Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV
Makaita M. Gombe aff001; Brigid E. Cakouros aff001; Getrude Ncube aff002; Nonhlanhla Zwangobani aff003; Portia Mareke aff001; Alec Mkwamba aff001; Marta R. Prescott aff004; Taurai Bhatasara aff002; Michael Murwira aff003; Alexio Z. Mangwiro aff001; Margaret L. Prust aff004
Působiště autorů: Demand Driven Evaluations for Decisions (3DE), Clinton Health Access Initiative, Harare, Zimbabwe aff001; HIV Prevention, Ministry of Health and Child Care, Harare, Zimbabwe aff002; Technical Directorate, Zimbabwe National Family Planning Council, Harare, Zimbabwe aff003; Applied Analytics Team, Clinton Health Access Initiative, Boston, United States of America aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
Understanding the perspectives and preferences of clients eligible for pre-exposure prophylaxis (PrEP) is essential to designing programs that meet clients’ needs. To date, most PrEP programs in limited-resource settings have been implemented by partner organizations for specific target populations, but the government of Zimbabwe aims to make PrEP available to the broader population at substantial risk in public sector clinics. However, there is limited information on general population perspectives about PrEP in Zimbabwe.
A qualitative study was conducted to explore clients’ motivation to take or decline PrEP and continue or discontinue PrEP. Through a PrEP pilot in one urban family planning clinic and one rural youth center in Zimbabwe, 150 HIV-negative clients screened as being at high risk of HIV and were offered PrEP between January and June 2018. Sixty semi-structured interviews were conducted with clients who agreed to follow-up (including 5 decliners, all from the rural youth center, and 55 accepters, with 42 from the rural youth center and 13 from the urban family planning clinic). Interviews were conducted after either the first or second PrEP follow-up appointment or after the client declined PrEP. Interviews were audio recorded, de-identified, transcribed, and coded thematically.
PrEP uptake was driven by risk perception for HIV, and in many cases, that risk was introduced by the unsafe behavior or HIV-positive status of a partner. Among sero-discordant couples (SDCs), the desire to safely conceive a child was also cited as a factor in taking PrEP. Clients who opted for PrEP preferred it to other forms of HIV prevention. SDCs reported decreased condom use after PrEP initiation and in some cases were using PrEP while trying to conceive a child. After initiating PrEP, clients had more confidence in their sexual relationships and less stress associated with negotiating condom use. Family and partner support was critical to starting and continuing PrEP, but some clients stopped PrEP or missed appointments due to side effects or logistical challenges such as transportation.
Results of this study can be used to provide operational guidance for national public sector roll-out of PrEP as part of combination HIV prevention in Zimbabwe. Based on feedback and experiences of clients, the training materials for health workers can be refined to ensure that health workers are prepared to counsel clients on the decision to start and/or continue PrEP and answer common client questions. Program advertisements should also be targeted with key messages that speak to client experiences.
Clinical Trial Registry Number: PACTR201710002651160.
Adverse reactions – HIV – HIV infections – HIV prevention – Human families – Nurses – Pre-exposure prophylaxis – Zimbabwe
1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Pre-exposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–2599. doi: 10.1056/NEJMoa1011205 21091279
2. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410. doi: 10.1056/NEJMoa1108524 22784037
3. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral pre-exposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–434. doi: 10.1056/NEJMoa1110711 22784038
4. WHO. WHO | Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV. July 2012. http://www.who.int/hiv/pub/guidance_prep/en/.
5. WHO. WHO | WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP). 2015. Available from: http://www.who.int/hiv/pub/prep/policy-brief-prep-2015/en/.
6. UNAIDS. UNAIDS Zimbabwe Country report 2019 Available from: https://www.unaids.org/en/regionscountries/countries/zimbabwe. Accessed September 8, 2019
7. Zimbabwe HIV Estimates Report AIDS and TB Unit, Ministry of Health and Child Care. 2018. Available from: http://nac.org.zw/wp-content/uploads/2019/01/Zimbabwe-HIV-Estimates-Report-2018.pdf.
8. Collier KL, Colarossi LG, Sanders K. Raising Awareness of Pre-Exposure Prophylaxis (PrEP) among Women in New York City: Community and Provider Perspectives. J Health Commun. 2017 Mar;22(3):183–189. doi: 10.1080/10810730.2016.1261969 28248625
9. Pintye J, Beima-Sofie KM, Makabong'O PA, Njoroge A, Trinidad SB, Heffron RA, et al. HIV-Uninfected Kenyan Adolescent and Young Women Share Perspectives on Using Preexposure Prophylaxis During Pregnancy. AIDS Patient Care STDS. 2018 Jul 23.
10. Corneli A, Perry B, Agot K, Ahmed K, Malamatsho F, Van Damme L. Facilitators of adherence to the study pill in the FEM-PrEP clinical trial. PLoS One. 2015 Apr 13;10(4):e0125458. doi: 10.1371/journal.pone.0125458 25867624
11. Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. 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 Behav. 2013 Jul;17(6):2162–72. doi: 10.1007/s10461-012-0317-8 23080358
12. UNAIDS. Global AIDS Update 2019. Available from: http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf. Published 2019.
13. Ministry of Health and Child Care. AIDS and TB Programme. National Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV. 2016. Available from: https://aidsfree.usaid.gov/sites/default/files/zw_arv_therapy_prevention.pdf
14. Mutseta A. The ‘Small House’ Phenomenon in Zimbabwe’s Urban Space: Study in Glen Norah-Harare. Open Science Journal 2016; 1(2)
15. Muchabaiwa W. The Small House Phenomenon and Polygyny in Zimbabwe: A Problematic Context for Child Socialisation and Development. Africology: The Journal of Pan African Studies 2017; 10(3): 149–162.
