Open AccessUnderstanding user perspectives of and preferences for oral Pr EP for HIV prevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa
Author(s) -
Eakle Robyn,
Weatherburn Peter,
Bourne Adam
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25306
Subject(s) - psychological intervention , psycinfo , medicine , context (archaeology) , pre exposure prophylaxis , serodiscordant , breastfeeding , family medicine , human immunodeficiency virus (hiv) , medline , men who have sex with men , nursing , pediatrics , paleontology , political science , law , biology , syphilis , antiretroviral therapy , viral load
Oral pre‐exposure prophylaxis (Pr EP ) for HIV prevention has been proven to significantly reduce new HIV infections yet scale‐up has been slow. As contexts continue to adjust to make space for Pr EP , it is crucial to understand the perspectives and experiences of potential end‐users. In order to inform Pr EP and demand creation interventions, this paper examines personal perspectives on adopting and using Pr EP among HIV at‐risk populations in sub‐Saharan Africa. Methods Using the principles of a scoping review in July 2018, we explored the extent, range, and nature of published literature regarding Pr EP uptake and use among; men who have sex with men, HIV serodiscordant couples, adolescent girls and young women, pregnant and breastfeeding women, women partners of migrant workers; and people who use drugs. Steps included: identification of the research question; identification of relevant studies; study selection; charting the data; and collation – summarizing and reporting results. PubMed and PsycInfo were searched for papers relating to Pr EP uptake and use in sub‐Saharan Africa. Resulting papers were reviewed with data extracted and compiled in Excel for analysis. A broad content analysis was conducted and organized into high‐level themes. Results and discussion Thirty‐five papers were included in this review. There was little opposition in general to oral Pr EP ; however, there were significant nuances in its broader acceptability, applicability, and usability. We identified five themes within which these are discussed. These relate to balancing complexities of personal empowerment and stigma; navigating complex risk environments; influences of relationships and partners; efficacy and side effects; and practicalities of use. This body of research suggests that while product attributes and the logistics of Pr EP delivery and use are important topics, it is vital to consider stigma, the interactions of Pr EP use with relationships, and the need for broader understanding of ARV s for prevention versus treatment. Conclusions Planning for, programming and promoting the adoption of oral Pr EP necessitates a deeper understanding of end‐user priorities in order to ensure successful interventions. This review illustrates the nuances facilitating or deterring Pr EP use that may affect the larger effort of Pr EP scale‐up.