Understanding user perspectives of and preferences for oral PrEPforHIVprevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa

In: Journal of the International AIDS Society, Band 22, Heft S4

Open Access

Abstract

AbstractIntroductionOral pre‐exposure prophylaxis (PrEP) forHIVprevention has been proven to significantly reduce newHIVinfections yet scale‐up has been slow. As contexts continue to adjust to make space for PrEP, it is crucial to understand the perspectives and experiences of potential end‐users. In order to inform PrEPand demand creation interventions, this paper examines personal perspectives on adopting and using PrEPamongHIVat‐risk populations in sub‐Saharan Africa.MethodsUsing the principles of a scoping review in July 2018, we explored the extent, range, and nature of published literature regarding PrEPuptake and use among; men who have sex with men,HIVserodiscordant couples, adolescent girls and young women, pregnant and breastfeeding women, women partners of migrant workers; and people who use drugs. Steps included: identification of the research question; identification of relevant studies; study selection; charting the data; and collation – summarizing and reporting results. PubMed and PsycInfo were searched for papers relating to PrEPuptake and use in sub‐Saharan Africa. Resulting papers were reviewed with data extracted and compiled in Excel for analysis. A broad content analysis was conducted and organized into high‐level themes.Results and discussionThirty‐five papers were included in this review. There was little opposition in general to oral PrEP; however, there were significant nuances in its broader acceptability, applicability, and usability. We identified five themes within which these are discussed. These relate to balancing complexities of personal empowerment and stigma; navigating complex risk environments; influences of relationships and partners; efficacy and side effects; and practicalities of use. This body of research suggests that while product attributes and the logistics of PrEPdelivery and use are important topics, it is vital to consider stigma, the interactions of PrEPuse with relationships, and the need for broader understanding ofARVs for prevention versus treatment.ConclusionsPlanning for, programming and promoting the adoption of oral PrEPnecessitates a deeper understanding of end‐user priorities in order to ensure successful interventions. This review illustrates the nuances facilitating or deterring PrEPuse that may affect the larger effort of PrEPscale‐up.