“We know this will be hard at the beginning, but better in the long term”: understanding PrEP uptake in the general population in Eswatini

Bärnighausen, Kate; Matse, Sindy; Hughey, Allison B.; Hettema, Anita; Bärnighausen, Till; McMahon, Shannon A.

doi:10.1080/09540121.2019.1653437

Cited by 19 publications

(25 citation statements)

References 30 publications

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“…This could be attributed to the multiple co-occurring transitions during adolescence such as increased autonomy, decreased adult supervision, identity formation, peer influence, and social transition, potentially leading to early sexual debut and health risk behaviors that may lead to HIV infection (Cicchetti & Rogosch, 2002 ; Schulenberg, Maggs, & Hurrelmann, 1999 ). Despite this, the levels of PrEP acceptability and uptake among AYP in sub-Saharan Africa remain unclear, as research on PrEP has focused on high-risk adult populations (Bärnighausen et al, 2019 ; Shah, Gillespie, Holt, Morris, & Camacho-Gonzalez, 2019 ; Vaughn, Dillon, & Kedia, 2019 ; World Health Organization, 2017b ). Previous work among MSM showed that stigma, drug effects, and adherence were among the barriers to PrEP uptake (Holloway et al, 2017 ; Owens et al, 2020 ), while a facilitator of uptake was the provision of PrEP free of charge (Golub et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. Few studies have explored adolescents and young people’s perspectives toward PrEP. We conducted 24 group discussions and 60 in-depth interviews with males and females aged 13–24 years in Uganda, Zimbabwe, and South Africa between September 2018 and February 2019. We used the framework approach to generate themes and key concepts for analysis following the social ecological model. Young people expressed a willingness to use PrEP and identified potential barriers and facilitators of PrEP uptake. Barriers included factors at individual (fear of HIV, fear of side effects, and PrEP characteristics), interpersonal (parental influence, absence of a sexual partner), community (peer influence, social stigma), institutional (long waiting times at clinics, attitudes of health workers), and structural (cost of PrEP and mode of administration, accessibility concerns) levels. Facilitators included factors at individual (high HIV risk perception and preventing HIV/desire to remain HIV negative), interpersonal (peer influence, social support and care for PrEP uptake), community (adequate PrEP information and sensitization, evidence of PrEP efficacy and safety), institutional (convenient and responsive services, provision of appropriate and sufficiently resourced services), and structural (access and availability of PrEP, cost of PrEP) levels. The findings indicated that PrEP is an acceptable HIV prevention method. PrEP uptake is linked to personal and environmental factors that need to be considered for successful PrEP roll-out. Multi-level interventions needed to promote PrEP uptake should consider the social and structural drivers and focus on ways that can inspire PrEP uptake and limit the barriers.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The Ministry of Health of the Kingdom of Eswatini (formerly Swaziland) with support from Heidelberg University and the Clinton Health Access Initiative conducted one of the first PrEP general population demonstration projects between August 2017 and January 2019 in six public health clinics. Preliminary data revealed a need to focus on men and to include the perspective of community leaders [ 34 , 35 ]. Our nested mixed-methods study examines men’s response to PrEP in order to i) identify the main characteristics of men at risk of an HIV infection and men who take up PrEP, as well as their risk perceptions, ii) explore MSW’s reasons for taking up or declining PrEP and their experiences with PrEP, and iii) describe men’s experience with facility-based PrEP education and delivery and advance MSW’s recommendations for further PrEP education and service delivery.…”

Section: Introductionmentioning

confidence: 99%

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

et al. 2020

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Few studies on HIV Pre-Exposure Prophylaxis (PrEP) have focused on men who have sex with women. We present findings from a mixed-methods study in Eswatini, the country with the highest HIV prevalence in the world (27%). Our findings are based on risk assessments, in-depth interviews and focus-group discussions which describe men's motivations for taking up or declining PrEP. Quantitatively, men self-reported starting PrEP because they had multiple or sero-discordant partners or did not know the partner's HIV-status. Men's self-perception of risk was echoed in the qualitative data, which revealed that the hope of facilitated sexual performance or relations, a preference for pills over condoms and the desire to protect themselves and others also played a role for men to initiate PrEP. Trust and mistrust and being able or unable to speak about PrEP with partner(s) were further considerations for initiating or declining PrEP. Once on PrEP, men's sexual behavior varied in terms of number of partners and condom use. Men viewed daily pill-taking as an obstacle to starting PrEP. Side-effects were a major reason for men to discontinue PrEP. Men also worried that taking anti-retroviral drugs daily might leave them mistaken for a person living with HIV, and viewed clinic-based PrEP education and initiation processes as a further obstacle. Given that men comprise only 29% of all PrEP users in Eswatini, barriers to men's uptake of PrEP will need to be addressed, in terms of more malefriendly services as well as trialing community-based PrEP education and service delivery.

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“…Evidence from other PrEP implementation projects [ 40 , 41 ] lend credit to POWER staff’s concern that high provider workloads could derail implementation. For example, “increased workload and documentation burden amid healthcare workforce shortages” emerged as a key challenge in the PrEP Implementation for Young Women and Adolescents (PrIYA) study, which, from 2017 to 2018, integrated PrEP into 16 MCH/FP facilities in Kisumu, Kenya [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

Roche

Barnabee

Omollo

et al. 2022

BMC Health Serv Res

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Introduction Across sub-Saharan Africa, ministries of health have proposed integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning (FP) services to reach adolescent girls and young women (AGYW); however, evidence on effective implementation strategies is still limited. We conducted a qualitative study of integrated PrEP-FP service implementation at two FP clinics in Kisumu, Kenya. Methods From June 2017 to May 2020, the Prevention Options for Women Evaluation Research (POWER) study enrolled 1000 sexually active, HIV-negative AGYW age 16 to 25. Actions taken to implement PrEP were captured prospectively in 214 monitoring and evaluation documents and 15 interviews with PrEP implementers. We analysed data using conventional and directed content analysis, with the latter informed by the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation. Results POWER deployed a variety of implementation strategies to train and educate stakeholders (e.g., having new providers shadow PrEP providers); develop stakeholder interrelationships (e.g., organizing support teams with protected time to reflect on implementation progress and make refinements); provide technical assistance; and change physical infrastructure and workflow. Although these strategies reportedly influenced contextual factors across four of the five CFIR domains, they primarily interacted with contextual factors relevant to inner setting, especially implementation climate and readiness for implementation. Overall, implementing PrEP proved easier and less labor-intensive at a private, youth-friendly clinic than a public FP clinic, largely because the baseline structural characteristics (e.g., space, workflow) and organizational mission of the former were more conducive to offering AGYW-centered care. Nevertheless, adoption of PrEP delivery among non-study staff at both sites was low, likely due to the widespread perception that PrEP was not within their scope of work. Conclusions Some FP clinics may be “lower-hanging fruit” than others for PrEP implementation. Approaching PrEP implementation as a behavioral intervention for FP providers may help ensure that providers have the requisite capability, opportunity, and motivation to adopt the clinical innovation. In particular, PrEP implementers should assess the need for implementation strategies that support providers’ clinical decision-making, establish worker expectations and accountability, and address workload constraints. Trial registration Clinical Trial Number: NCT03490058.

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“We know this will be hard at the beginning, but better in the long term”: understanding PrEP uptake in the general population in Eswatini

Cited by 19 publications

References 30 publications

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

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

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

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