A qualitative study to explore daily versus on-demand oral pre-exposure prophylaxis (PrEP) in young people from South Africa, Uganda and Zimbabwe.

Autor: Dietrich JJ; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa.; African Social Sciences Unit of Research and Evaluation (ASSURE), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Ahmed N; Mortimer Market Centre, Central North West London NHS Trust, London, United Kingdom.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa., Tshabalala G; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Wu M; Harvard College, Cambridge, MA, United States of America., Mulaudzi M; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Hornschuh S; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Atujuna M; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa., Muhumuza R; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda., Ssemata AS; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom., Stranix-Chibanda L; University of Zimbabwe Clinical Trials Research Centre, Faculty of Medicine and Health Sciences, Harare, Zimbabwe., Nematadzira T; University of Zimbabwe Clinical Trials Research Centre, Faculty of Medicine and Health Sciences, Harare, Zimbabwe., Bekker LG; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa., Martinson N; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Seeley J; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom., Fox J; King's College London, London, United Kingdom.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Jun 29; Vol. 18 (6), pp. e0287627. Date of Electronic Publication: 2023 Jun 29 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0287627
Abstrakt: Background: Adolescents in sub-Saharan Africa (SSA) remain vulnerable to HIV infection. While pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission as a daily or on-demand regimen, tailored approaches are necessary. The Combined HIV Adolescent PrEP and Prevention Study (CHAPS) is a mixed-methods research program investigating the acceptability and feasibility of implementing daily and on-demand PrEP among young people in SSA. It also aims to determine an on-demand dosing schedule for insertive sex. For this paper, we explored preferences for daily versus on-demand PrEP amongst adolescents as part of CHAPS.
Methods: Purposive sampling was used to recruit participants from Soweto and Cape Town (South Africa), Wakiso district (Uganda) and Chitungwiza (Zimbabwe). At the time of the study in 2018/2019, Uganda had not rolled out PrEP to the general population; in Zimbabwe, PrEP for young people was only available at selected sites with one located within the study recruitment area. In South Africa, PrEP was made available to selected high-risk groups. We conducted 60 in-depth interviews and 24 group discussions amongst young people aged 13-24 without HIV in South Africa, Uganda, and Zimbabwe. All in-depth interviews and group discussions were audio-recorded, transcribed verbatim and translated to English. Data were analysed using framework analysis. The main themes were centered around preferences for daily and on-demand PrEP.
Results: Reasons for on-demand preferences included stigma, pill fatigue, adherence and side effects. Reasons for daily PrEP preferences included factors related to sexual risk behaviour, continuous protection against incidents of unintentional exposure, and the increased efficacy of a daily dose. Participants at all sites preferring daily PrEP identified the same reasons, with more males than females citing inadvertent blood contact or perceived increased efficacy. Similarly, participants at all sites preferring on-demand PrEP gave the same reasons for their preferences for on-demand PrEP; the exception was South Africans who did not mention the hope of having fewer side effects by not taking daily PrEP. Additionally, more males than females cited intermittent sex as a reason for opting for on-demand PrEP.
Conclusions: Our study is the first known to explore and describe youth preferences for daily versus on-demand PrEP. While the choice is clear-cut, the reasons cited in the different options provide invaluable insights into their decisions, and the actual and perceived facilitators and barriers to access to PrEP. Further education is needed amongst young people, not only about PrEP but also in other areas of comprehensive sexuality education. Exploring all options of HIV prevention is crucial to provide a tailored, one-size-does-not-fit-all approach to adolescent care in SSA to reduce and, the continued and increasing risk of this preventable infection.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Dietrich et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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