Qualitative Assessment of Barriers and Facilitators of PrEP Use Before and After Rollout of a PrEP Program for Priority Populations in South-central Uganda
Uganda piloted HIV pre-exposure prophylaxis (PrEP) for priority populations (sex workers, fishermen, truck drivers, discordant couples) in 2017. To assess facilitators and barriers to PrEP uptake and adherence, we explored perceptions of PrEP before and experiences after rollout among community memb...
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| Veröffentlicht in: | AIDS and behavior 2021-11, Vol.25 (11), p.3547-3562 |
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| creator | Ddaaki, William Strömdahl, Susanne Yeh, Ping Teresa Rosen, Joseph G. Jackson, Jade Nakyanjo, Neema Kagaayi, Joseph Kigozi, Godfrey Nakigozi, Gertrude Grabowski, M. Kathryn Chang, Larry W. Reynolds, Steven J. Nalugoda, Fred Ekström, Anna Mia Kennedy, Caitlin E. |
| description | Uganda piloted HIV pre-exposure prophylaxis (PrEP) for priority populations (sex workers, fishermen, truck drivers, discordant couples) in 2017. To assess facilitators and barriers to PrEP uptake and adherence, we explored perceptions of PrEP before and experiences after rollout among community members and providers in south-central Uganda. We conducted 75 in-depth interviews and 12 focus group discussions. We analyzed transcripts using a team-based thematic framework approach. Partners, family, peers, and experienced PrEP users provided adherence support. Occupational factors hindered adherence for sex workers and fishermen, particularly related to mobility. Pre-rollout concerns about unskilled/untrained volunteers distributing PrEP and price-gouging were mitigated. After rollout, awareness of high community HIV risk and trust in PrEP effectiveness facilitated uptake. PrEP stigma and unexpected migration persisted as barriers. Community-initiated, tailored communication with successful PrEP users may optimize future engagement by addressing fears and rumors, while flexible delivery and refill models may facilitate PrEP continuation and adherence. |
| doi_str_mv | 10.1007/s10461-021-03360-3 |
| format | Article |
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Partners, family, peers, and experienced PrEP users provided adherence support. Occupational factors hindered adherence for sex workers and fishermen, particularly related to mobility. Pre-rollout concerns about unskilled/untrained volunteers distributing PrEP and price-gouging were mitigated. After rollout, awareness of high community HIV risk and trust in PrEP effectiveness facilitated uptake. PrEP stigma and unexpected migration persisted as barriers. 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To assess facilitators and barriers to PrEP uptake and adherence, we explored perceptions of PrEP before and experiences after rollout among community members and providers in south-central Uganda. We conducted 75 in-depth interviews and 12 focus group discussions. We analyzed transcripts using a team-based thematic framework approach. Partners, family, peers, and experienced PrEP users provided adherence support. Occupational factors hindered adherence for sex workers and fishermen, particularly related to mobility. Pre-rollout concerns about unskilled/untrained volunteers distributing PrEP and price-gouging were mitigated. After rollout, awareness of high community HIV risk and trust in PrEP effectiveness facilitated uptake. PrEP stigma and unexpected migration persisted as barriers. 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| ispartof | AIDS and behavior, 2021-11, Vol.25 (11), p.3547-3562 |
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| subjects | Anti-HIV Agents - therapeutic use Barriers Community Disease prevention Fish populations Fishermen Fishing communities Health Psychology Health risks HIV HIV Infections - drug therapy HIV Infections - prevention & control Human immunodeficiency virus Humans Implementation science Infectious Diseases Medicin och hälsovetenskap Medicine Medicine & Public Health Migration Occupational exposure Original Paper Peers Populations Pre-Exposure Prophylaxis Prophylaxis Prostitution Public Health Sex industry Sex Workers Sexually transmitted diseases STD Uganda |
| title | Qualitative Assessment of Barriers and Facilitators of PrEP Use Before and After Rollout of a PrEP Program for Priority Populations in South-central Uganda |
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