Qualitative Assessment of Barriers and Facilitators of PrEP Use Before and After Rollout of a PrEP Program for Priority Populations in South-central Uganda

William Ddaaki, Susanne Strömdahl, Ping Teresa Yeh, Joseph G. Rosen, Jade Jackson, Neema Nakyanjo, Joseph Kagaayi, Godfrey Kigozi, Gertrude Nakigozi, M. Kathryn Grabowski, Larry W. Chang, Steven J. Reynolds, Fred Nalugoda, Anna Mia Ekström, Caitlin E. Kennedy

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalAIDS and behavior
DOIs
StateAccepted/In press - 2021

Keywords

  • Fishing communities
  • Implementation science
  • Pre-exposure prophylaxis
  • Sex workers
  • Uganda

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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