ArticlePDF Available

Motivators for oral PrEP uptake and adherence in the eThekwini municipality, KwaZulu-Natal

AIDS Care

May 2023
35(2):1-16

DOI:10.1080/09540121.2023.2208322

Authors:

Jyotika Basdav

Durban University of Technology

Poovendhree Reddy

Durban University of Technology

Firoza Haffejee

Durban University of Technology

Pre-exposure prophylaxis (PrEP) is a single daily pill that prevents a seropositive HIV status. Since 2016, South Africa has staggered PrEP roll-out, with uptake levels not reaching optimal goals. The aim of this study was to determine motivation behind PrEP initiation and adherence among South African users. A phenomenological qualitative study (n = 15) was used. Participants were purposively recruited from two primary healthcare clinics in eThekwini, KwaZulu-Natal. Thematic analysis was used to analyse the data. Three themes were identified: motivation for PrEP uptake, PrEP adherence and PrEP awareness. Initiation was influenced by healthcare professionals. Responsibility for one's well-being, serodiscordant relationships and sexual partner's behavioural patterns contributed toward initiation. Most were fully compliant, using reminders to negate medication forgetfulness. The internet and healthcare professionals served as information sources, however, few were aware of PrEP prior to this. Innovative ways are required to increase awareness levels and increase uptake.

Content uploaded by Firoza Haffejee

Content may be subject to copyright.

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=caic20

AIDS Care

Psychological and Socio-medical Aspects of AIDS/HIV

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/caic20

Motivators for oral PrEP uptake and adherence in

the eThekwini municipality, KwaZulu-Natal

Jyotika Basdav, Poovendhree Reddy & Firoza Haffejee

To cite this article: Jyotika Basdav, Poovendhree Reddy & Firoza Haffejee (2023): Motivators for

oral PrEP uptake and adherence in the eThekwini municipality, KwaZulu-Natal, AIDS Care, DOI:

10.1080/09540121.2023.2208322

To link to this article: https://doi.org/10.1080/09540121.2023.2208322

Published online: 05 May 2023.

Submit your article to this journal

View related articles

View Crossmark data

Motivators for oral PrEP uptake and adherence in the eThekwini municipality,

KwaZulu-Natal

Jyotika Basdav

, Poovendhree Reddy

and Firoza Haﬀejee

Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa;

Department of Community Health Studies,

Durban University of Technology, Durban, South Africa

ABSTRACT

Pre-exposure prophylaxis (PrEP) is a single daily pill that prevents a seropositive HIV status. Since

2016, South Africa has staggered PrEP roll-out, with uptake levels not reaching optimal goals. The

aim of this study was to determine motivation behind PrEP initiation and adherence among South

African users. A phenomenological qualitative study (n= 15) was used. Participants were

purposively recruited from two primary healthcare clinics in eThekwini, KwaZulu-Natal. Thematic

analysis was used to analyse the data. Three themes were identiﬁed: motivation for PrEP

uptake, PrEP adherence and PrEP awareness. Initiation was inﬂuenced by healthcare

professionals. Responsibility for one’s well-being, serodiscordant relationships and sexual

partner’s behavioural patterns contributed toward initiation. Most were fully compliant, using

reminders to negate medication forgetfulness. The internet and healthcare professionals served

as information sources, however, few were aware of PrEP prior to this. Innovative ways are

required to increase awareness levels and increase uptake.

ARTICLE HISTORY

Received 18 October 2022

Accepted 21 April 2023

KEYWORDS

Pre-exposure prophylaxis

(PrEP); initiation and/or

uptake; adherence; clinic

users or clinic patients; South

Africa

Introduction

The HIV epidemic continues unabated in South

Africa where the current prevalence is 13.7%, with

the province of KwaZulu-Natal reporting the highest

HIV prevalence (Médecins Sans Frontières, 2021; Stat-

istics South Africa, 2021). Adolescent girls and young

women are disproportionately at risk of infection

(UNAIDS, 2020). Current preventive methods, such

as voluntary medical circumcision, have increased

over the years (Kharsany et al., 2019) but condom

use remains low particularly among the youth (Haﬀe-

jee, Koorbanally, et al., 2018; Kharsany et al., 2019).

Pre-exposure prophylaxis (PrEP) roll-out was intro-

duced in 2016 in South Africa using a phased

approach (PrEP Watch, 2017). PrEP was ﬁrst rolled

out to sex workers thereafter to other high risk popu-

lations which included men who have sex with men,

adolescent girls and young women and serodiscordant

couples (PrEP Watch, 2017).

To date approximately 370,000–371,000 people are

currently using PrEP (PrEP Watch, 2022). Clinical

guidelines permit for discontinuation and/or re-initiat-

ing use, depending on the risk exposure period. Eligi-

bility criteria are determined by having a seronegative

status, risk of contracting HIV and/or wanting to use

this prophylaxis (Bekker et al., 2016). PrEP roll-out is

a free service oﬀered at South African clinics, however,

not all clinics oﬀer this service (My PrEP, 2021). Cur-

rently, at the point of PrEP initiation at South African

clinics, PrEP users are provided with one month’s

supply of PrEP for the ﬁrst three months. Thereafter,

a three-monthly supply is dispensed. Within this con-

text, PrEP can be termed as self-controlled prevention

(Nakathingo et al., 2021). Previous South African trial

results have revealed unsuccessful daily adherence

(Marrazzo et al., 2015; Van Damme et al., 2012) and

authors have argued that PrEP is an unsuccessful bio-

medical intervention in HIV prevention.

It is therefore essential to understand motivating fac-

tors towards uptake as this may potentially result in bet-

ter adherence. Moreover, PrEP marketing strategies,

aimed in a diversiﬁed manner, cater towards various

uptake motivations and personal priorities would be

beneﬁcial (Camlin et al., 2020). Conversely, self-per-

ceived HIV risk is based on sexual partners’personal

characteristics and risky practices but in-turn may not

be a true reﬂection of one’s own HIV risk (Scorgie

et al., 2021). Within this context, one may choose not

to use PrEP as one does not deem oneself at risk. People

aged 20 and older had lower odds of interest in PrEP

compared to those younger than 20 years (Hill et al.,

2020). Low uptake levels were observed among men in

China and America (Lai et al., 2020; Patel, Ginsburg et

CONTACT Jyotika Basdav jbasdav@yahoo.com

AIDS CARE

https://doi.org/10.1080/09540121.2023.2208322

al., 2018) while a southern African study identiﬁed

moderate uptake amongst women (Scorgie et al.,

2021). Multi-faceted reasons are associated with PrEP

initiation such as alleviating fears of seroconversion

(Aidoo-Frimpong et al., 2020; Eakle et al., 2019;

Owens, Hubach, Williams et al., 2020); providing pro-

tection against HIV infection (Maseko et al., 2020)

and perceived as a favourable user option (Johnson

et al., 2020).

Furthermore, problems associated with condom use

include inconsistent condom use and/or lack thereof

(Eakle et al., 2019; Gombe et al., 2020; Jani et al.,

2021; Maseko et al., 2020; Nakathingo et al., 2021);

inability to negotiate safe sexual practices (Camlin

et al., 2020; Jani et al., 2021); polygamous relationships

(Camlin et al., 2020; Maseko et al., 2020) and serodiscor-

dant relationships during times of family planning and

pregnancy (Bärnighausen et al., 2020; Drainoni et al.,

2018; Nakathingo et al., 2021; Patel, Leddy et al., 2018;

Pintye et al., 2017). In addition, a recent study estab-

lished that South African women used PrEP during

pregnancy and postpartum (Joseph Davey et al., 2021).

Re-initiation occurred when risk exposure increased

(Rousseau et al., 2021) and discontinuation was associ-

ated with the inability to attend follow-up visits and

medication side eﬀects (Serota et al., 2019). A report

by UNAIDS (2015) indicated that side eﬀects with

PrEP occur within the ﬁrst month of use where head-

aches, nausea and weight loss were commonly experi-

enced (Bekker et al., 2016).

In the province of KZN, low PrEP awareness and

uptake levels have been identiﬁed (Beesham et al.,

2021; Grammatico et al., 2021;Haﬀejee et al., 2022).

Women revealed PrEP initiation occurred due to their

partners’behavioural practices and inconsistent con-

dom use or lack thereof (Beesham et al., 2021). More-

over, PrEP discontinuation occurred within the ﬁrst

month of use as a result of experiencing side eﬀects

(Beesham et al., 2022). Additionally, those who did

not deem themselves at risk of HIV acquisition, forget-

fulness, family and partner inﬂuences were predisposing

factors toward discontinuation (Beesham et al., 2022).

In terms of preference, young women (aged 14–35

years) would prefer using PrEP rather than condoms.

Interestingly, these young people stated that PrEP

would be more beneﬁcial to men due to their polyga-

mous practices (Chimbindi et al., 2022). It is anticipated

that as PrEP programs expand, uptake and continuum

will increase in order to achieve HIV prevention goals.

It was reported that on-site PrEP champions obtaining

sexual history in an open and non-judgmental manner

have a positive impact towards initiation (Irungu & Bae-

ten, 2020). The aim of this study was to determine

motivation for PrEP initiation, adherence and aware-

ness levels among PrEP users in the eThekwini munici-

pality in the province of KwaZulu-Natal, South Africa.

Methods

This qualitative study was conducted at two public pri-

mary healthcare clinics located within the central

business district in the eThekwini municipality in the

KwaZulu-Natal province, South Africa. This study

adopted a phenomenological approach as this provided

insights from participants’viewpoints (Giacomini,

2012) regarding their PrEP use experiences which

reaﬃrmed the study’s aim to understand their lived

descriptions (Sorrell & Redmond, 1995). Two types of

approaches are used during phenomenological inter-

views: Tier One is the actual interview process. At this

stage, the researcher has prepared an interview guide

and contextualises herself into the participant’s world.

At this point, rapport is established and the researcher

listens attentively and patiently. Establishing rapport is

vital as this encourages participants to share their

experiences (Sorrell & Redmond, 1995). The interviewer

was a young female, of similar age to the mean age of

participants, hence rapport between the researcher

and the participants was established as participants

were able to share their experiences honestly and with-

out fear of judgment. The researcher ensured partici-

pants felt comfortable to share their daily experiences.

During Tier Two, the interviews are transcribed,

coded, analysed and conclusions are made.

Utilising the phenomenological approach in the cur-

rent study provided insights to PrEP users’lived experi-

ences. Reliability is determined by the researcher’s

ability to trust the information shared by the partici-

pants. This is reaﬃrmed if the data are transparent, con-

sistent and relatable to pre-existing information.

Validity is determined by analysing the information

shared by the participants and reaching a conclusion

(Høﬀding et al., 2022). Thomas (2021) stated that the

researcher should trust the descriptions and language

in which the participants choose to relay their experi-

ences. If the researcher does not trust the participant,

this has an adverse impact on the interview as the

research questions remain unanswered (Høﬀding

et al., 2022). Additionally, the researcher cannot predict

the type of disclosures during the interview process and

should continue listening without abruptly interrupting

the participant (Thomas, 2021).

The Durban University of Technology Institutional

Ethics Committee provided ethical clearance for this

study (IREC 148/20). Gatekeeper permission was pro-

vided by the KwaZulu-Natal Department of Health

2J. BASDAV ET AL.

and operational managers from two primary healthcare

clinics. Participants were purposively selected to include

those who were 18 and older, identiﬁed as a current

and/or previous PrEP user of at least six months dur-

ation. An administrative staﬀmember from each clinic

informed patients about the research study, those who

showed an interest in the study were subsequently intro-

duced to the on-site researcher. If they agreed to partici-

pate, informed consent was obtained prior to the

interview process. All participation was voluntary.

All interviews were conducted in a private room at

each clinic using a semi-structured interview guide

and lasted approximately 30 min. The interview

explored reasons for PrEP initiation, self-reported

daily adherence and PrEP awareness. Sexual behaviours

prior to and during PrEP use, stigmas and disclosure

practices were also explored during the interviews, how-

ever, are not included in the current report. As a result

of data collection occurring during the COVID-19 pan-

demic, all gazetted protocols under the country’s

National State of Disaster were adhered to. Participants

were informed that they could withdraw and/or choose

not to answer any question/s if they felt uncomfortable

during any stage of the interview. Participant numbers

were allocated to ensure conﬁdentiality. At the begin-

ning of the interview, generic questions, such as demo-

graphic information, were obtained in order to set the

tone for the interview. This allowed the researcher to

become familiar with the participant’s verbal responses

and body cues.