16. Mushinga, M. The “Small House”: An Ethnographic Investigation into Economically Independent Women and Sexual Networks in Zimbabwe. PhD thesis University of Pretoria 2013.
17. Christiansen LB. "Respectable Women" versus "Small Houses": Feminist Negotiations of Sexual Morality, Marriage and the Challenge of HIV/AIDS in Zimbabwe. Journal of Southern African Studies 2013; 39 (3): 511–526.
18. Collier KL, Colarossi LG, Sanders K. Raising Awareness of Pre-Exposure Prophylaxis (PrEP) among Women in New York City: Community and Provider Perspectives, Journal of Health Communication 2017, 22:3, 183–189. doi: 10.1080/10810730.2016.1261969 28248625
19. Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 984:11(1): 1–47.
20. Miles M, Huberman AM. Qualitative data analysis: an expanded sourcebook, 2nd Ed. Thousand Oaks, Calif: Sage Publications; 1994.
21. Glaser B, Strauss A. The discovery of grounded research: Strategies for qualitative research. Chicago: Aldine. 1967
22. Brooks RA, Kaplan RL, Lieber E, Landovitz RJ, Lee SJ, Leibowitz AA. Motivators, concerns, and barriers to adoption of pre-exposure prophylaxis for HIV prevention among gay and bisexual men in HIV serodiscordant male relationships. AIDS Care 2011 September; 23(9): 1136–1145. doi: 10.1080/09540121.2011.554528 21476147
23. Smith DJ. Modern marriage, men’s extramarital sex, and HIV risk in southeastern Nigeria. American Journal of Public Health 2007, 97(6):997–1005. doi: 10.2105/AJPH.2006.088583 17463366
24. Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, Greenberg L, Allen S.New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. Lancet 2008, 371(9631):2183–2191. doi: 10.1016/S0140-6736(08)60953-8 18586173
25. Pulerwitz J, Izazola-Licea JA, Gortmaker SL. Extrarelational sex among Mexican men and their partners’ risk of HIV and other sexually transmitted diseases. American Journal of Public Health 2001, 91(10):1650–1652.
26. Amaro H. Love, sex, and power: considering women’s realities in HIV prevention. American Psychologist 1995, 50(6):437–447. doi: 10.1037//0003-066x.50.6.437 7598292
27. Stephenson R. Community-level gender equity and extramarital sexual risk-taking among married men in eight African countries. International perspectives on sexual and reproductive health 2010, 36(4), 178–188. doi: 10.1363/3617810 21245024
28. Turmen T. Gender and HIV/AIDS. International Journal of Gynaecology and Obstetrics 2003, 82: 411–418. doi: 10.1016/s0020-7292(03)00202-9 14499987
29. Underwood C, Skinner J, Osman N, Schwandt H. Structural determinants of adolescent girls’ vulnerability to HIV: views from community members in Botswana, Malawi, and Mozambique. Soc Sci Med. 2011; 73(2): 343–50. doi: 10.1016/j.socscimed.2011.05.044 21724310
30. Hawkins K, Price N, Mussa F. Milking the cow: young women's construction of identity and risk in age‐disparate transactional sexual relationships in Maputo, Mozambique. Glob Public Health. 2009; 4(2): 169–82. doi: 10.1080/17441690701589813 19333807
31. Wamoyi J, Wight D, Plummer M, Mshana GH, Ross D. Transactional sex amongst young people in rural northern Tanzania: an ethnography of young women's motivations and negotiation. Reprod Health. 2010; 7: 2. doi: 10.1186/1742-4755-7-2 20429913
32. Mack N, Odhiambo J, Wong CM, Agot K. Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: Results of a consultation with community stakeholders. BMC Health Services Research 2014, 14:231. doi: 10.1186/1472-6963-14-231 24886646
33. Jaspal R, Daramilas C, Lee A. Perceptions of pre-exposure prophylaxis (PrEP) among HIV-negative and HIV-positive men who have sex with men (MSM), Cogent Medicine 2016, 3:1.
34. Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et. al. 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 Behav. 2013 Jul; 17(6):2162–72. doi: 10.1007/s10461-012-0317-8 23080358
35. Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR. Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients, AIDS Care 2017, 29:6, 751–758. doi: 10.1080/09540121.2016.1234679 27680304
36. Ojikutu BO, Bogart LM, Higgins-Biddle M, Dale SK, Allen W, Dominique T, et al. Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Use Among Black Individuals in the United States: Results from the National Survey on HIV in the Black Community (NSHBC). AIDS and Behavior (2018) 22:3576–3587 doi: 10.1007/s10461-018-2067-8 29468493
37. Dubov A, Galbo P Jr, Altice FL, Fraenkel L. Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study. Am J Mens Health. 2018 Nov;12(6):1843–1854. doi: 10.1177/1557988318797437 30160195
38. Mack N, Wong C, McKenna K, Lemons A, Odhiambo J, Agot K. Human Resource Challenges to Integrating HIV Pre-Exposure Prophylaxis (PrEP) into the Public Health System in Kenya: A Qualitative Study. Afr J Reprod Health. 2015 Mar;19(1):54–62. 26103695
39. Ministry of Health and Child Care Implementation Plan for HIV Pre-Exposure Prophylaxis In Zimbabwe 2018–2020. 2018 Available at: http://www.mohcc.gov.zw/index.php?option=com_phocadownload&view=category&id=6:acts-policies&Itemid=680
40. Ministry of Health and Child Care. Training Manual for HIV Pre-Exposure Prophylaxis. Module included in national HIV Integrated Training 2018. 2018.
41. Ministry of Health and Child Care. Comprehensive National HIV Communications Strategy for Zimbabwe: 2019–2025. 2019.
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