When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling

Abstract

Oral pre-exposure prophylaxis (PrEP) using the antiretroviral drug emtricitabine/tenofovir disoproxil fumarate (Truvada) has been shown to dramatically reduce the risk of HIV acquisition for women at higher risk of infection if taken daily. Understanding when and why women would intentionally stop using an efficacious oral PrEP drug within the context of their “normal” daily lives is essential for delivering effective PrEP risk-reduction counselling. We conducted 60 qualitative interviews with women at higher risk of HIV in Bondo, Kenya, and Pretoria, South Africa, as part of a larger study. Participants charted their sexual contacts over the previous six months, indicated whether they would have taken PrEP if available, and discussed whether and why they would have suspended PrEP use. Nearly all participants said they would have used PrEP in the previous six months; half indicated they would have suspended PrEP use at some point. Participants’ reasons for an extended break from PrEP were related to partnership dynamics (e.g., perceived low risk of a stable partner) and phases of life (e.g., trying to conceive). Life events (e.g., holidays and travel) could prompt shorter breaks in PrEP use. These circumstances may or may not correspond to actual contexts of lower risk, highlighting the importance of tailored PrEP risk-reduction counselling.

Motives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis – a qualitative analysis

“…General motives to temporarily or completely stop PrEP were in line with expectations, problems with uptake such as travelling, sickness and side‐effects, as noted in previous studies . The motives to temporarily stop daily PrEP or switch to event‐driven PrEP were primarily related to decreases in sexual risk behaviour.…”

“…The motives to temporarily stop daily PrEP or switch to event‐driven PrEP were primarily related to decreases in sexual risk behaviour. Our data therefore provide real‐life support to earlier data on intentions to use or stop PrEP, showing that PrEP users temporarily stopped daily PrEP as they found themselves in a non‐risky episode of their lives, a phenomenon referred to as “seasons of risk” , “seasons of vulnerability” and “seasons of PrEP ”. While some studies conceptualized such episodes of reduced intake as indication of non‐adherence to the daily regimen , we argue, among other authors , that such well‐informed decisions indicate self‐efficacy in managing PrEP‐regimens according to current risk level.…”

“…The above results highlight the added value of offering a choice between PrEP‐regimens, as it enables MSM to match and adjust HIV prevention strategies to their potentially changeable individual needs and the sexual context of their life. If individual needs are not met, adherence can decline . The adjustability of PrEP‐regimens to changing life circumstances contributes to a personalized HIV prevention approach that potentially can maximize PrEP's potential as a public health measure.…”

Integrated delivery of antiretroviral treatment and pre‐exposure prophylaxis toHIV‐1 serodiscordant couples in East Africa: a qualitative evaluation study in Uganda

“…Much qualitative research on antiretrovirals for prevention in Africa reports user perspectivesattitudes, knowledge, preferences, and influences on the use of PrEP and immediate ART [16][17][18][19][20][21][22][23][24][25][26]. Qualitative methods have also been used to shed light on reasons underlying suboptimal PrEP adherence in the VOICE and FEM-PrEP clinical trials [27][28][29][30][31][32].…”

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

“…Understanding the variety of product associations and PrEP perceptions of women with differing socioeconomic and geo-spatial locations catalyses an understanding of what women want and how to position microbicides for effective product introduction (see Namey et al 2016). The challenge remains for marketing experts to find a balance between what women want and to effectively tailor supporting promotional messages, delivery and distribution of products to varying users.…”