Furthermore, the researcher encouraged each partici-

pant to voice his/her discomfort if he/she were to feel

uncomfortable at any stage during the interview. Reas-

surance was provided prior to asking sensitive questions

and when hesitancy towards sensitive questions was

identiﬁed. All interviews were audio recorded and

thereafter transcribed verbatim. Data and thematic sat-

uration were reached after 12 interviews and 3 sub-

sequent interviews were conducted to conﬁrm

saturation. A snack pack to the value of ZAR50

(approximately equivalent to US $3.07) was provided

for each participant.

Data analysis

Thematic analysis was conducted according to the steps

set by Braun and Clarke (2006). A deductive approach

was utilised as certain themes were expected due to gui-

dance of existing literature when creating the semi-

structured interview guide (Golub et al., 2017;Haﬀejee,

Koorbanally, et al., 2018; Oldenburg et al., 2018; van der

Straten et al., 2014). Once the audio ﬁles were tran-

scribed, a thorough reading was conducted. Side notes

were created during the reading process for each tran-

scription. Thereafter, similar phrases and/or sentences

were coded into various groups and consequently subdi-

vided into main and sub-themes. Upon completion of

this process, reading of the main and sub-themes was

completed to conﬁrm that all groups were identiﬁed

and allocated correctly. The primary investigator was

responsible for all the initial coding, a proportion of

which checked by a second investigator. There was no

discrepancy between the coding of the two investigators.

This process was assisted by an interview guide which

pre-identiﬁed themes and sub-themes. Quotes were

grammatically corrected, where necessary. Content

analysis was utilised in order to quantify demographic

data which can be represented categorically (Hsieh &

Shannon, 2005). Mean and standard deviation for age

and duration of PrEP use were calculated using IBM®

SPSS version 27.

Results and discussion

All participants (n= 15) were Black African and resided

within the eThekwini municipality area. Most were

females (n= 13), aged 30.4 ± 8.14 years and employed

full time (n= 8). Full participant demographics are indi-

cated in Table 1. Only one participant reported enga-

ging in transactional sex. Over a third (n= 6) reported

experiencing abuse at some stage in their lives. Of

those who reported a history of abuse: three experienced

emotional abuse; two reported physical abuse and one

participant experienced sexual abuse. All participants

reported having a single partner at the time the study

was conducted. The participant reporting transactional

sex was currently in a monogamous relationship.

Table 1. Sociodemographic proﬁle of PrEP users (n= 15).

Gender

Female 13

Male 2

Employment status

Full time employment 8

Part time employment 1

Informal employment 2

Unemployed 1

Student 3

Relationship status

Single 1

In a relationship 13

Married 1

Condom use

Consistent 2

Inconsistent 12

No condom use 1

Condom use was reported to be inconsistent if participants reported using

condoms sometimes, occasionally or most of the time. Those participants

who reported using a condom at every sexual encounter were reported as

consistent condom use.

AIDS CARE 3

The mean duration of PrEP usage was 20.73 ± 7.01

months (range: 7–31 months). Few reported re-initiat-

ing PrEP (n= 2). The discontinuation period reported

among participants was between one and three years.

A third experienced more than one side eﬀect as a result

of daily usage of PrEP. The less common reported side

eﬀects were itchiness, swollen thighs, sweating and

weakness. None of the participants sought symptomatic

relief for their side eﬀects (Table 2).

Three focal themes emerged among PrEP adopters’

experiences, which included motivation for uptake,

adherence and PrEP awareness.

Theme one: motivation for PrEP uptake

All participants chose to use PrEP based on their per-

sonal circumstances and cited a combination of reasons

for their decisions. In particular, four main reasons were

identiﬁed among the participants.

Sub theme 1.1: responsibility for their own well-

being and overall health status

Most of the participants revealed that they chose PrEP

as a mechanism to protect themselves from HIV thereby

maintaining their seronegative status.

I am using PrEP just to protect myself from HIV. (P1,

female, 36)

The best way to protect myself is to take PrEP. (P7,

male, 24)

Coz’I know my status. I’m currently HIV negative I

want to keep it that way (P15, female, 35)

Interestingly, one participant began using PrEP as she

requested her partner to have an HIV test done. She

purchased two HIV home test kits for her partner and

herself. The test conﬁrmed his seronegative status yet

she chose to use PrEP despite being aware of his nega-

tive HIV status.

I asked my boyfriend to do the HIV test …So, he said

he knows that he is HIV negative, uhh okay I then

decided to go buy a kit –an HIV test kit. I tested him

myself then I found him negative but I decided to

take PrEP because I don’t know what would happen. I

don’t know what’s next, he can be HIV negative today

and then maybe if he goes out (chuckles) in 5 min, he

can come back home HIV positive. So, I’m–I’m just

you know I’m protecting myself. (P15, female, 35)

Most of the participants in this study revealed that

PrEP initiation occurred primarily due to the desire

to prevent seroconversion, highlighting the accep-

tance toward PrEP as a method to protect one’sself

from HIV infection. Across gender groups, partici-

pants understood that they were responsible for

their own health and could not rely on their sexual

partners to ensure their seronegative status. PrEP

use ensured that they were able to protect themselves

from future seroconversion. Similarly, multi-country

African and American studies established uptake

facilitators were due to preventing HIV infection

and maintaining a seronegative status (Hill et al.,

2021; Muhumuza et al., 2021). Correspondingly,

those who chose to use PrEP, took responsibility for

their own health as suggested by Aidoo-Frimpong

et al. (2020)emphasisingthepositiveimpactPrEP

use can have, by providing protection against HIV,

if correctly adhered to. Adopting the phenomenologi-

cal approach allowed for exploration regarding par-

ticipants’reasons and/or motivation towards PrEP

initiation and as a result these ﬁndings were compar-

able to other study reports.

Sub theme 1.2: partner’s behavioural patterns

A few female participants alluded to inﬁdelity, for their

medication usage by acknowledging that they are at risk

of HIV infection, due to their partners’sexual behav-

iour. The decision to use PrEP alleviated their concern

of possibly contracting HIV.

My boyfriend, yoh he was cheating a lot. I was just

scared. (P2, female, 22)

My choice was to protect myself against men cos they

are untrustworthy so if someone doesn’t want to take

PrEP maybe they want to take ARVs, I’m scared of

HIV. (P1, female, 36)

I won’t lie - my boyfriend –he cheats a lot, so now I feel

like my life is in danger, my health is in danger. So, I

decided to go with PrEP. (P8, female, 22)

Table 2. PrEP usage and reported side eﬀects (n= 9).

PrEP re-initiation

No 13

Yes 2

PrEP duration

0–6 months 0

7–12 months 3

13–18 months 2

19–24 months 4

25 months or more 6

Side eﬀects while using PrEP

Yes 9

No 6

Type of side eﬀects (n = 9)

Nausea 3

Vomiting 2

Headaches 2

Fatigue 2

Appetite changes 2

Diarrhoea 1

NB. Participants reported several side eﬀects.

4J. BASDAV ET AL.

Participant 5 described PrEP as a “stress-free”medi-

cation when referring to her partner.

PrEP is a medication that makes you feel free from

stresses about your boyfriend, yes, stress-free. (P5,

female, 27)

The view shared by Participant 6 indicates that she is

unsure of her partner’s whereabouts at any point in

time when they are not spending time together. This

point of view indirectly relates to Participant 5’s descrip-

tion of PrEP use.

I do not know where my partner is right –even now I

do not know where he is, doing what with who …(P6,

female, 27)

This study emphasises how women initiated PrEP due

to fears, mistrust and uncertainty related to their part-

ners’potential polygamous practices outside the

relationship. Concerns of polygamous practices were

voiced by these women as some were aware of their

partners’inﬁdelity. Another concern raised was lack

of awareness of their partners’whereabouts when

they are not together. Participant 1 alluded to trust

issues related to nondisclosure of additional partners.

To abate these fears and concerns, PrEP provided

peace of mind to avoid potential seroconversion

because of their partners’sexual practices. Traditionally

men are decision makers in relationships and their

female counterparts are particularly vulnerable as

these women have no control over their partners’

additional relationships. Moreover, refusal of condom

use can occur, further highlighting the vulnerability

to which women are subjected. Under these circum-

stances, unequal power dynamics occur where

women can potentially be identiﬁed as passive submiss-

ive partners. Likewise, women residing in the province

of KZN indicated PrEP uptake was due to their part-

ners’behavioural practices (Beesham et al., 2021), as

speciﬁed in the current report. One participant

described PrEP as a stress-free medication due to the

uncertainty of her partner’s practices which was

reaﬃrmed by a Malawian study, where PrEP was also

described as a stress reliever within this context

(Maseko et al., 2020). Another African study discov-

ered motivation towards PrEP initiation was also due

to mistrust of a sexual partner (Muhumuza et al.,

2021).

Sub theme 1.3: serodiscordant relationships

Three participants reported that their partners were

HIV positive.

To be honest, I’ve got a partner and my partner is posi-

tive. (P3, female, 25)

Because my wife (has) HIV. (P7, male, 24)

She’s HIV positive. (P13, male 27)

Over the decades, having a partner living with HIV was

identiﬁed as a high risk toward HIV transmission and

those who were seronegative were apprehensive regard-

ing intimate relationships with a partner who is living

with HIV. This was attributed to fear of HIV trans-

mission and related stigmas as suggested by previous

studies (Tester & Hoxmeier, 2020; Van Dijk et al., 2022).

I have PrEP now, what will be my other excuse? I used it

before. (P13, male, 27)

PrEP thus alleviates the fear associated with sexual

relationships in serodiscordant couples. Previous

studies have shown that young people were afraid of

entering into intimate partnerships, such as marriage,

due to risk of HIV infection (Haﬀejee, Ngidi, et al.,

2018). The PrEP era has the potential of risk reduction

in such relationships.

Furthermore, participants were able to self-identify

risk exposure periods as suggested by Participant

3. She also mentioned that it was not necessary to con-

tinue with PrEP when her partner was away, supporting

the discontinuation and re-initiation of PrEP. Further-

more, her partner who worked away from home had

not been home for an extended period due to

COVID-19 restrictions therefore she chose to discon-

tinue PrEP use. She revealed that her partner would

be arriving home in the following month hence this jus-

tiﬁed her reason for re-initiation due to his return home.

Whenever he’s not around I then just don’t feel the

need of taking PrEP at that time …(P3, female, 25).

The cycle of PrEP initiation and re-initiation high-

lights the importance from PrEP users’viewpoints

where they are able to honestly self-identify their own

risk perception. Instances of discontinuation and re-

initiation occur due to change in risk perception (Rous-

seau et al., 2021) which seems to be well received and

understood among those who did so in this study.

Another study found that in serodiscordant relation-

ships, the responsibility is shared between partners

where one uses ARV treatment and the other partner

uses PrEP (Sack et al., 2021). Likewise, this is conﬁrmed

in the present study as all participants revealed their

respective partners were on ARV treatment.

Sub theme 1.4: healthcare professionals and peer

inﬂuences

Nurses encouraged PrEP use by explaining the beneﬁts

of PrEP. Few participants indicated that this was the

reason for uptake.

AIDS CARE 5

The nurse told me about the advantage and disadvan-

tage of using PrEP, so I started using it. (P9, female, 31)

The nurse started telling us about PrEP …due to my

experiences, I have people that I know who are HIV

positive. (P14, female, 25)

Another participant recalled how she found out about

PrEP whilst waiting in the clinic queue and further

inquired about PrEP when consulting with the nurse.

There was one lady who was also in the queue, she then

told me about PrEP. (P15, female, 35)

A friend had recommended PrEP to one participant

who visited the clinic on that speciﬁc day for PrEP

initiation.

I came for PrEP, my friend had advised me about PrEP.

(P8, female, 22)

Interesting ﬁndings were the inﬂuences by nurses and

peers encouraging uptake. One of the clinic sites was

a family planning clinic where nurses and HIV coun-

sellors provided education focused on female repro-

ductive health including HIV and general health-

related conditions which occurred while patients

waited to be attended by the nurses. It is noteworthy

to mention that public healthcare facilities are over-

burdened with patients with an extensive waiting

period, yet, these healthcare professionals understand

the importance of facilitating awareness and allowing

patients to become active decision makers pertaining

to their health. Kenyan women acknowledged the

importance of healthcare providers in facilitating

adherence where non-judgmental conversations

occurred, depicting positive patient experiences (Pin-

tye et al., 2017). The ﬁndings established by Busza

et al. (2021) indicated that women ﬁrst required

time to make an informed decision prior to initiation,

however, this contradicts the present ﬁndings as

women initiated PrEP on the same day that the

nurses originally shared this information with them.

Designated on-site PrEP champions are present at

the clinics and are solely responsible for PrEP

initiation.

