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


Autoři: 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
doi: 10.1371/journal.pone.0227632

Souhrn

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Trial registration

Clinical Trial Registry Number: PACTR201710002651160.

Klíčová slova:

Adverse reactions – HIV – HIV infections – HIV prevention – Human families – Nurses – Pre-exposure prophylaxis – Zimbabwe


Zdroje

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Článek vyšel v časopise

PLOS One


2020 Číslo 1