ART), who needs PrEP, identifying people at substantial risk of HIV infection; (2) PrEP screening and eligibility (e.g., PrEP eligibility criteria, screening for substantial HIV risk and PrEP eligibility, PrEP contraindications, acute HIV infection); (3) Initial and follow-up visit requirements (e.g., visit procedures, national HIV testing guidelines, PrEP counseling), and; (4) PrEP stigma, side effects, and HIV seroconversion (e.g., creatinine elevation, strategies to minimize PrEP stigma, seroconversion management), as previously described ( 16 ).…”

Impact of COVID-19 on income, prevention attitudes, and access to healthcare among male clients in a Sexually Transmitted Infections clinic

“…Although PrEP has been shown to be a robust biomedical strategy to prevent HIV infection, real-life roll-out and implementation among vulnerable populations remain low. 30 , 31 , 32 , 33 , 34 …”