This translates to the ability of accessing more

than one service at the same time on the same day

such as accessing family planning methods and

PrEP.Inaddition,peerinﬂuence and recommen-

dations by healthcare providers, clinic staﬀand coun-

sellors had a positive impact on uptake (Chemnasiri

et al., 2020; Muhumuza et al., 2021;Owens,Hubach,

Lester et al., 2020;Rothetal.,2019). Likewise, in the

current study, one participant began using PrEP as a

result of a friend’s recommendation while other par-

ticipants started PrEP use due to the nurses’

suggestion. Additionally, friends and nurses are

deemed as PrEP information sources (Ahouada

et al., 2020) and if conducted in a positive manner,

patients feel comfortable (Sack et al., 2021). This in-

turn will facilitate uptake and adherence as conﬁrmed

by the current ﬁndings. Peer inﬂuence is vital as rec-

ommendations are done in a safe and comfortable

manner. Moreover, this creates a non-judgmental

and non-stigmatising space to encourage uptake as

gender groups would be able to identify similar

experiences within their peer groups.

Theme two: PrEP adherence

Most (n= 9) were fully compliant toward daily medi-

cation use and indicated that they had not missed a

dose from their ﬁrst day of using PrEP. Some partici-

pants recalled missing a few doses in the beginning

until a time where it became second nature. Despite

the latter, adherence rates were facilitated by use of

reminders. Over a third (n= 6) utilised more than one

method to ensure daily adherence thereby negating

missing doses.

Sub theme 2.1: reminders

Most participants (n= 8) set an alarm as a reminder to

take their medication. Three participants, who were

already using daily oral contraceptives, employed this

method as a reminder to take their PrEP medication

at the same time.

Coz’I’m also taking Triphasil® so I take it together.

(P15, female, 35)

I remember coz I’m taking my oral con. (P5, female, 27)

Less conventional methods included using a television

program and a cup of coﬀee as reminders to take their

medication.

After Imbewu (television program) or sometimes

before Imbewu I will (take) my pills. (P10, female, 51)

I’macoﬀee lover so after having my cup of coﬀee, you

know I don’t mind taking them. (P15, female, 35)

Their daily routine provided assistance in remember-

ing while one participant recalled how her previous

tuberculosis (TB) diagnosis assisted with daily adher-

ence as she was required to take her TB medication

daily. In serodiscordant relationships, partners

reminded each other to take their medication as Par-

ticipant 7 identiﬁed.

We (remind) each other to take (our) medication. (P7,

male, 24)

6J. BASDAV ET AL.

Similarly, Participant 8 conﬁrmed that in addition to an

alarm, her family members provided assistance by

reminding her to take her medication.

Yes, my aunt tells me …even my brothers …they know

8o’clock I need to take my pills so they remind me. (P8,

female, 22)

Two participants speciﬁed that they did not use any

reminders but automatically remembered, as the

information provided during initiation was suﬃcient

for daily recall to take their medication. Previous

studies have shown that when one understands the

beneﬁts derived from daily use (Brooks et al., 2020;

Eakle et al., 2019; Gombe et al., 2020) and one’s

choice to use PrEP (Rousseau et al., 2021) proper

adherence resulting in optimal protection levels were

ensured (Chemnasiri et al., 2020; Eakle et al., 2019;

Van der Elst et al., 2013). This was evident among

PrEP users in this study as their motivation for uptake

also ensured daily adherence. Participants established

methods to incorporate their medication use into

their pre-existing daily routine. Daily medication

recollection was considered as a barrier towards

adherence (Zimba et al., 2019), however, once remem-

bering became second nature it was no longer deemed

a barrier as seen among participants of the current

study. Southern African studies revealed that using

an alarm, television program and oral contraceptive

medication were methods for remembering (Busza

et al., 2021; Rousseau et al., 2021). This was similar

to the present study ﬁndings. PrEP eﬃcacy remains

unchanged for those who use contraceptive medi-

cation in conjunction with PrEP (UNAIDS, 2015).

In addition, one participant recalled previous daily

medication use which facilitated the memory process

for daily PrEP use. This is aﬃrmed by other studies

which incorporated PrEP with daily pre-existing

medication, hormone and/or vitamin schedules (Cahill

et al., 2020; Tangmunkongvorakul et al., 2013).

Govender and Abdool Karim (2018) established that

urban women residing in KZN would prefer long-act-

ing products which seamlessly complemented their

chosen family planning methods and displayed accep-

tance towards using pills. This is corroborated by the

current ﬁndings as those women who used oral con-

traceptives had no diﬃculty incorporating daily PrEP

use and forgetfulness was avoided under these

circumstances.

Family members and sexual partners also provided

assistance, which was corroborated by previous studies

(Joseph Davey et al., 2021; Ware et al., 2012). In such

instances, sexual partners are supportive of their part-

ner’s PrEP use which reaﬃrms their choice to use

PrEP. As a result, PrEP use does not place strain on

the relationship itself, as partners can be seen as sup-

porters of their PrEP use (Gombe et al., 2020). An

interesting ﬁnding by Beesham et al. (2022) stated

that KZN women who had one sexual partner had

better odds for adherence. Likewise, women in this

study reported being monogamous and adherence

was good.

Sub theme 2.2: substance use

Social lifestyles did not impact negatively on daily

adherence. For those who consumed alcohol frequently

(n= 5), daily doses were adhered to. Despite alcohol

consumption, they remembered to take the medication

at the designated time.

I drink and then when it’s time for medication …take

my meds and then carry-on drinking. (P6, female, 27)

At the time of initiation, healthcare professionals are

cognizant of the potential negative impact frequent

alcohol consumption can have towards adherence. As

a result, this is disclosed during the initiation process

in order to prevent PrEP users from intentionally skip-

ping a dose as revealed by Participant 13.

The nurse told me PrEP has no eﬀect on me getting

drunk so I take it anyway. (P13, male, 27)

Participant 10 reveals how she continued her social life-

style without compromising her PrEP use by altering

her dosing times to the morning as she knew she

would forget while drinking and/or partying.

So, I will take it in the morning –in the afternoon I will

be drinking from 2 o’clock, maybe we will be braaiing

and all those things so I won’t have time or maybe I

will forget. (P10, female, 51)

Adherence rates were not negatively impacted by the

participants’social lifestyle as indicated by the current

participants. Participants were able to ﬁnd the balance

without disrupting both their social lifestyles and alco-

hol consumption. Only one participant revealed infre-

quent consumption of alcohol, which resulted in her

intentionally missing a dose on that day. None of the

participants reported drug injection use. Other studies

have identiﬁed that party lifestyle and work-related tra-

vel negatively aﬀected daily adherence (Cahill et al.,

2020; Tangmunkongvorakul et al., 2013; Van der Elst

et al., 2013). This is further emphasised by Chemnasiri

et al. (2020) who aﬃrmed that when intoxicated, medi-

cation was not taken. In contrast to results reported by

Van der Elst et al. (2013) and Rousseau et al. (2021),

participants did not intentionally miss their dose due

to alcohol indulgence. Additionally, the beneﬁts derived

AIDS CARE 7

from PrEP use do not interfere with alcohol use

(UNAIDS, 2015). Alternative dosing schedules were

identiﬁed to overcome forgetfulness because of alcohol

use.

Sub theme 2.3: reasons for missing doses

Participant 6 recalled how she missed a dose due to an

unplanned event.

I did not plan to sleep at my boyfriend’s house but then

it happened and my pills were at home. So, early in the

morning we had to rush home to take my meds. (P6,

female, 27)

One participant revealed that it takes approximately half

an hour from her place of residence to the closest clinic

by public transportation. Furthermore, she is an infor-

mal vendor and had to stop using PrEP for a few days

due to lack of ﬁnances for travel.

Sometimes I stop …maybe 3 days …No money to

come to the clinic, I’m waiting (to) sell something

and then (I can) take the pills. (P4, female, 26)

Unplanned activities can result in missing a dose such as

when sleeping over at a partner’s place (Rousseau et al.,

2021) which supports the current ﬁndings. Unintended

interruptions do not adversely impact adherence, once

these obstacles are resolved once PrEP reﬁlls are

obtained and adhered to as initially prescribed (Rous-

seau et al., 2021). Clinical implications for occasionally

missing a daily dose do not signiﬁcantly impact overall

eﬃcacy rates. However, if doses are missed frequently,

this increases one’s chance of HIV acquisition and

potentially becoming resistant to HIV medication

(CDC, 2021; VA National HIV, 2020). Furthermore,

ﬁnancial constraints are faced by those who do not

have formal employment. Similarly, Hannaford et al.

(2020) and Beesham et al. (2021) found that those

who require public transportation maybe not be able

to access healthcare facilities due to ﬁnancial con-

straints. This reiterates the current ﬁndings of a partici-

pant having to stop using PrEP due to ﬁnancial

constraints. Healthcare services are often accessed out-

side of their communities as PrEP delivery sites are lim-

ited (PrEP Watch, 2020). Secondly, there is limited

access to healthcare facilities in non-urban areas (Sim-

bayi et al., 2019), subsequently, most people access

healthcare in urban areas (Rensburg, 2021). More than

two-thirds of the population in South Africa access

the public healthcare system due to high levels of pov-

erty and unemployment (de Villiers, 2021) thereby

overburdening the system (Rensburg, 2021). Formal

employment ensures ﬁnancial security and some par-

ticipants were unemployed in this study.

Sub theme 2.4: diﬀerence in prescribing regimens

Slight variations in instructions are given at the various

clinics which sometimes result in participants feeling

conﬂicted. Other participants did not encounter this

as they only used one healthcare facility to obtain

their PrEP reﬁlls. Participant 2 shared an experience

when accessing PrEP from another clinic when she is

at her parents’home (a township area on the outskirts

of the city). She resides in the city centre as she attends

a college within the surrounding locality. This created

confusion and uncertainty, however, she decided to

continue as prescribed by the nurses in the city.

When I was at home …the nurses there (parents’home

area) explained things diﬀerently to the nurses here

(research clinic location) because I had to take PrEP

pills there if I’m not at college. The nurses there told

me to take the pills 7 days before you umh, engage in

sexual intercourse but then here, they told me I had

to take the pills every day just to stay on the safe side.

They explained to me that I don’t have to necessarily

take them at the exact same time every day but I have

to take them every day. And then there they just said

you can take them 7 days before engaging in inter-

course. (P2, female, 22)

PrEP is prescribed as a daily pill to ensure protection

against HIV infection. However, during PrEP trials,

intermittent and event-driven dosing was analysed in

conjunction with daily dosing. PrEP guidelines have

indicated daily dosing is more than 95% eﬀective for

sexual and drug injection transmission routes. On

demand dosing is eﬀective in men who have sex with

men (MSM) and transgender women only (Bekker

et al., 2020). Current PrEP prescribing regimen is a

single daily dose for those either initiating or re-initiat-

ing (Department of Health, 2021). An American study

highlights the discrepancy between healthcare pro-

fessionals practising in rural areas resulting in lack of

PrEP awareness, knowledge and prescribing regimens

compared to urban healthcare professionals (Owens,

Hubach, Lester et al., 2020). Furthermore, study

ﬁndings revealed that urban healthcare professionals

were more knowledgeable concerning PrEP (Owens,

Hubach, Lester et al., 2020). Despite the confusion

regarding daily dosing versus intermittent dosing, the

participant continued with daily dosing as prescribed

by urban healthcare professionals instead of intermit-

tent dosing as suggested by rural healthcare pro-

fessionals. This highlights the discrepancy among

healthcare professionals practicing in urban and rural

areas. Preference for infrastructure and economic

growth is often noted in urban and peri-urban areas

as most of the population reside in these areas. This

also occurs due to migration out of rural areas into

more urbanised areas due to limited employability in

8J. BASDAV ET AL.

rural areas (Plaatjies, 2018; Van Schalkwyk, 2015).

Necessary support and introduction of new technol-

ogies are rolled out in these areas due to the proximity

of universities, employment opportunities, healthcare

facilities and other amenities which are accessible within

these localities. Rural areas do not have the required

support and infrastructure as a result are often “forgot-

ten about”when disseminating new interventions par-

ticularly healthcare interventions as preference is given

to urban areas for further development (Plaatjies, 2018).

Sub theme 2.5: side eﬀects

Most participants experienced side eﬀects during the

ﬁrst month of PrEP use. Gastrointestinal symptoms

were more commonly reported. During the initiation

process, participants were informed that they could

potentially experience side eﬀects. Disclosure of side

eﬀects is a vital factor towards daily adherence as this

prepares the patient. If they happen to experience any

side eﬀect/s it was seen as “normal”and not a cause

for concern. One participant recalled expecting side

eﬀects but did not experience these.

