Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
Highlights
HIV in men who have sex with men (MSM) continues to be of high public health importance in the UK with 34% of the 2,630 new HIV cases in 2020 reported among MSM [1]
We present results related to how participants reported using pre-exposure prophylaxis (PrEP) organized into four practicalities approach (PAPA) themes and 10 subthemes that emerged from the data: (1) Reported adherence; (2) Perceptions; (3) Practicalities; and (4) Social and environmental factors
Forty-one PROUD participants were interviewed; thirtyeight selected from the immediate and deferred groups and three further in-depth interviews (IDIs) with a trans woman, a participant who declined PrEP, and one who seroconverted during the trial (Fig. 2)
Summary
HIV in men who have sex with men (MSM) continues to be of high public health importance in the UK with 34% of the 2,630 new HIV cases in 2020 reported among MSM [1]. In 2015 the World Health Organization (WHO) recommended pre-exposure prophylaxis (PrEP) to prevent sexual acquisition of HIV as part of a combination prevention approach for high-risk groups, including transgender women (TGW) and MSM [2] based on evidence of several clinical trials that demonstrated PrEP to be highly effective when taken correctly [3–6]. This includes the UK PROUD trial, which reported a relative risk reduction of 86% in HIV incidence for those offered PrEP in the intervention arm [5]. Adequate adherence (at least 4 pills per week for those on daily PrEP) is vital to prevent drug resistant strains of AIDS and Behavior (2022) 26:2768–2782
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