Providers' Attitudes and Experiences with Pre-Exposure Prophylaxis Implementation in a Population-Based Study in Kenya and Uganda.
Carol S CamlinMonica GetahunCatherine A KossLawrence OwinoCecilia AkatukwasaHarriet ItiakoritAnjeline OnyangoRobert BakanomaFredrick AtwineIrene MaeriJames AyiekoMucunguzi AtukundaAsiphas OwaraganiseFlorence MwangwaNorton SangJane KabamiRachel L KaplanGabriel ChamieMaya L PetersenCraig R CohenElizabeth A BukusiMoses R KamyaDiane V HavlirEdwin D CharleboisPublished in: AIDS patient care and STDs (2022)
Pre-exposure prophylaxis (PrEP) implementation is underway across sub-Saharan Africa. However, little is known about health care providers' experiences with PrEP provision in generalized epidemic settings, particularly outside of selected risk groups. In this study (NCT01864603), universal access to PrEP was offered to adolescents and adults at elevated risk during population-level HIV testing in rural Kenya and Uganda. Providers received training on PrEP prescribing and support from local senior clinicians. We conducted in-depth interviews with providers ( n = 19) in four communities in Kenya and Uganda to explore the attitudes and experiences with implementation. Transcripts were coded and analyzed using interpretivist methods. Providers had heterogenous attitudes toward PrEP in its early implementation: some expressed enthusiasm, while others feared being blamed for "failures" (HIV seroconversions) if participants were nonadherent, or that offering PrEP would increase "immorality." Providers supported PrEP usage among HIV-serodifferent couples, whose mutual support for daily pill-taking facilitated harmony and protection from HIV. Providers reported challenges with counseling on "seasons of risk," and safely stopping and restarting PrEP. They felt uptake was hampered for women by difficulties negotiating with partners, and for youth by parental consent requirements. They believed PrEP continuation was hindered by transportation costs, stigma, pill burden, and side effects, and was facilitated by counseling, proactive management of side effects, and home/community-based provision. Providers are critical "implementation actors" in interventions to promote adoption of new technologies such as PrEP. Dedicated training and ongoing support for providers may facilitate successful scale-up.
Keyphrases
- men who have sex with men
- hiv testing
- hiv positive
- healthcare
- primary care
- mental health
- quality improvement
- physical activity
- young adults
- hiv aids
- palliative care
- emergency department
- adipose tissue
- pregnant women
- skeletal muscle
- hiv infected
- antiretroviral therapy
- hepatitis c virus
- optical coherence tomography
- depressive symptoms
- social support
- pregnancy outcomes