I was expecting it (laughs) but I was ready. (P15,

female, 35)

Participant 2 recalled attempting to take PrEP in the

morning and experienced weakness. In order to over-

come this, she took PrEP at night.

…if I took PrEP in the morning and have breakfast,

yoh I would have passed out in like a couple hours

after taking it. (P2, female, 22)

Similarly, Participant 10 initially commenced taking

PrEP in the mornings, however, due to the nausea and

sweating experienced she changed her medication

time to the night. She remarked how public transpor-

tation commuters and work colleagues questioned her

regarding the sweating.

When I started (using) them it was in the morning but

because of this nausea I said no, let me just change it

(to) when I go to bed …I have to take, sometimes a

taxi and then I sweat –people will say ‘what’s wrong

with you?’…and I will be sweating the whole way,

when I arrive at work –(they ask) ‘why are you sweat-

ing?’I will tell them no, it’s okay. (They then asked)

‘Are you not pregnant?’(Participant replied) ‘No, I’m

not pregnant’. (P10, female, 51)

Participant 6 revealed that she had previously used post-

exposure prophylaxis (PEP) and recalled having “terri-

ble, terrible side eﬀects”therefore when she began

using PrEP, she decided to take them later in the day.

She anticipated similar experiences with PrEP as she

experienced previously.

I thought there was gonna be hectic side eﬀects so I pre-

ferred it in the afternoons not mornings when I was

going to work. (P6, female, 27)

One participant recollected been scared of long-term

PrEP use as her friends informed her that she would

not be able to have children. She felt at ease after sharing

this information with the nurse who conﬁrmed that it

was not true.

Some of my friends told me that if I continue taking

PrEP I’m not gonna have any kids and stuﬀ. Then

after I heard (this), I did ask the nurse and then the

nurse said ‘no there’s no such thing’. (P2, female, 22)

Gastrointestinal and neurological side eﬀects were com-

monly experienced among participants. Numerous

studies also reported gastrointestinal complaints as a

common occurrence (Arnold et al., 2017; Beesham

et al., 2021; Busza et al., 2021; Camlin et al., 2020; Die-

trich et al., 2021; Gombe et al., 2020; Kecojevic et al.,

2021; Paparini et al., 2018; Pintye et al., 2017; Reza-

Paul et al., 2020). Less commonly identiﬁed symptoms

were appetite changes (Beesham et al., 2021; Gombe

et al., 2020) which were experienced among a few par-

ticipants. A Zimbabwean study revealed the importance

of informing PrEP users about the side eﬀects as this can

negatively impact adherence (Gombe et al., 2020). Dis-

closing side eﬀects during the initiation process creates

awareness thereby negating skipping doses (Falcao et al.,

2017; Gombe et al., 2020). In this study, the potential of

experiencing side eﬀects was conceded by participants

and discontinuation did not occur because of experien-

cing side eﬀects which contradicts ﬁndings of other

African studies (Beesham et al., 2022; Zimba et al.,

2019). Moreover, participants indicated learning how

to minimise experiencing associated symptoms which

is supported by other studies (Gombe et al., 2020;

Owens, Hubach, Lester et al., 2020). The present study

ﬁndings also reported how myths relating to PrEP side

eﬀects can adversely aﬀect continuation and uptake.

When awareness levels are low, new healthcare inter-

ventions often create a platform for incorrect infor-

mation, indirectly contributing to stigmas as suggested

by one participant.

Sub theme 2.6: information sources

Two-thirds (n= 10) required additional and/or extra

information on PrEP. Five participants consulted inter-

net sources while three sourced information from both

the internet and nurses during follow-up appointments.

In addition, to using the internet, one participant also

obtained information from a friend who was using

PrEP. Only one participant requested additional infor-

mation from the nurse. The reasons for accessing

AIDS CARE 9

additional information were related to long-term and

associated side eﬀects regarding prolonged medication

use.

Yes, coz I was looking for the side eﬀects but I didn’t

(ﬁnd) any negative side eﬀects. (P12, female, 41)

Overall, the information provided online was useful,

which reinforced the decision to use PrEP, as depicted

by Participant 15.

No, everything was clear I understood everything you

know and I felt even more comfortable after you

know getting the information from Google then, I

was sure. (P15, female, 35)

However, one participant was confused about the infor-

mation on serodiscordance and required more clarity.

Another participant established that PrEP was por-

trayed negatively on the internet but he chose to ignore

it. Exact websites and/or web pages were not identiﬁed

by participants. However, search terms were added

onto the Google search engine in order to retrieve

necessary information.

Some of it but some of it was so negative …I just dis-

missed it (laughs) …because I haven’t had any of the

experience, they were talking about there. So, I just

said ‘ay, this is not for me’. (P13, male, 27)

In this study, PrEP use continued despite the negative

information found online. In the technology era, people

depend on the internet to source information on various

topics. At times, information can be misinterpreted due

to a lack of understanding. Roll-out strategies inﬂuence

available key information as this can create a particular

impression of the person using PrEP. If this is unrelata-

ble, PrEP initiation would not occur. Information perti-

nent to PrEP on public platforms could unfavourably

impact uptake and adherence especially if portrayed

negatively as indicated in the present study. Appropriate

marketing strategies are required to prevent discontinu-

ation and/or refusal to commence PrEP uptake, which

may occur if potential users ﬁnd negative information

(Young et al., 2021). In addition, health promotion

regarding new interventions is required to ensure the

correct information is disseminated. In South Africa,

initial PrEP roll-out focused on female sex workers

(FSW) and MSM, thereafter rolled out was phased

into the general populace. Within this context, stigmas

and prejudice can easily arise as those who do not ident-

ify as a FSW or MSM would be subjected to discrimina-

tory practices if they used PrEP.

Sub theme 2.7: PrEP accessibility

PrEP accessibility plays a vital role in continued adher-

ence. Those who initiated PrEP at a university clinic

were unaware of PrEP delivery sites outside the univer-

sity. Upon completion of their tertiary studies, they were

therefore uncertain of other clinics that dispensed PrEP,

resulting in discontinuation. Participant 13 recalled

accessing HIV testing services at a clinic, where PrEP

was delivered, which was how he found out he could

access PrEP at that clinic resulting in re-initiation.

Uhh, you see the ﬁrst thing they told me when I ﬁrst

took PrEP, they told me it was only available in their

clinic - they were introducing it. So, I thought it was

only available there, so when I left tertiary, I had

nowhere –I didn’t know I could get it somewhere

else …Uhh, I came here for testing and then they told

me about PrEP. (P13, male, 27)

Easy access points are essential as this directly impacts

adherence. Mobile clinics, hair and nail salons could

serve as potential PrEP providers creating a comfortable

and anonymous environment. The study ﬁndings from

Muhumuza et al. (2021) emphasise how delivery sites

can hinder PrEP continuum and uptake. South Africa

has low PrEP awareness levels, in order for demand to

be created, PrEP awareness campaigns are required to

increase uptake levels and delivery sites. Innovative

ways are required to create interest such as using mini-

bus taxis and buses as canvasses to create awareness.

Minibus taxis and buses are both commonly used in

the public transport industry which travel to diﬀerent

localities daily. Educational institutions should also par-

ticipate in this dialogue as students are particularly vul-

nerable and diﬃculties experienced may diﬀer from the

general youth populace.

Theme three: PrEP awareness

Only two participants were aware of PrEP prior to

initiation and their visit to a clinic was solely for PrEP

initiation.

When was the ﬁrst time I heard about PrEP? I think I

read about it somewhere. (P6, female, 27)

Those who were unaware of PrEP, heard about it for the

ﬁrst time during their clinic visit as indicated by Partici-

pant 14.

No, I didn’t know about PrEP. I just came here (for) my

uhh, daily prevention pills and then I heard about it and

then I decided to try out. (P14, female, 25)

Clinic visits among Zimbabwean women were solely for

initiating PrEP (Busza et al., 2021), which contrasts with

the current study ﬁndings where only two women were

previously aware of PrEP. The latter is corroborated by

studies conducted in Malaysia, China and Lebanon (Lai

et al., 2020; Lim et al., 2017; Storholm et al., 2021). There

10 J. BASDAV ET AL.

are conﬂicting reports emanating from American

studies where one study reported that American

women clinic visits were solely for PrEP initiation

(Pyra et al., 2022) which contrasts with other studies

where participants had low levels of awareness (Hill

et al., 2021; Taggart et al., 2020). Reports from the Afri-

can continent including South Africa also reported low

to moderate awareness levels (Chimbindi et al., 2018;

Eakle et al., 2019; Nakathingo et al., 2021; Pillay et al.,

2020; Poteat et al., 2020; Rousseau et al., 2021; Shamu

et al., 2021; Zimba et al., 2019). Studies previously con-

ducted in KwaZulu-Natal revealed that not many were

aware of PrEP (Chimbindi et al., 2018,2022;Haﬀejee

et al., 2022; Nakasone et al., 2020). Beesham et al.

(2021), reported that women ﬁrst heard about PrEP

from healthcare professionals, as is also evident from

the current study.

Organisations and platforms such as loveLife and

MTV Shuga raise awareness on sexual and reproductive

health (SRH) aimed at the youth (UNICEF, 2002,2015).

Alternatives are required in order to increase awareness

as not all are able to access these platforms. Schools have

been identiﬁed as an avenue to disseminate HIV and

SRH education (EDC, 2022) using the Life Orientation

curriculum as proposed by Reddy et al. (2005). There-

fore, it is important when creating awareness, educators

are provided with appropriate training and have inclus-

ive and honest discussions pertaining to HIV, SRH and

sexuality. When awareness levels increase, so does

uptake, in-turn PrEP delivery sites will also increase

due to demand. It is essential to increase awareness

and uptake especially in the KZN province which has

a high burden of HIV (Médecins Sans Frontières,

2021; Simbayi et al., 2019). When awareness levels are

high, appropriate sexual health decisions can be made

by choosing the best available preventive method

(Rojas Castro et al., 2019). In addition, peer inﬂuence

towards awareness and uptake are essential (Shahma-

nesh et al., 2021).

Conclusion

The current study has identiﬁed motivators for PrEP

uptake, adherence and awareness levels within the con-

text of everyday life. For the most part, PrEP was used to

maintain a seronegative status, particularly in serodis-

cordant relationships. Overall, optimal adherence rates

were self-reported and facilitated by utilising reminders.

Participants did not have pre-existing chronic medical

conditions that required prolonged daily medication,

therefore in the beginning there was unintended skip-

ping of doses. Alcohol use and experiencing side

eﬀects did not result in discontinuation. Furthermore,

this study highlights that nurses promoted PrEP in a

positive manner that was non-judgmental and non-stig-

matising, which helped to enhance initiation. In order

to assist nurses at public state facilities, innovative

ways are essential in increasing PrEP awareness which

will subsequently increase uptake and decrease the

HIV prevalence rate. More exploratory studies are

required based on sexuality, those residing in high

HIV prevalence and/or rural areas to best understand

the challenges faced and/or to implement the positive

experiences in future PrEP and HIV prevention market-

ing strategies.

Acknowledgements

Thank you to all the participants who shared their experi-

ences. To the staﬀand operational managers of the primary

healthcare clinics, thank you for hosting this research study

and ensuring its success. To the KwaZulu-Natal Department

of Health, thank you for providing consent for this study.

Author contributions: All authors designed the study. JB con-

ducted the interviews and subsequent data analysis. FH and

PR provided input for the data analysis. JB compiled the

ﬁrst draft of the article and received guidance from FH and

PR. All authors revised and approved the ﬁnal manuscript.

Disclosure statement

No potential conﬂict of interest was reported by the author(s).

Funding

The study was funded by the Durban University of Technol-

ogy as part of an ongoing study. In addition, JB was a Durban

University of Technology scholarship recipient.

ORCID

Jyotika Basdav http://orcid.org/0000-0002-1789-1976

Poovendhree Reddy http://orcid.org/0000-0003-0197-8951

Firoza Haﬀejee http://orcid.org/0000-0002-3908-8949

References

Ahouada, C., Diabaté, S., Gning, N. N., Hessou, S., Batona, G.,

Guédou, F. A., Béhanzin, L., Zannou, M. D., & Alary, M.

(2020). Acceptability of pre-exposure prophylaxis (PrEP)

among men who have sex with men (MSM) in Benin: A

qualitative study. AIDS Care,32(2), 242–248. https://doi.

org/10.1080/09540121.2019.1622643

Aidoo-Frimpong, G., Wilson, K., & Przybyla, S. (2020).

