Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

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 pre-exposure 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 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Garcia-Lerma J, Otten R, Qari S, Jackson E, Cong M, Masciotra S, et al. Prevention of rectal SHIV transmission in macaques by daily or intermittent prophylaxis with emtricitabine and tenofovir. PLoS Med. 2008;5(2):28.

    Article  Google Scholar 

  2. García-Lerma J, Cong M, Mitchell J, Youngpairoj A, Zheng Q, Masciotra S, et al. Intermittent prophylaxis with oral truvada protects macaques from rectal SHIV infection. Sci Transl Med. 2010;2(14):14.

    Article  Google Scholar 

  3. Denton P, Estes J, Sun Z, Othieno F, Wei B, Wege A, et al. Antiretroviral pre-exposure prophylaxis prevents vaginal transmission of HIV-1 in humanized BLT mice. PLoS Med. 2008;5(1):e16.

    Article  PubMed  Google Scholar 

  4. Neff C, Ndolo T, Tandon A, Habu Y, Akkina R. Oral pre-exposure prophylaxis by anti-retrovirals raltegravir and maraviroc protects against HIV-1 vaginal transmission in a humanized mouse model. PLoS One. 2010;5(12):e15257.

    Article  PubMed  CAS  Google Scholar 

  5. Grant R, Lama J, Anderson P, McMahan V, Liu A, Vargas L, et al. Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men. N Engl J Med. 2010;363(27):2587–99.

    Article  PubMed  CAS  Google Scholar 

  6. Pivotal study finds that HIV medications are highly effective as prophylaxis against HIV infection in men and women in Africa. University of Washington International Clinical Research Center, Partners in PrEP Study; 2011 [cited 2011 July 30, 2011]; Available from: http://depts.washington.edu/uwicrc/research/studies/files/PrEP_PressRelease-UW_13Jul2011.pdf. Accessed 19 Sept 2012.

  7. CDC trial and another major study find PrEP can reduce risk of HIV infection among heterosexuals. 2011 [cited 2011 July 30, 2011]; Available from: http://www.cdc.gov/nchhstp/newsroom/PrEPHeterosexuals.html. Accessed 19 Sept 2012.

  8. Golub SA, Kowalczyk W, Weinberger CL, Parsons JT. Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr. 2010;54:548–55.

    Article  PubMed  Google Scholar 

  9. Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education. J Acquir Immune Defic Syndr. 2009;50:77–83.

    Article  PubMed  Google Scholar 

  10. Galea J, Kinsler J, Salazar X, Lee S, Giron M, Sayles J, et al. Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS. 2011;22:256–62.

    Article  PubMed  CAS  Google Scholar 

  11. Dunkle K, Wingood G, Camp C, DiClemente R. Intention to use pre-exposure prophylaxis among African-American and white women in the United States: results from a national telephone survey. XVII International AIDS Conference; Mexico City, Mexico; 2008.

  12. Schneider J, Dandona R, Pasupneti S, Lakshmi V, Liao C, Yeldandi V, et al. Initial commitment to pre-exposure prophylaxis and circumcision for HIV prevention amongst Indian truck drivers. PLoS One. 2010;5(7):e11922.

    Article  PubMed  Google Scholar 

  13. Ware NC, Wyatt MA, Haberer JE, Baeten JM, Kintu A, Psaros C, Safren S, et al. What’s love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV serodiscordant couples. J Acquir Immune Defic Syndr. 2012;59(5):463–8.

    Article  PubMed  CAS  Google Scholar 

  14. Mutua G, Sanders E, Mugo P, Anzala O, Haberer J, Bangsberg D, et al. A randomized trial of intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men: safety and Adherence. PLoS One. 2012;7:e33103.

    Article  PubMed  CAS  Google Scholar 

  15. Smith A, Muhaari A, Agwanda C, Kowuo D, van der Elst EM, Davies A. Female clients and partners of MSM sex workers in Mombasa. Paper presented at the 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA. Mombasa: CROI; 2010.

    Google Scholar 

  16. Ritchie J, Spencer L, editors. Qualitative data analysis for applied policy research. London: Routledge; 1994.

    Google Scholar 

  17. Underhill K, Operario D, Skeer M, Mimiaga M, Mayer K. Packaging PrEP to prevent HIV: an integrated framework to plan for pre-exposure prophylaxis implementation in clinical practice. J Acquir Immune Defic Syndr. 2010;55(1):8–13.

    Article  PubMed  Google Scholar 

  18. Remien RH, Stirratt JJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, et al. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS. 2005;19:807–14.

    Article  PubMed  Google Scholar 

  19. Paxton LA, Hope T, Jaffe HW. Pre-exposure prophylaxis for HIV infection: what if it works? Lancet. 2007;370:89–93.

    Article  PubMed  Google Scholar 

  20. Nozaki I, Dube C, Kakimoto K, Yamada N, Simpungwe JB. Social factors affecting ART adherence in rural settings in Zambia. AIDS Care. 2011;10:1–8.

    Article  Google Scholar 

  21. Mansergh G, Koblin B, Colfax G, McKirnan D, Flores S, Hudson S. Preefficacy use and sharing of antiretroviral medications to prevent sexually-transmitted HIV infection among US men who have sex with men. J Acquir Immune Defic Syndr. 2010;55(2):e14–6.

    Article  PubMed  Google Scholar 

  22. Larson E, Lin SX, Gomez-Duarte C. Antibiotic use in Hispanic households, New York City. Emerg Infect Dis. 2003;9:1096–102.

    Article  PubMed  Google Scholar 

  23. Petersen EE, Rasmussen SA, Daniel KL, Yazdy MM, Honein MA. Prescription medication borrowing and sharing among women of reproductive age. J Womens Health. 2008;17(7):1073–80.

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by funding from International AIDS Vaccine Initiative and Gilead Sciences. This work was made possible in part by the support of the United States Agency for International Development (USAID). The contents are the responsibility of the study authors and do not necessarily reflect the views of USAID or the United States Government. We wish to thank clinic staff in Nairobi and Mtwapa for conducting the trial and the study participants for their participation. This report was published with permission from Kenya Medical Research Institute.

Conflict of Interest

Authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Centre for Geographic Medicine Research—Coast, Kenya Medical Research Institute, P.O. Box 230, Kilifi, Kenya

    Elisabeth Maria Van der Elst, Peter Mugo, Jennifer Kanungi & Eduard Joachim Sanders

  2. International AIDS Vaccine Initiative, Nairobi, Kenya

    Judie Mbogua

  3. Brown University, Providence, RI, USA

    Don Operario

  4. Kenya AIDS Vaccine Initiative, Nairobi, Kenya

    Gaudensia Mutua

  5. Rhode Island Hospital and Brown University, Providence, RI, USA

    Caroline Kuo

  6. International AIDS Vaccine Initiative, New York, NY, USA

    Sagri Singh & Frances Priddy

  7. Center for Global Health, Massachusetts General Hospital, Boston, MA, USA

    Jessica Haberer

  8. Nuffield Department of Clinical Medicine, University of Oxford, Headington, Oxford, UK

    Eduard Joachim Sanders

Authors
  1. Elisabeth Maria Van der Elst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judie Mbogua
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Don Operario
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gaudensia Mutua
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caroline Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Mugo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jennifer Kanungi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sagri Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jessica Haberer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Frances Priddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eduard Joachim Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisabeth Maria Van der Elst.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Van der Elst, E.M., Mbogua, J., Operario, D. 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 17, 2162–2172 (2013). https://doi.org/10.1007/s10461-012-0317-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-012-0317-8

Keywords

Search

Navigation