Original Paper

AIDS and Behavior

, Volume 17, Issue 6, pp 2162-2172

First online:

High Acceptability of HIV Pre-exposure Prophylaxis but Challenges in Adherence and Use: Qualitative Insights from a Phase I Trial of Intermittent and Daily PrEP in At-Risk Populations in Kenya

  • Elisabeth Maria Van der ElstAffiliated withCentre for Geographic Medicine Research—Coast, Kenya Medical Research Institute Email author 
  • , Judie MboguaAffiliated withInternational AIDS Vaccine Initiative
  • , Don OperarioAffiliated withBrown University
  • , Gaudensia MutuaAffiliated withKenya AIDS Vaccine Initiative
  • , Caroline KuoAffiliated withRhode Island Hospital and Brown University
  • , Peter MugoAffiliated withCentre for Geographic Medicine Research—Coast, Kenya Medical Research Institute
  • , Jennifer KanungiAffiliated withCentre for Geographic Medicine Research—Coast, Kenya Medical Research Institute
  • , Sagri SinghAffiliated withInternational AIDS Vaccine Initiative
  • , Jessica HabererAffiliated withCenter for Global Health, Massachusetts General Hospital
    • , Frances PriddyAffiliated withInternational AIDS Vaccine Initiative
    • , Eduard Joachim SandersAffiliated withCentre for Geographic Medicine Research—Coast, Kenya Medical Research InstituteNuffield Department of Clinical Medicine, University of Oxford

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This paper used qualitative methods to explore experiences of men who have sex with men and female sex workers in Nairobi and Mtwapa, Kenya, who used oral pre-exposure prophylaxis (PrEP) for HIV prevention as part of a four-month trial of safety, acceptability and adherence. Fifty-one of 72 volunteers who took part in a randomized, placebo-controlled, blinded trial that compared daily and intermittent dosage of PrEP underwent qualitative assessments after completing the trial. Analyses identified three themes: (i) acceptability of PrEP was high, i.e. side effects were experienced early in the study but diminished over time, however characteristics of pills could improve comfort and use; (ii) social impacts such as stigma, rumors, and relationship difficulties due to being perceived as HIV positive were prevalent; (iii) adherence was challenged by complexities of daily life, in particular post-coital dosing adherence suffered from alcohol use around time of sex, mobile populations, and transactional sex work. These themes resonated across dosing regimens and gender, and while most participants favored the intermittent dosing schedule, those in the intermittent group noted particular challenges in adhering to the post-coital dose. Culturally appropriate and consistent counseling addressing these issues may be critical for PrEP effectiveness.


Men who have sex with men HIV pre-exposure prophylaxis PrEP Adherence Kenya