Factors inﬂuencing pre-exposure prophylaxis uptake

among current users: A qualitative study. Journal of HIV/

AIDS & Social Services,19(3), 252–262. https://doi.org/10.

1080/15381501.2020.1810838

Arnold, T., Brinkley-Rubinstein, L., Chan, P. A., Perez-

Brumer, A., Bologna, E. S., Beauchamps, L., Johnson, K.,

AIDS CARE 11

Mena, L., & Nunn, A. (2017). Social, structural, behavioral

and clinical factors inﬂuencing retention in pre-exposure

prophylaxis (PrEP) care in Mississippi. PloS one,12(2),

Article e0172354. https://doi.org/10.1371/journal.pone.

0172354

Bärnighausen, K., Matse, S., Hughey, A. B., Hettema, A.,

Bärnighausen, T. W., & McMahon, S. A. (2020). “We

know this will be hard at the beginning, but better in the

long term”: Understanding PrEP uptake in the general

population in Eswatini. AIDS Care,32(2), 267–273.

https://doi.org/10.1080/09540121.2019.1653437

Beesham, I., Heﬀron, R., Evans, S., Baeten, J. M., Smit, J.,

Beksinska, M., & Mansoor, L. E. (2021). Exploring the

use of oral pre-exposure prophylaxis (PrEP) among

women from Durban, South Africa as part of the HIV pre-

vention package in a clinical trial. AIDS and Behavior,25

(4), 1112–1119. https://doi.org/10.1007/s10461-020-

03072-0

Beesham, I., Joseph Davey, D. L., Beksinska, M., Bosman, S.,

Smit, J., & Mansoor, L. E. (2022). Daily oral pre-exposure

prophylaxis (PrEP) continuation among women

from Durban, South Africa, who initiated PrEP as

standard of care for HIV prevention in a clinical trial.

AIDS and Behavior,26, 2623–2631. https://doi.org/10.

1007/s10461-022-03592-x

Bekker, L.-G., Rebe, K., Venter, F., Maartens, G., Moorhouse,

M., Conradie, F., Wallis, C., Black, V., Harley, B., & Eakles,

R. (2016). Southern African guidelines on the safe use of

pre-exposure prophylaxis in persons at risk of acquiring

HIV-1 infection. Southern African Journal of HIV

Medicine,17(1), Article 455. https://doi.org/10.4102/

sajhivmed.v17i1.455

Bekker, L., Brown, B., Joseph-Davey, D., Gill, K., Moorhouse,

M., Delany-Moretlwe, S., Myer, L., Orrell, C., Rebe, K.,

Venter, F., & Wallis, C. L. (2020). Southern African guide-

lines on the safe, easy and eﬀective use of pre-exposure pro-

phylaxis: 2020. Southern African Journal of HIV Medicine,

21(1), Article 1152. https://doi.org/10.4102/sajhivmed.

v21i1.1152

Braun, V., & Clarke, V. (2006). Using thematic analysis in psy-

chology. Qualitative Research in Psychology,3(2), 77–101.

https://doi.org/10.1191/1478088706qp063oa

Brooks, R. A., Nieto, O., Landrian, A., Fehrenbacher, A., &

Cabral, A. (2020). Experiences of pre-exposure prophylaxis

(PrEP)-related stigma among black MSM PrEP users in Los

Angeles. Journal of Urban Health,97,679–691. https://doi.

org/10.1007/s11524-019-00371-3

Busza, J., Phillips, A. N., Mushati, P., Chiyaka, T., Magutshwa,

S., Musemburi, S., & Cowan, F. M. (2021). Understanding

early uptake of PrEP by female sex workers in Zimbabwe.

AIDS Care,33(6), 729–735. https://doi.org/10.1080/

09540121.2020.1832192

Cahill, S. R., Keatley, J., Taylor, S. W., Sevelius, J., Elsesser, S.

A., Geﬀen, S. R., Wang, T., & Mayer, K. H. (2020). “Some of

us, we don’t know where we’re going to be tomorrow.”

Contextual factors aﬀecting PrEP use and adherence

among a diverse sample of transgender women in

San Francisco. AIDS Care,32(5), 585–593. https://doi.

org/10.1080/09540121.2019.1659912

Camlin, C. S., Koss, C. A., Getahun, M., Owino, L., Itiakorit,

H., Akatukwasa, C., Maeri, I., Bakanoma, R., Onyango,

A., Atwine, F., Ayieko, J., Kabami, J., Mwangwa, F.,

Atukunda, M., Owaraganise, A., Kwarisiima, D., Sang, N.,

Bukusi, E. A., Kamya, M. R., …Havlir, D. V. (2020).

Understanding demand for PrEP and early experiences of

PrEP use among young adults in rural Kenya and

Uganda: A qualitative study. AIDS and Behavior,24(7),

2149–2162. https://doi.org/10.1007/s10461-020-02780-x

CDC. (2021). PrEP Medication guide: Reduce your risk of get-

ting HIV.https://www.cdc.gov/stophivtogether/library/

topics/prevention/brochures/cdc-lsht-prevention-

brochure-prep-medication-guide-patient.pdf

Chemnasiri, T., Varangrat, A., Amico, K. R., Chitwarakorn,

A., Dye, B. J., Grant, R. M., Holtz, T. H., & The HPTN

067/ADAPT Study Team. (2020). Facilitators and barriers

aﬀecting PrEP adherence among Thai men who have sex

with men (MSM) in the HPTN 067/ADAPT study. AIDS

Care,32(2), 249–254. https://doi.org/10.1080/09540121.

2019.1623374

Chimbindi, N., Mthiyane, N., Zuma, T., Baisley, K., Pillay, D.,

McGrath, N., Harling, G., Sherr, L., Birdthistle, I., Floyd, S.,

Dreyer, J., Nakasone, S., Seeley, J., & Shahmanesh, M.

(2022). Antiretroviral therapy based HIV prevention tar-

geting young women who sell sex: A mixed method

approach to understand the implementation of PrEP in a

rural area of KwaZulu-Natal, South Africa. AIDS Care,34

(2), 232–240. https://doi.org/10.1080/09540121.2021.

1902933

Chimbindi, N., Zuma, T., Nakasone, S., Birdthistle, I.,

Mthiyane, N., Dreyer, J., Seeley, J., Baisley, K., Pillay, D.,

& Shahmanesh, M. (2018). Platforms, processes and per-

ceptions of PrEP delivery through DREAMS in a rural set-

ting in KwaZulu-Natal, South Africa. AIDS Research and

Human Retroviruses.

de Villiers, K. (2021). Bridging the health inequality

gap: An examination of South Africa’s social inno-

vation in health landscape. Infectious Diseases of

Poverty,10, Article 19. https://doi.org/10.1186/s40249-

021-00804-9

Department of Health. (2021). 2021 Updated guidelines for the

provision of oral pre-exposure prophylaxis (prep) to persons

a substantial risk of HIV infection.https://www.

knowledgehub.org.za/system/ﬁles/elibdownloads/2022-08/

PrEP%20Guidelines%20Update%2012%20%20Nov%20%

202021%20Final.pdf

Dietrich, J. J., Atujuna, M., Tshabalala, G., Hornschuh, S.,

Mulaudzi, M., Koh, M., Ahmed, N., Muhumuza, R.,

Ssemata, A. S., & Otwombe, K. (2021). A qualitative

study to identify critical attributes and attribute-levels for

a discrete choice experiment on oral pre-exposure prophy-

laxis (PrEP) delivery among young people in Cape Town

and Johannesburg, South Africa. BMC Health Services

Research,21(1), 1–13. https://doi.org/10.1186/s12913-020-

05942-8

Drainoni, M.-L., Biancarelli, D. L., Leech, A. A., Sullivan, M.,

& Bazzi, A. R. (2018). Implementing a pre-exposure pro-

phylaxis intervention for safer conception among HIV ser-

odiscordant couples: Recommendations for health care

providers. Journal of Health Disparities Research and

Practice,11(2), 19–33.

Eakle, R., Bothma, R., Bourne, A., Gumede, S., Motsosi, K., &

Rees, H. (2019). “I am still negative”: Female sex workers’

perspectives on uptake and use of daily preexposure pro-

phylaxis for HIV prevention in South Africa. PLoS ONE,

12 J. BASDAV ET AL.

14(4), Article e0212271. https://doi.org/10.1371/journal.

pone.0212271

EDC. (2022). South Africa school-based sexuality and HIV pre-

vention education activity.https://www.edc.org/south-

africa-school-based-sexuality-and-hiv-prevention-

education-activity#challenge

Falcao, J., Ahoua, L., Zerbe, A., Mattei, P. d., Baggaley, R.,

Chivurre, V., Mulondo, P., Ramiro, I., Shona Dalal, M. F.,

O’Reilly, K., & El-Sadr, W. (2017). Willingness to use

short-term oral pre-exposure prophylaxis (PrEP) by

migrant miners and female partners of migrant miners in

Mozambique. Culture, Health & Sexuality,19(12), 1389–

1403. https://doi.org/10.1080/13691058.2017.1316424

Giacomini, M. (2012). Theory matters in qualitative health

research. In I. Bourgeault, R. Dingwall, & R. D. Vries

(Eds.), The SAGE handbook of qualitative methods in health

research (pp. 125–156). SAGE Publications Ltd. https://doi.

org/10.4135/9781446268247

Golub, S. A., Gamarel, K. E., & Surace, A. (2017).

Demographic diﬀerences in PrEP-related stereotypes:

Implications for implementation. AIDS and Behavior,21

(5), 1229–1235. https://doi.org/10.1007/s10461-015-1129-4

Gombe, M. M., Cakouros, B. E., Ncube, G., Zwangobani, N.,

Mareke, P., Mkwamba, A., Prescott, M. R., Bhatasara, T.,

Murwira, M., Mangwiro, A. Z., & Prust, M. L. (2020).

Key barriers and enablers associated with uptake and con-

tinuation of oral pre-exposure prophylaxis (PrEP) in the

public sector in Zimbabwe: Qualitative perspectives of gen-

eral population clients at high risk for HIV. PLoS One,15

(1), Article e0227632. https://doi.org/10.1371/journal.

pone.0227632

Govender, E., & Abdool Karim, Q. (2018). Understanding

women and men’s acceptability of current and new HIV

prevention technologies in KwaZulu-natal, South Africa.

AIDS Care,30(10), 1311–1314. https://doi.org/10.1080/

09540121.2018.1488027

Grammatico, M. A., Moll, A. P., Choi, K., Springer, S. A., &

Shenoi, S. V. (2021). Feasibility of a community-based

delivery model for HIV pre-exposure prophylaxis among

bar patrons in rural South Africa. Journal of the

International AIDS Society,24(11), Article e25848.

https://doi.org/10.1002/jia2.25848

Haﬀejee, F., Fasanmi-Kana, O., Ally, F., Thandar, Y., &

Basdav, J. (2022). Four years later: Do South Africans

know what pre-exposure prophylaxis for HIV is? AIDS

Care,1–8. https://doi.org/10.1080/09540121.2022.2032573

Haﬀejee, F., Koorbanally, D., & Corona, R. (2018). Condom

use among South African university students in the pro-

vince of KwaZulu-Natal. Sexuality & Culture,22(4),

1279–1289. https://doi.org/10.1007/s12119-018-9523-5

Haﬀejee, F., Ngidi, N. D., & Singh, D. (2018). Is the HIV epi-

demic changing views on marriage aspirations?

Perspectives of university students in Durban, South

Africa. AIDS Care,30(7), 853–856. https://doi.org/10.

1080/09540121.2017.1400641

Hannaford, A., Lim, J., Moll, A. P., Khoza, B., & Shenoi, S. V.

(2020). ‘PrEP should be for men only’: Young heterosexual

men’s views on PrEP in rural South Africa. Global Public

Health,15(9), 1337–1348. https://doi.org/10.1080/

17441692.2020.1744680

Hill, L. M., Lightfoot, A. F., Riggins, L., & Golin, C. E. (2021).

Awareness of and attitudes toward pre-exposure

prophylaxis among African American women living in

low-income neighborhoods in a southeastern city. AIDS

Care,33(2), 239–243. https://doi.org/10.1080/09540121.

2020.1769834

Hill, L. M., Maseko, B., Chagomerana, M., Hosseinipour, M.

C., Bekker, L.-G., Pettifor, A., & Rosenberg, N. E. (2020).

HIV risk, risk perception, and PrEP interest among adoles-

cent girls and young women in Lilongwe, Malawi:

Operationalizing the PrEP cascade. Journal of the

International AIDS Society,23(S3), Article e25502.

https://doi.org/10.1002/jia2.25502

Høﬀding, S., Martiny, K., & Roepstorﬀ,A.(2022). Can we

trust the phenomenological interview? Metaphysical, epis-

temological, and methodological objections.

