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
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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.
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- 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
AIDS and Behavior
Volume 17, Issue 6 , pp 2162-2172
- Cover Date
- Print ISSN
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- Springer US
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- Men who have sex with men
- HIV pre-exposure prophylaxis
- Industry Sectors
- Author Affiliations
- 1. Centre for Geographic Medicine Research—Coast, Kenya Medical Research Institute, P.O. Box 230, Kilifi, Kenya
- 2. International AIDS Vaccine Initiative, Nairobi, Kenya
- 3. Brown University, Providence, RI, USA
- 4. Kenya AIDS Vaccine Initiative, Nairobi, Kenya
- 5. Rhode Island Hospital and Brown University, Providence, RI, USA
- 6. International AIDS Vaccine Initiative, New York, NY, USA
- 7. Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- 8. Nuffield Department of Clinical Medicine, University of Oxford, Headington, Oxford, UK