AIDS and Behavior

, Volume 17, Issue 6, pp 2162–2172 | Cite as

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 Elst
  • Judie Mbogua
  • Don Operario
  • Gaudensia Mutua
  • Caroline Kuo
  • Peter Mugo
  • Jennifer Kanungi
  • Sagri Singh
  • Jessica Haberer
  • Frances Priddy
  • Eduard Joachim Sanders
Original Paper


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 


  1. 1.
    Garcia-Lerma J, Otten R, Qari S, Jackson E, Cong M, Masciotra S, et al. Prevention of rectal SHIV transmission in macaques by daily or intermittent prophylaxis with emtricitabine and tenofovir. PLoS Med. 2008;5(2):28.CrossRefGoogle Scholar
  2. 2.
    García-Lerma J, Cong M, Mitchell J, Youngpairoj A, Zheng Q, Masciotra S, et al. Intermittent prophylaxis with oral truvada protects macaques from rectal SHIV infection. Sci Transl Med. 2010;2(14):14.CrossRefGoogle Scholar
  3. 3.
    Denton P, Estes J, Sun Z, Othieno F, Wei B, Wege A, et al. Antiretroviral pre-exposure prophylaxis prevents vaginal transmission of HIV-1 in humanized BLT mice. PLoS Med. 2008;5(1):e16.PubMedCrossRefGoogle Scholar
  4. 4.
    Neff C, Ndolo T, Tandon A, Habu Y, Akkina R. Oral pre-exposure prophylaxis by anti-retrovirals raltegravir and maraviroc protects against HIV-1 vaginal transmission in a humanized mouse model. PLoS One. 2010;5(12):e15257.PubMedCrossRefGoogle Scholar
  5. 5.
    Grant R, Lama J, Anderson P, McMahan V, Liu A, Vargas L, et al. Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men. N Engl J Med. 2010;363(27):2587–99.PubMedCrossRefGoogle Scholar
  6. 6.
    Pivotal study finds that HIV medications are highly effective as prophylaxis against HIV infection in men and women in Africa. University of Washington International Clinical Research Center, Partners in PrEP Study; 2011 [cited 2011 July 30, 2011]; Available from: Accessed 19 Sept 2012.
  7. 7.
    CDC trial and another major study find PrEP can reduce risk of HIV infection among heterosexuals. 2011 [cited 2011 July 30, 2011]; Available from: Accessed 19 Sept 2012.
  8. 8.
    Golub SA, Kowalczyk W, Weinberger CL, Parsons JT. Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr. 2010;54:548–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education. J Acquir Immune Defic Syndr. 2009;50:77–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Galea J, Kinsler J, Salazar X, Lee S, Giron M, Sayles J, et al. Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS. 2011;22:256–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Dunkle K, Wingood G, Camp C, DiClemente R. Intention to use pre-exposure prophylaxis among African-American and white women in the United States: results from a national telephone survey. XVII International AIDS Conference; Mexico City, Mexico; 2008.Google Scholar
  12. 12.
    Schneider J, Dandona R, Pasupneti S, Lakshmi V, Liao C, Yeldandi V, et al. Initial commitment to pre-exposure prophylaxis and circumcision for HIV prevention amongst Indian truck drivers. PLoS One. 2010;5(7):e11922.PubMedCrossRefGoogle Scholar
  13. 13.
    Ware NC, Wyatt MA, Haberer JE, Baeten JM, Kintu A, Psaros C, Safren S, et al. What’s love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV serodiscordant couples. J Acquir Immune Defic Syndr. 2012;59(5):463–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Mutua G, Sanders E, Mugo P, Anzala O, Haberer J, Bangsberg D, et al. A randomized trial of intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men: safety and Adherence. PLoS One. 2012;7:e33103.PubMedCrossRefGoogle Scholar
  15. 15.
    Smith A, Muhaari A, Agwanda C, Kowuo D, van der Elst EM, Davies A. Female clients and partners of MSM sex workers in Mombasa. Paper presented at the 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA. Mombasa: CROI; 2010.Google Scholar
  16. 16.
    Ritchie J, Spencer L, editors. Qualitative data analysis for applied policy research. London: Routledge; 1994.Google Scholar
  17. 17.
    Underhill K, Operario D, Skeer M, Mimiaga M, Mayer K. Packaging PrEP to prevent HIV: an integrated framework to plan for pre-exposure prophylaxis implementation in clinical practice. J Acquir Immune Defic Syndr. 2010;55(1):8–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Remien RH, Stirratt JJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, et al. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS. 2005;19:807–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Paxton LA, Hope T, Jaffe HW. Pre-exposure prophylaxis for HIV infection: what if it works? Lancet. 2007;370:89–93.PubMedCrossRefGoogle Scholar
  20. 20.
    Nozaki I, Dube C, Kakimoto K, Yamada N, Simpungwe JB. Social factors affecting ART adherence in rural settings in Zambia. AIDS Care. 2011;10:1–8.CrossRefGoogle Scholar
  21. 21.
    Mansergh G, Koblin B, Colfax G, McKirnan D, Flores S, Hudson S. Preefficacy use and sharing of antiretroviral medications to prevent sexually-transmitted HIV infection among US men who have sex with men. J Acquir Immune Defic Syndr. 2010;55(2):e14–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Larson E, Lin SX, Gomez-Duarte C. Antibiotic use in Hispanic households, New York City. Emerg Infect Dis. 2003;9:1096–102.PubMedCrossRefGoogle Scholar
  23. 23.
    Petersen EE, Rasmussen SA, Daniel KL, Yazdy MM, Honein MA. Prescription medication borrowing and sharing among women of reproductive age. J Womens Health. 2008;17(7):1073–80.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Elisabeth Maria Van der Elst
    • 1
  • Judie Mbogua
    • 2
  • Don Operario
    • 3
  • Gaudensia Mutua
    • 4
  • Caroline Kuo
    • 5
  • Peter Mugo
    • 1
  • Jennifer Kanungi
    • 1
  • Sagri Singh
    • 6
  • Jessica Haberer
    • 7
  • Frances Priddy
    • 6
  • Eduard Joachim Sanders
    • 1
    • 8
  1. 1.Centre for Geographic Medicine Research—CoastKenya Medical Research InstituteKilifiKenya
  2. 2.International AIDS Vaccine InitiativeNairobiKenya
  3. 3.Brown UniversityProvidenceUSA
  4. 4.Kenya AIDS Vaccine InitiativeNairobiKenya
  5. 5.Rhode Island Hospital and Brown UniversityProvidenceUSA
  6. 6.International AIDS Vaccine InitiativeNew YorkUSA
  7. 7.Center for Global HealthMassachusetts General HospitalBostonUSA
  8. 8.Nuffield Department of Clinical MedicineUniversity of OxfordHeadington, OxfordUK

Personalised recommendations