Phenomenology and the Cognitive Sciences,21(1), 33–51.

https://doi.org/10.1007/s11097-021-09744-z

Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to

qualitative content analysis. Qualitative Health Research,

15(9), 1277–1288. https://doi.org/10.1177/

1049732305276687

Irungu, E. M., & Baeten, J. M. (2020). PrEP rollout in Africa:

Status and opportunity. Nature Medicine,26(5), 655–664.

https://doi.org/10.1038/s41591-020-0872-x

Jani, N., Mathur, S., Kahabuka, C., Makyao, N., & Pilgrim, N.

(2021). Relationship dynamics and anticipated stigma: Key

considerations for PrEP use among Tanzanian adolescent

girls and young women and male partners. PLOS ONE,

16(2), Article e0246717. https://doi.org/10.1371/journal.

pone.0246717

Johnson, A. K., Fletcher, F. E., Ott, E., Wishart, M., Friedman,

E. E., Terlikowski, J., & Haider, S. (2020). Awareness and

intent to use pre-exposure prophylaxis (PrEP) among

African American women in a family planning clinic.

Journal of Racial and Ethnic Health Disparities,7(3), 550–

554. https://doi.org/10.1007/s40615-019-00683-9

Joseph Davey, D., Knight, L., Markt-Maloney, J., Tsawe, N.,

Gomba, Y., Mashele, N., Dovel, K., Gorbach, P., Bekker,

L. G., Coates, T. J., & Myer, L. (2021). “I had made the

decision, and No One was going to stop Me”—

Facilitators of PrEP adherence during pregnancy and post-

partum in Cape Town, South Africa. AIDS and Behavior,25

(12), 3978–3986. https://doi.org/10.1007/s10461-021-

03320-x

Kecojevic, A., Meleo-Erwin, Z. C., Basch, C. H., &

Hammouda, M. (2021). A thematic analysis of pre-

exposure prophylaxis (PrEP) YouTube videos. Journal of

Homosexuality,68(11), 1877–1898. https://doi.org/10.

1080/00918369.2020.1712142

Kharsany, A. B. M., Cawood, C., Lewis, L., Yende-Zuma, N.,

Khanyile, D., Puren, A., Madurai, S., Baxter, C., George,

G., Govender, K., Beckett, S., Samsunder, N., Toledo, C.,

Ayalew, K. A., Diallo, K., Glenshaw, M., Herman-Roloﬀ,

A., Wilkinson, E., de Oliveira, T., …Abdool Karim, Q.

(2019). Trends in HIV prevention, treatment, and inci-

dence in a hyperendemic area of KwaZulu-Natal, South

Africa. JAMA Network Open,2(11), Article e1914378.

https://doi.org/10.1001/jamanetworkopen.2019.14378

Lai, J., Pan, P., Lin, Y., Ye, L., Xie, L., Xie, Y., Liang, B., Zheng,

F., Chen, R., Wen, L., Luo, Y., Liang, H., & Jiang, J. (2020).

A survey on HIV/AIDS-related knowledge, attitudes, risk

behaviors, and characteristics of Men who have sex with

men among university students in Guangxi, China.

AIDS CARE 13

BioMed Research International,2020, Article ID 7857231.

https://doi.org/10.1155/2020/7857231

Lim, S. H., Mburu, G., Bourne, A., Pang, J., Wickersham, J. A.,

Wei, C. K. T., Yee, I. A., Wang, B., Cassolato, M., & Azwa, I.

(2017). Willingness to use pre-exposure prophylaxis for

HIV prevention among men who have sex with men in

Malaysia: Findings from an online survey. PLoS ONE,12

(9), Article e0182838. https://doi.org/10.1371/journal.

pone.0182838

Marrazzo, J. M., Ramjee, G., Richardson, B. A., Gomez, K.,

Mgodi, N., Nair, G., Palanee, T., Nakabiito, C., Van Der

Straten, A., Noguchi, L., Hendrix, C. W., Dai, J. Y.,

Ganesh, S., Mkhize, B., Taljaard, M., Parikh, U. M., Piper,

J., Mâsse, B., Grossman, C., …for the VOICE Study

Team. (2015). Tenofovir-based preexposure prophylaxis

for HIV infection among African women. New England

Journal of Medicine,372(6), 509–518. https://doi.org/10.

1056/NEJMoa1402269

Maseko, B., Hill, L. M., Phanga, T., Bhushan, N., Vansia, D.,

Kamtsendero, L., Pettifor, A. E., Bekker, L.-G.,

Hosseinipour, M. C., & Rosenberg, N. E. (2020).

Perceptions of and interest in HIV preexposure prophylaxis

use among adolescent girls and young women in Lilongwe,

Malawi. PLoS ONE,15(1), Article e0226062. https://doi.

org/10.1371/journal.pone.0226062

Médecins Sans Frontières. (2021, December 1). World AIDS

Day 2021: Bringing care to remote communities in South

Africa.https://reliefweb.int/report/south-africa/world-

aids-day-2021-bringing-care-remote-communities-south-

africa

Muhumuza, R., Ssemata, A. S., Kakande, A., Ahmed, N.,

Atujuna, M., Nomvuyo, M., Bekker, L. G., Dietrich, J. J.,

Tshabalala, G., Hornschuh, S., Maluadzi, M., Chibanda-

Stranix, L., Nematadzira, T., Weiss, H. A., Nash, S., Fox,

J., & Seeley, J. (2021). Exploring perceived barriers and

facilitators of PrEP uptake among young people in

Uganda, Zimbabwe, and South Africa. Archives of Sexual

Behavior,50(4), 1729–1742. https://doi.org/10.1007/

s10508-020-01880-y

My PrEP. (2021). Where is PrEP available? https://myprep.co.

za/info/where-is-prep-available/

Nakasone, S. E., Chimbindi, N., Mthiyane, N., Nkosi, B.,

Zuma, T., Baisley, K., Dreyer, J., Pillay, D., Floyd, S.,

Birdthistle, I., Seeley, J., & Shahmanesh, M. (2020). “They

have this not care–don’t care attitude:”A mixed methods

study evaluating community readiness for oral PrEP in

adolescent girls and young women in a rural area of

South Africa. AIDS Research and Therapy,17, Article 55.

https://doi.org/10.1186/s12981-020-00310-2

Nakathingo, F. M., Ashipala, D. O., & Iiyambo, P. T. (2021).

Knowledge, awareness and willingness to use HIV pre-

exposure prophylaxis (PrEP) among students at the

University of Namibia. Global Journal of Health Science,

13(3), Article 48. https://doi.org/10.5539/gjhs.v13n3p48

Oldenburg, C. E., Nunn, A. S., Montgomery, M., Almonte, A.,

Mena, L., Patel, R. R., Mayer, K. H., & Chan, P. A. (2018).

Behavioral changes following uptake of HIV pre-exposure

prophylaxis among men who have sex with men in a clini-

cal setting. AIDS and Behavior,22(4), 1075–1079. https://

doi.org/10.1007/s10461-017-1701-1

Owens, C., Hubach, R. D., Lester, J. N., Williams, D.,

Voorheis, E., Reece, M., & Dodge, B. (2020). Assessing

determinants of pre-exposure prophylaxis (PrEP) adher-

ence among a sample of rural Midwestern men who have

sex with men (MSM). AIDS Care,1–8. https://doi.org/10.

1080/09540121.2020.1757021

Owens, C., Hubach, R. D., Williams, D., Voorheis, E., Lester,

J., Reece, M., & Dodge, B. (2020). Facilitators and barriers

of pre-exposure prophylaxis (PrEP) uptake among rural

men who have sex with men living in the Midwestern

U.S. Archives of Sexual Behavior,49(6), 2179–2191.

https://doi.org/10.1007/s10508-020-01654-6

Paparini, S., Nutland, W., Rhodes, T., Nguyen, V.-K., &

Anderson, J. (2018). DIY HIV prevention: Formative quali-

tative research with men who have sex with men who

source PrEP outside of clinical trial. PLoS ONE,13(8),

Article e0202830. https://doi.org/10.1371/journal.pone.

0202830

Patel, R. C., Leddy, A. M., Odoyo, J., Anand, K., Stanford-

Moore, G., Wakhungu, I., Bukusi, E. A., Baeten, J. M., &

Brown, J. M. (2018). What motivates serodiscordant

couples to prevent HIV transmission within their relation-

ships: Findings from a PrEP implementation study in

Kenya. Culture, Health & Sexuality,20(6), 625–639.

https://doi.org/10.1080/13691058.2017.1367421

Patel, V. V., Ginsburg, Z., Golub, S. A., Horvath, K. J., Rios,

N., Mayer, K. H., Kim, R. S., & Arnsten, J. H. (2018).

Empowering With PrEP (E-PrEP), a peer-led social

media-based intervention to facilitate HIV preexposure

prophylaxis adoption among young black and Latinx Gay

and bisexual men: Protocol for a cluster randomized con-

trolled trial. JMIR Research Protocols,7(8), Article e11375.

https://doi.org/10.2196/11375

Pillay, D., Stankevitz, K., Lanham, M., Ridgeway, K., Murire,

M., Briedenhann, E., Jenkins, S., Subedar, H., Hoke, T., &

Mullick, S. (2020). Factors inﬂuencing uptake, continu-

ation, and discontinuation of oral PrEP among clients at

sex worker and MSM facilities in South Africa. PLOS

ONE,15(4), Article e0228620. https://doi.org/10.1371/

journal.pone.0228620

Pintye, J., Beima-Soﬁe, K. M., Kimemia, G., Ngure, K., Brown

Trinidad, S., Heﬀron, R., Baeten, J., Odoyo, J., Mugo, N.,

Bukusi, E. A., Kelley, M. C., & John-Stewart, G. C.

(2017). “I did not want to give birth to a child who has

HIV”: Experiences using PrEP during pregnancy among

HIV-uninfected Kenyan women in HIV-serodiscordant

couples. JAIDS Journal of Acquired Immune Deﬁciency

Syndromes,76(3), 259–265. https://doi.org/10.1097/QAI.

0000000000001516

Plaatjies, N. (2018). Rural infrastructure development: the sol-

ution for urbanization? https://www.igd.org.za/infocus/

11396-rural-infrastructure-development-the-solution-for-

urbanization

Poteat, T., Malik, M., van der Merwe, L. L. A., Cloete, A.,

Adams, D., Nonyane, B. A. S., & Wirtz, A. L. (2020).

PrEP awareness and engagement among transgender

women in South Africa: A cross-sectional, mixed methods

study. The Lancet HIV,7(12), e825–e834. https://doi.org/

10.1016/S2352-3018(20)30119-3

PrEP Watch. (2017). PrEP implementation pack: South Africa

2016-2017. http://prepwatch.org/wp-content/uploads/

2017/07/SA_ImplementationPack.pdf

PrEP Watch. (2020). PrEP in South Africa.https://data.

prepwatch.org/

14 J. BASDAV ET AL.

PrEP Watch. (2022, January 26). South Africa.https://www.

prepwatch.org/country/south-africa/

Pyra, M., Johnson, A. K., Devlin, S., Uvin, A. Z., Irby, S.,

Stewart, E., Blum, C., Green, M., Haider, S., Hirschhorn,

L. R., & Ridgway, J. P. (2022). HIV Pre-exposure prophy-

laxis Use and persistence among black ciswomen:

“Women need to protect themselves, period”.Journal of

Racial and Ethnic Health Disparities,9, 820–829. https://

doi.org/10.1007/s40615-021-01020-9

Reddy, P., Shegs, J., & McCauley, A. P. (2005). Programming

for HIV prevention in South African schools: A report on

program implementation.https://knowledgecommons.

popcouncil.org/cgi/viewcontent.cgi?article =

1053&context = departments_sbsr-hiv

Rensburg, R. (2021, July 7). Healthcare in South Africa: How

inequity is contributing to ineﬃciency.https://www.wits.

ac.za/news/latest-news/opinion/2021/2021-07/healthcare-

in-south-africa-how-inequity-is-contributing-to-

ineﬃciency.html

Reza-Paul, S., Lazarus, L., Maiya, R., Haldar, P., Rewari, B. B.,

Venugopal, M. S., Hafeez Ur Rahman, S., Venukumar, K.

