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. 2022 Aug;26(8):2768-2782.
doi: 10.1007/s10461-022-03624-6. Epub 2022 Feb 19.

Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England

Dora Arnold-Forster  1 , Robert Horne  2 , Will Nutland  3 , Sonali Wayal  4 , Michael Rayment  5 , Caroline Rae  5 , Monica Desai  6 , Amanda Clarke  7 , Ann Sullivan  5 , Sheena McCormack  5   8 , Mitzy Gafos  9   10
Affiliations

Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England

Dora Arnold-Forster et al. AIDS Behav. 2022 Aug.

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.

Keywords: Adherence; Perceptions and practicalities approach (PAPA); Pre-exposure prophylaxis (PrEP).

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Conflict of interest statement

The PROUD study provided drug free of charge by Gilead Sciences plc. Which also distributed it to participating clinics and provided funds for additional diagnostic tests for HCV and drug levels. SMc reports grants from the European Union H2020 scheme, EDCTP 2, the National Institute of Health Research, and Gilead Sciences; other support from Gilead Sciences, and the Population Council Microbicide Advisory Board; and is Chair of the Project Advisory Committee for USAID grant awarded to CONRAD to develop tenofovir-based products for use by women (non-financial). AS’s organisation has received Gilead fellowships in the past. The remaining authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Perceptions and practicalities approach (including NCF). Adapted from Horne et al. [12]
Fig. 2
Fig. 2
Purposive selection of participants for in-depth interviews based on trial arm allocation, risk behaviour and adherence
See this image and copyright information in PMC

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