High Acceptability of HIV Pre-exposure Prophylaxis but Challenges in Adherence and Use: Qualitative Insights from a Phas
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ORIGINAL PAPER
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
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Published online: 19 October 2012 Springer Science+Business Media New York 2012
Abstract 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 preexposure 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 E. M. Van der Elst (&) P. Mugo J. Kanungi E. J. Sanders Centre for Geographic Medicine Research—Coast, Kenya Medical Research Institute, P.O. Box 230, Kilifi, Kenya e-mail: [email protected] J. Mbogua International AIDS Vaccine Initiative, Nairobi, Kenya
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. Keywords Men who have sex with men HIV pre-exposure prophylaxis PrEP Adherence Kenya
D. Operario Brown University, Providence, RI, USA
Introduction
G. Mutua Kenya AIDS Vaccine Initiative, Nairobi, Kenya
Pre-exposure prophylaxis (PrEP) refers to the use of antiretroviral medications (ARVs) by HIV-negative individuals to reduce risk of HIV infection, and to date, is one of the most promising strategies in the field of biomedical HIV prevention. Prophylactic use of ARVs in animal models has been shown repeatedly to reduce simian/HIV acquisition [1–4]. A phase III randomized controlled trial tested the efficacy of once-daily oral dose of emtricitabine–tenofovir (Truvada) versus placebo on HIV incidence among men and transgender women who have sex with men in Peru, Ecuador, South Africa, Brazil, Thailand, and the United States [5]. Results demonstrated a 44 % reduction in the incidence of HIV infection among partic
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