T., Ramaiah, M., Pasha, A., Sharma, M., Steen, R., &

Lorway, R. (2020). The Ashodaya PrEP project: Lessons

and implications for scaling up PrEP from a community-

led demonstration project among female sex workers in

Mysore, India. Global Public Health,15(6), 889–904.

https://doi.org/10.1080/17441692.2020.1724316

Rojas Castro, D., Delabre, R. M., & Molina, J.-M. (2019). Give

PrEP a chance: Moving on from the “risk compensation”

concept. Journal of the International AIDS Society,22(S6),

Article e25351. https://doi.org/10.1002/jia2.25351

Roth, A., Felsher, M., Tran, N., Bellamy, S., Martinez-Donate,

A., Krakower, D., & Szep, Z. (2019). Drawing from the the-

ory of planned behaviour to examine pre-exposure prophy-

laxis uptake intentions among heterosexuals in high HIV

prevalence neighbourhoods in Philadelphia, Pennsylvania,

USA: An observational study. Sexual Health,16(3), 218–

224. https://doi.org/10.1071/SH18081

Rousseau, E., Katz, A. W. K., O’Rourke, S., Bekker, L.-G.,

Delany-Moretlwe, S., Bukusi, E., Travill, D., Omollo, V.,

Morton, J. F., O’Malley, G., Haberer, J. E., Heﬀron, R.,

Johnson, R., Celum, C., Baeten, J. M., & van der Straten,

A. (2021). Adolescent girls and young women’s PrEP-

user journey during an implementation science study in

South Africa and Kenya. PLoS ONE,16(10), Article

e0258542. https://doi.org/10.1371/journal.pone.0258542

Sack, D. E., De Schacht, C., Paulo, P., Graves, E., Emílio, A.

M., Matino, A., Fonseca, C. L., Aboobacar, A. U., Van

Rompaey, S., & Audet, C. M. (2021). Pre-exposure prophy-

laxis use among HIV serodiscordant couples: A qualitative

study in Mozambique. Global Health Action,14(1), Article

1940764. https://doi.org/10.1080/16549716.2021.1940764

Scorgie, F., Khoza, N., Delany-Moretlwe, S., Velloza, J.,

Mangxilana, N., Atujuna, M., Chitukuta, M.,

Matambanadzo, K. V., Hosek, S., Makhale, L., & Celum,

C. (2021). Narrative sexual histories and perceptions of

HIV risk among young women taking PrEP in Southern

Africa: Findings from a novel participatory method.

Social Science & Medicine,270, Article 113600. https://

doi.org/10.1016/j.socscimed.2020.113600

Serota, D. P., Rosenberg, E. S., Sullivan, P. S., Thorne, A. L.,

Rolle, C.-P. M., Del Rio, C., Cutro, S., Luisi, N., Siegler,

A. J., Sanchez, T. H., & Kelley, C. F. (2019). Pre-exposure

prophylaxis uptake and discontinuation among young

black men who have sex with men in Atlanta, Georgia: A

prospective cohort study. Clinical Infectious Diseases,71

(3), 574–582. https://doi.org/10.1093/cid/ciz894

Shahmanesh, M., Okesola, N., Chimbindi, N., Zuma, T.,

Mdluli, S., Mthiyane, N., Adeagbo, O., Dreyer, J., Herbst,

C., McGrath, N., Harling, G., Sherr, L., & Seeley, J.

(2021). Thetha Nami: Participatory development of a

peer-navigator intervention to deliver biosocial HIV pre-

vention for adolescents and youth in rural South Africa.

BMC Public Health,21(1), 1–13. https://doi.org/10.1186/

s12889-021-11399-z

Shamu, S., Shamu, P., Khupakonke, S., Farirai, T., Chidarikire,

T., Guloba, G., & Nkhwashu, N. (2021). Pre-exposure pro-

phylaxis (PrEP) awareness, attitudes and uptake willingness

among young people: Gender diﬀerences and associated

factors in two South African districts. Global Health

Action,14(1), Article 1886455. https://doi.org/10.1080/

16549716.2021.1886455

Simbayi, L., Zuma, K., Zungu, N., Moyo, S., Marinda, E.,

Jooste, S., Mabaso, M., Ramlagan, S., North, A., van Zyl,

J., Mohlabane, N., Dietrich, C., Naidoo, I., & The

SABSSM V Team (2019). South African National HIV

prevalence, incidence, behaviour and communication sur-

vey, 2017. http://www.hsrc.ac.za/uploads/pageContent/

10779/SABSSM%20 V.pdf

Sorrell, J. M., & Redmond, G. M. (1995). Interviews in quali-

tative nursing research: Diﬀering approaches for ethno-

graphic and phenomenological studies. Journal of

Advanced Nursing,21(6), 1117–1122. https://doi.org/10.

1046/j.1365-2648.1995.21061117.x

Statistics South Africa. (2021). Mid-year population estimates.

Storholm, E. D., Mutchler, M. G., Ghosh-Dastidar, B., Balan,

E., Mokhbat, J., Kegeles, S. M., & Wagner, G. J. (2021).

Gearing up for PrEP in the Middle East and North

Africa: An initial look at willingness to take PrEP among

young men who have sex with men in Beirut, Lebanon.

Behavioral Medicine,47(2), 111–119. https://doi.org/10.

1080/08964289.2019.1661822

Taggart, T., Liang, Y., Pina, P., & Albritton, T. (2020).

Awareness of and willingness to use PrEP among black

and Latinx adolescents residing in higher prevalence

areas in the United States. PLoS ONE,15(7), Article

e0234821. https://doi.org/10.1371/journal.pone.0234821

Tangmunkongvorakul, A., Chariyalertsak, S., Amico, K. R.,

Saokhieo, P., Wannalak, V., Sangangamsakun, T.,

Goicochea, P., & Grant, R. (2013). Facilitators and barriers

to medication adherence in an HIV prevention study

among men who have sex with men in the iPrEx study in

Chiang Mai, Thailand. AIDS Care,25(8), 961–967.

https://doi.org/10.1080/09540121.2012.748871

Tester, G., & Hoxmeier, J. C. (2020). PrEP, TasP and the

casual sex scripts among serodiscordant gay men. Journal

of HIV/AIDS & Social Services,19(2), 124–139. https://

doi.org/10.1080/15381501.2020.1753620

Thomas, S. P. (2021). Resolving tensions in phenomenological

research interviewing. Journal of Advanced Nursing,77(1),

484–491. https://doi.org/10.1111/jan.14597

UNAIDS. (2015). Oral pre-exposure prophylaxis questions and

answers. https://www.unaids.org/sites/default/ﬁles/media_

asset/UNAIDS_JC2765_en.pdf

AIDS CARE 15

UNAIDS. (2020). Fact sheet - Latest global and regional stat-

istics on the status of the AIDS epidemic.https://www.

unaids.org/sites/default/ﬁles/media_asset/UNAIDS_

FactSheet_en.pdf

UNICEF. (2002). Lovelife campaign.https://www.comminit.

com/unicef/content/lovelife-campaign

UNICEF. (2015). MTV Shuga - A multi-platform communi-

cation initiative achieving HIV behaviour change for adoles-

cents in Africa.https://www.comminit.com/unicef/content/

mtv-shuga-multi-platform-communication-initiative-

achieving-hiv-behaviour-change-adolesc

VA National HIV. (2020). PrEP: Frequently asked questions

for veterans. https://www.hiv.va.gov/pdf/prep-faqs.pdf

Van Damme, L., Corneli, A., Ahmed, K., Agot, K., Lombaard,

J., Kapiga, S., Malahleha, M., Owino, F., Manongi, R.,

Onyango, J., Temu, L., Monedi, M. C., Mak’Oketch, P.,

Makanda, M., Reblin, I., Makatu, S. E., Saylor, L.,

Kiernan, H., Kirkendale, S., …, For the FEM-PrEP Study

Group (2012). Preexposure prophylaxis for HIV infection

among African women. New England Journal of

Medicine,367(5), 411–422. https://doi.org/10.1056/

NEJMoa1202614

Van der Elst, E. M., Mbogua, J., Operario, D., Mutua, G., Kuo,

C., Mugo, P., Kanungi, J., Singh, S., Haberer, J., Priddy, F.,

& Sanders, E. J. (2013). High acceptability of HIV pre-

exposure prophylaxis but challenges in adherence and

use: Qualitative insights from a phase I trial of intermittent

and daily PrEP in at-risk populations in Kenya. AIDS and

Behavior,17(6), 2162–2172. https://doi.org/10.1007/

s10461-012-0317-8

van der Straten, A., Stadler, J., Montgomery, E., Hartmann,

M., Magazi, B., Mathebula, F., Schwartz, K., Laborde, N.,

& Soto-Torres, L. (2014). Women’s experiences with oral

and vaginal Pre-exposure prophylaxis: The VOICE-C

qualitative study in Johannesburg, South Africa. PLoS

ONE,9(2), Article e89118. https://doi.org/10.1371/

journal.pone.0089118

Van Dijk, M., De Wit, J. B. F., Guadamuz, T. E., Martinez, J.

E., & Jonas, K. J. (2022). Bridging the serodivide: Attitudes

of PrEP users towards sex partners living with HIV. AIDS

Care,34(3), 349–352. https://doi.org/10.1080/09540121.

2021.1954588

Van Schalkwyk, B. B. (2015). Challenges in realising sustain-

able community development in rural South Africa.

Agriculture, Forestry and Fisheries,4(4-1), 73–79. https://

doi.org/10.11648/j.aﬀ.s.2015040401.19

Ware, N. C., Wyatt, M. A., Haberer, J. E., Baeten, J. M., Kintu,

A., Psaros, C., Safren, S., Tumwesigye, E., Celum, C. L., &

Bangsberg, D. R. (2012). What’s love got to do with it?

Explaining adherence to oral antiretroviral pre-exposure

prophylaxis (PrEP) for HIV serodiscordant couples.

Journal of Acquired Immune Deﬁciency Syndromes,59(5),

463–468. https://doi.org/10.1097/QAI.0b013e31824a060b

Young, I., Boydell, N., Patterson, C., Hilton, S., & McDaid, L.

(2021). Conﬁguring the PrEP user: Framing pre-exposure

prophylaxis in UK newsprint 2012–2016. Culture, Health

& Sexuality,23(6), 772–787. https://doi.org/10.1080/

13691058.2020.1729420

Zimba, C., Maman, S., Rosenberg, N. E., Mutale, W.,

Mweemba, O., Dunda, W., Phanga, T., Chibwe, K. F.,

Matenga, T., Freeborn, K., Schrubbe, L., Vwalika, B., &

Chi, B. H. (2019). The landscape for HIV pre-exposure pro-

phylaxis during pregnancy and breastfeeding in Malawi

and Zambia: A qualitative study. PLoS ONE,14(10),

Article e0223487. https://doi.org/10.1371/journal.pone.

0223487

16 J. BASDAV ET AL.

ResearchGate has not been able to resolve any citations for this publication.

Daily Oral Pre-exposure Prophylaxis (PrEP) Continuation Among Women from Durban, South Africa, Who Initiated PrEP as Standard of Care for HIV Prevention in a Clinical Trial

Article

Full-text available

Aug 2022
AIDS BEHAV

HIV incidence among women in Eastern and Southern Africa remains unacceptably high, highlighting the need for effective HIV prevention options, including pre-exposure prophylaxis (PrEP). The Evidence for Contraceptive Options and HIV Outcomes trial offered daily oral PrEP to participants during the latter part of the clinical trial as an additional HIV prevention choice. We explored daily oral PrEP continuation at trial exit among women enrolled from Durban, South Africa who initiated oral PrEP at the trial site. Of the 132 women initiating oral PrEP, 87% reported continuation of oral PrEP at month 1, 80% at month 3, and 75% continued using oral PrEP at their final trial visit and were referred to off-site facilities for ongoing oral PrEP access. The median duration of oral PrEP use in trial participants who used oral PrEP was 91 days (IQR 87 to 142 days). Women who disclosed their oral PrEP use to someone had increased odds of continuing oral PrEP at trial exit. Women who reported > 1 sex partner and those who felt they would probably or definitely get infected with HIV had reduced odds of continuing oral PrEP at trial exit. Of those discontinuing oral PrEP (n = 32), > 50% discontinued within the first month, and the most common reason for discontinuation was reporting side effects. The high rates of oral PrEP continuation in our study are encouraging and our findings can be utilized by other clinical trials providing oral PrEP as standard of care for HIV prevention and by oral PrEP implementation programmes.

Four years later: Do South Africans know what pre-exposure prophylaxis for HIV is?

