Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa
| العنوان: | Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa |
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| المؤلفون: | Saiqa Mullick, Michele Lanham, Sarah A. Jenkins, Elmari Briedenhann, Kayla Stankevitz, Kathleen Ridgeway, Hasina Subedar, Theresa Hoke, Mercy Murire, Diantha Pillay |
| المصدر: | PLoS ONE PLoS ONE, Vol 15, Iss 4, p e0228620 (2020) |
| بيانات النشر: | Public Library of Science (PLoS), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | RNA viruses, Male, Epidemiology, Administration, Oral, 030312 virology, Pathology and Laboratory Medicine, Geographical locations, Men who have sex with men, Condoms, South Africa, Pre-exposure prophylaxis, 0302 clinical medicine, Immunodeficiency Viruses, Risk Factors, Surveys and Questionnaires, Medicine and Health Sciences, Public and Occupational Health, 030212 general & internal medicine, Homosexuality, media_common, 0303 health sciences, Multidisciplinary, Professions, Medical Microbiology, HIV epidemiology, Viral Pathogens, Viruses, Medicine, Infectious diseases, Female, Pathogens, Thematic analysis, Research Article, HIV infections, Adult, medicine.medical_specialty, Adolescent, Anti-HIV Agents, Science, media_common.quotation_subject, HIV prevention, Men WHO Have Sex with Men, Qualitative property, Viral diseases, Microbiology, Interviews as Topic, Young Adult, 03 medical and health sciences, Retroviruses, medicine, Humans, Homosexuality, Male, Microbial Pathogens, Sex work, Sex Workers, Prophylaxis, business.industry, Lentivirus, Organisms, Biology and Life Sciences, HIV, Discontinuation, Risk perception, Withholding Treatment, Family medicine, People and Places, Africa, Pre-Exposure Prophylaxis, Population Groupings, Preventive Medicine, business, Sexuality Groupings |
| الوصف: | Background South Africa became the first country in Africa to introduce oral PrEP in June 2016. The National Department of Health has used a phased approach to rollout, allowing for a dynamic learn-and-adapt process which will lead ultimately to scale-up. Phased rollout began with provision of oral PrEP at facilities providing services to sex workers in 2016 and was expanded in 2017, first to facilities providing services to MSM and then to students at selected university campus clinics, followed by provision at primary health care facilities. Programmatic data shows variability in initiation and continuation between these populations. This study examines factors related to PrEP initiation, continuation, and discontinuation at facilities providing services to sex workers and MSM during the national PrEP rollout. Methods A cross-sectional survey was administered September 2017-January 2018 among clients (ages 18-62 and providers at 9 facilities implementing oral PrEP in South Africa, followed by in-depth interviews. The client survey captured PrEP initiation, continuation and discontinuation. Analysis was performed in STATA 13 for survey data and thematic analysis was performed in NViVO 11 for in-depth interview data. Results 299 clients (203 from sex worker facilities, 96 from MSM facilities) participated in the survey and additionally, in-depth interviews were conducted with 29 clients. Participants self-identified as either current users (n = 94; 36.2%), past users (n = 80; 30.8%) and never users of PrEP (n = 86; 33.1%). Participants who had never used PrEP either cited not being offered PrEP by a provider (57%, n = 49) or declining PrEP (43%, n = 37) as reasons for lack of uptake. The primary reason for declining to use oral PrEP was fear of side effects (41.7%, n = 15). The primary reasons for initiating and continuing on oral PrEP were all related to perceived risk associated with sexual activity. The majority of participants (87.9%, n = 153) also noted that printed IEC materials influenced their decision to initiate PrEP. Qualitative data suggested that several clients initiated on PrEP because they wanted additional protection beyond using condoms due to challenges such as partners refusing to use condoms, having partners with unknown HIV status, having multiple partners, involvement in sex work, or having a partner living with HIV. The majority (73.8%, n = 59) of participants who discontinued oral PrEP cited side effects as the primary reason for discontinuation, followed by feeling stigmatized (18.8%, n = 15). Conclusion This study provides valuable insights on early rollout of PrEP of how clients perceive oral PrEP and where to target efforts to improve the uptake of this highly effective HIV prevention product. By identifying strengths and areas for improvement, the ACCESS study has generated evidence that can be used to guide high quality scale-up in South Africa and may be instructive for other countries' efforts to expand quality access to oral PrEP. |
| تدمد: | 1932-6203 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::35c34925919b07d7a0f579b52dea2599Test https://doi.org/10.1371/journal.pone.0228620Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....35c34925919b07d7a0f579b52dea2599 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19326203 |
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