Article

Full-text available

Feb 2022

HIV incidence remains high among South Africans, with low uptake of preventative measures such as condom use. Pre-exposure prophylaxis (PrEP), which protects HIV-negative individuals from infection, was first introduced in SA in 2016. This study determined the knowledge of PrEP among university students (n = 282) and primary health care clinic users (n = 358) in KwaZulu-Natal, South Africa. Data were collected using a cross-sectional survey. The study population was at high-risk of HIV infection, with early age of sexual debut, multiple concurrent sexual partners and inconsistent condom usage. Only 12.3% (n = 79) stated that they had a full understanding of PrEP, which was higher among university students (9.8%; n = 63) than clinic users (2.5%; n = 16; p < 0.001). Specific PrEP knowledge was, however, low. Health Science students did not have a better knowledge than students from other faculties. Neither did users of clinics offering PrEP have a better knowledge than users of clinics not offering PrEP. Moreover, few participants (15%; n = 96) were aware of the availability of PrEP at their local clinic. Interventions to address the low level of PrEP knowledge within the population are required, to reduce the high HIV incidence.

Feasibility of a community‐based delivery model for HIV pre‐exposure prophylaxis among bar patrons in rural South Africa

Article

Full-text available

Nov 2021

Introduction South Africa, home to the world's largest HIV epidemic, has made great strides in improving access to HIV services, but specific groups, particularly young men, remain difficult to engage in the HIV care cascade. Alcohol use disorder, prevalent in South Africa, further complicates engagement. Congregate settings where alcohol is served, known as shebeens, are an ideal place to engage young people for HIV testing, treatment and prevention, including pre-exposure prophylaxis (PrEP). Here, we characterize the uptake of PrEP in shebeen patrons and explore the effect of alcohol consumption on PrEP uptake by piloting a community-based delivery model. Methods In the rural Kwazulu-Natal province (KZN) of South Africa, a field team made up of all men offered screenings outside of shebeens at 27 events over 6 months in 2020. Screenings included rapid HIV testing and Alcohol Use Disorder Identification Test (AUDIT). Participants who tested negative for HIV were offered PrEP as once daily oral tenofovir disoproxil fumarate/emtricitabine. Short-term retention was determined. Logistic regression was performed to identify predictors of PrEP uptake, including unadjusted and adjusted odds ratios (OR) with 95% confidence interval. Results One hundred and sixty-two shebeen patrons were screened, and 136 (84%) were eligible for PrEP. Among those eligible, 37 (27%) completed clinical evaluation and initiated PrEP. Among PrEP initiators, 91.9% were men, median age was 26.0 years (interquartile range 21–31), 32.4% were employed, 18.9% had running water and 70.3% had AUDIT scores indicating hazardous drinking. Among 37 initiators, 25 (68%) were retained at 1 month, and 19 (51%) were retained at 4 months. Independent predictors of PrEP uptake among all bar patrons, and only men (108 screened and 34 initiators), included younger age (OR 0.92 [0.88–0.97]) and lifetime number of sexual partners (OR 1.07 [1.02–1.13]). Conclusions Community-based PrEP delivery after engagement at shebeens in rural South Africa is a feasible and novel approach to reach a traditionally difficult-to-engage population, particularly young men. In this small sample, sexual risk behaviours predicted PrEP uptake. Hazardous drinking was not a barrier to PrEP initiation.

Adolescent girls and young women’s PrEP-user journey during an implementation science study in South Africa and Kenya

Article

Full-text available

Oct 2021
PLOS ONE

Successful scale-up of PrEP for HIV prevention in African adolescent girls and young women (AGYW) requires integration of PrEP into young women’s everyday lives. We conducted interviews and focus group discussions with 137 AGYW PrEP users aged 16–25 from South Africa and Kenya. Individual and relational enablers and disablers were explored at key moments during their PrEP-user journey from awareness, initiation and early use through persistence, including PrEP pauses, restarts, and discontinuation. PrEP uptake was facilitated when offered as part of an integrated sexual reproductive health service, but hampered by low awareness, stigma and misconceptions about PrEP in the community. Daily pill-taking was challenging for AGYW due to individual, relational and structural factors and PrEP interruptions (intended or unintended) were described as part of AGYW’s PrEP-user journey. Disclosure, social support, adolescent-friendly health counseling, and convenient access to PrEP were reported as key enablers for PrEP persistence.

Bridging the serodivide: attitudes of PrEP users towards sex partners living with HIV

Article

Full-text available

Jul 2021
AIDS CARE

The introduction of biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), holds the potential to overcome the serodivide. We investigated the attitudes of PrEP users towards having sex with partners living with HIV. PrEP users in the Netherlands were recruited online and completed three questionnaires over a period of six months. We investigated changes over time in feelings of fear of HIV, comfort, and attitudes towards condom use when having sex with men living with HIV (MLHIV). A majority of PrEP users in our sample (up to 71.6%) had sex with MLHIV. Feeling comfortable to have sex with MLHIV did not change over time, but was already at a high level at T1. Most importantly, feeling safe not to use condoms with HIV-positive partners significantly increased, and did so in a rather short period of time after the onset of PrEP use (3-6 months). Taken together, the findings suggest that that PrEP may contribute to decreasing the serodivide between MSM rather quickly after the onset of PrEP use.

Can we trust the phenomenological interview? Metaphysical, epistemological, and methodological objections

Article

Full-text available

Jul 2021

The paper defends the position that phenomenological interviews can provide a rich source of knowledge and that they are in no principled way less reliable or less valid than quantitative or experimental methods in general. It responds to several skeptic objections such as those raised against introspection, those targeting the unreliability of episodic memory, and those claiming that interviews cannot address the psychological, cognitive and biological correlates of experience. It argues that the skeptic must either heed the methodological and epistemological justification of the phenomenological interview provided, or embrace a more fundamental skepticism, a “deep mistrust”, in which scientific discourse can have no recourse to conscious processes as explananda , with ensuing dire consequences for our conception of science.

Pre-exposure prophylaxis use among HIV serodiscordant couples: a qualitative study in Mozambique

Article

Full-text available

Jul 2021

Background Pre-exposure prophylaxis (PrEP) has the potential to reduce HIV transmission and stem the HIV epidemic. Unfortunately, PrEP uptake in rural sub-Saharan Africa has been slow and medication adherence has been suboptimal. Objective To explore the perspectives, attitudes, and experiences of HIV serodiscordant partners taking PrEP and develop a messaging campaign to improve PrEP uptake in rural Mozambique to reduce HIV transmission among serodiscordant partners. Methods In this qualitative study, we interviewed 20 people in serodiscordant relationships using PrEP at a rural health center in Zambézia province, Mozambique and employed inductive and deductive coding to elicit their perspectives, attitudes, and experiences related to learning their partner’s HIV status, barriers to PrEP uptake, obstacles to PrEP adherence, and decisions to disclose their PrEP use with family and friends using thematic analysis. Results Our analysis generated nine themes across various levels of the socioecological model. Participants reported a strong desire to stay in the discordant relationship and highlighted the importance of working together to ensure PrEP and antiretroviral therapy adherence, with the majority skeptical that adherence could be achieved without both partners’ support (individual and interpersonal). Although most participants were reticent about sharing their serodiscordant status with family and friends (individual and interpersonal), those who did found their family and friends supportive (interpersonal). Participants suggested increasing community health agent availability to help people navigate HIV prevention and treatment (organizational). We then created three oral stories, using themes from the interviews, with examples from various levels of the socioecological model that will be used to generate support for PrEP use among community members. Conclusions Our findings informed oral template stories that will be used to emphasize how couples can work together to improve PrEP uptake and reduce incident HIV infections in serodiscordant couples elsewhere in rural Mozambique.

“I had Made the Decision, and No One was Going to Stop Me” —Facilitators of PrEP Adherence During Pregnancy and Postpartum in Cape Town, South Africa

Article

Full-text available

Dec 2021
AIDS BEHAV

PrEP is safe and effective but requires adherence during potential HIV exposure, yet the facilitators of long-term maternal adherence are not well understood. We conducted semi-structured interviews with 25 postpartum women who reported high adherence (PrEP use ≥ 25 days in last 30-days and never missed a PrEP prescription in pregnancy/postpartum period) within a PrEP service for pregnant and postpartum women. A thematic approach guided an iterative process of coding and analysis. Themes identified as drivers of optimal PrEP use were HIV risk perception, mainly because of partner’s behaviors and unknown serostatus, and a strong desire to have a baby free of HIV. Reported disclosure of PrEP use facilitated PrEP adherence. Women discussed having partner and family support, which included reminders to take PrEP daily. Primary barriers were anticipated or experienced stigma, overcome through education of partners and family about PrEP. Pregnant women experienced transient side-effects, but found ways to continue, including taking PrEP at night. PrEP programs for pregnant and postpartum women should integrate strategies to assist women with realistic appraisals of risk and teach skills for disclosure and securing support from significant others.

Thetha Nami : participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Article

Full-text available

Jul 2021
BMC PUBLIC HEALTH

Background: despite effective biomedical tools, HIV remains the largest cause of morbidity/mortality in South Africa. We used community-based participatory research (CBPR) informed by principles of social justice, to develop a peer-led biosocial intervention for HIV prevention in rural KwaZulu-Natal (KZN). Methods : Between March 2018 and September 2019 we used CBPR to iteratively co-create and contextually adapt a biosocial peer-led intervention to support HIV prevention. Men and women aged 18-30 years were selected by community leaders of 21 intervention implementation areas (izigodi) and underwent 20 weeks of training as peer-navigators. We synthesised quantitative and qualitative data collected during a 2016-2018 study into 17 vignettes illustrating the local drivers of HIV. During three participatory intervention development workshops and community mapping sessions, the peer-navigators critically engaged with vignettes, brainstormed solutions and mapped the components to their own izigodi. The intervention components were plotted to a Theory of Change which, following a six-month pilot and process evaluation, the peer-navigators refined. The intervention will be evaluated in a randomised controlled trial (NCT04532307). Results: following written and oral assessments, 57 of the 108 initially selected participated in two workshops to discuss the vignettes and co-create the Thetha Nami(`talk to me’). The intervention. included peer-led health promotion to improve self efficacy and demand for HIV prevention, referrals to social and educational resources and accessible youth-friendly clinical services to improve uptake of HIV prevention. During the pilot the peer-navigators approached 6871 young people, of whom 6141 (89%) accepted health promotion and 438 linked to care. During semi-structured interviews peer-navigators described the appeal of providing sexual health information to peers of a similar age and background but wanted to provide more than just “ onward referral ”. In the third participatory workshop 54 peer-navigators refined the Thetha Nami intervention to add three components structured assessment tool to tailor health promotion and referrals ; safe spaces and community advocacy to create an enabling environment; peer-mentorship and navigation of resources to improve retention in HIV prevention. Conclusion: local youth were able to use evidence to develop a contextually adapted peer-led intervention to deliver biosocial HIV prevention.

Exploring Perceived Barriers and Facilitators of PrEP Uptake among Young People in Uganda, Zimbabwe, and South Africa

Article

Full-text available

May 2021
ARCH SEX BEHAV

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. Few studies have explored adolescents and young people’s perspectives toward PrEP. We conducted 24 group discussions and 60 in-depth interviews with males and females aged 13–24 years in Uganda, Zimbabwe, and South Africa between September 2018 and February 2019. We used the framework approach to generate themes and key concepts for analysis following the social ecological model. Young people expressed a willingness to use PrEP and identified potential barriers and facilitators of PrEP uptake. Barriers included factors at individual (fear of HIV, fear of side effects, and PrEP characteristics), interpersonal (parental influence, absence of a sexual partner), community (peer influence, social stigma), institutional (long waiting times at clinics, attitudes of health workers), and structural (cost of PrEP and mode of administration, accessibility concerns) levels. Facilitators included factors at individual (high HIV risk perception and preventing HIV/desire to remain HIV negative), interpersonal (peer influence, social support and care for PrEP uptake), community (adequate PrEP information and sensitization, evidence of PrEP efficacy and safety), institutional (convenient and responsive services, provision of appropriate and sufficiently resourced services), and structural (access and availability of PrEP, cost of PrEP) levels. The findings indicated that PrEP is an acceptable HIV prevention method. PrEP uptake is linked to personal and environmental factors that need to be considered for successful PrEP roll-out. Multi-level interventions needed to promote PrEP uptake should consider the social and structural drivers and focus on ways that can inspire PrEP uptake and limit the barriers.

Motivators for oral PrEP uptake and adherence in the eThekwini municipality, KwaZulu-Natal

Abstract

Recommended publications

An exploration of South African university students’ experience with pre-exposure prophylaxis for HI...

Post-trial access to and use of pre-exposure prophylaxis in Durban, South Africa

What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo city municipality,...

Experiences of oral pre-exposure prophylaxis use among heterosexual men accessing sexual and reprodu...