Factors Associated With Willingness to Use Oral Pre-exposure Prophylaxis (Prep) Among Fishing Communities in Peri-urban Kampala, Uganda

doi:10.21203/rs.3.rs-265902/v1

Download PDF

Research Article

Factors Associated With Willingness to Use Oral Pre-exposure Prophylaxis (Prep) Among Fishing Communities in Peri-urban Kampala, Uganda

https://doi.org/10.21203/rs.3.rs-265902/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background: The World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence.

Objective: To examine the perceptions and factors associated with willingness to use oral PrEP among members of fishing communities in Uganda, a key population at risk of HIV.

Methods: We conducted an explanatory sequential mixed-methods study at Ggaba fishing community from February to June 2019. Survey data were collected from a systematic random sample of 283 community members. We carried out bivariate tests of association of willingness to use PrEP with demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson regression model to describe factors associated with willingness to use PrEP. We purposively selected 16 participants for focus group discussions to contextualize survey findings, analysing data inductively and identifying emergent themes related to perceptions of PrEP.

Key results: We enrolled 283 participants with a mean age of 31±8 years. Most (80.9%) were male. The majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months. Self-reported HIV prevalence was 6.4%. Most (80.6%, 95%CI 75.5-85.0) were willing in principle to use PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99, 95%CI 1.31-3.02, P= 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03-1.24, P=0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39-2.81, P<0.001). In focus group discussions, participants described pill burden, side-effects, drug safety, and accessibility as potential barriers to PrEP use.

Conclusions and recommendations: Oral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and also address issues of access to drugs.

Health Economics & Outcomes Research

Health Policy

Pre-exposure prophylaxis

fisherfolk

acceptability

key populations

Of the 1.7 million new HIV infections that occurred globally in 2019, 62% were among key populations and 28% of these infections occurred in key populations of East and Southern Africa [1]. In Uganda, as in many settings, the HIV burden is mostly concentrated in key populations [2]. In 2019, the average national HIV prevalence rate among adults aged 15–49 years was 5.8%[3], while 15%-40% of adult fisher folk were living with HIV[4]. Fisherfolk in Uganda are at elevated risk of exposure to HIV due to high degrees of mobility, poor access to information about HIV, and limited access to HIV prevention resources, including oral pre-exposure prophylaxis (PrEP)[5].

Daily use of oral PrEP is reported to reduce the risk of HIV transmission through sex by 75–99%[6, 7]. Based on this evidence and following the 2015 WHO recommendation[8], the Ministry of Health rolled out oral PrEP (300mg of Tenofovir daily or 300mg of Lamivudine daily) to key populations in Uganda, including fisherfolk beginning in August 2017[9]. To date, an estimated 21,000–22,000 members of key populations in Uganda including but not limited to sex workers, long-distance truck drivers, barmaids, and discordant couples have accessed oral PrEP[10]. However, studies show that poor user knowledge, negative community perceptions toward the drug, stigma, cultural beliefs, and low perceived risk of HIV transmission continue to dampen acceptability of oral PrEP leading to poor adherence and reduced effectiveness[11–13]. Studies outside Uganda have found levels of awareness of PrEP as low as 29.7% among HIV key populations, and acceptability ranging from 35.4–64.4%[14, 15].

Though fishing communities are among the key populations targeted for oral PrEP, to date, the majority of these communities have lacked access to PrEP services due to structural barriers and little is known about their receptivity to PrEP [16]. We aimed study to explore the dynamics of PrEP acceptability among fisherfolk and to identify the factors necessary to improve PrEP uptake in this key population in order to inform countrywide PrEP rollout in Uganda.

We carried out a cross-sectional study using an explanatory sequential mixed-methods design, integrating survey data and focus group discussions collected from 5th February to 4th June 2019.

The study was conducted in Ggaba, a semi-urban landing site on Lake Victoria located in Makindye division of Kampala district, the capital of Uganda. Ggaba has a population of around 17,000 people[17] with the major economic activity being fishing. The population is highly transient and has a high HIV transmission rate of 3.39 per 100 person-years at-risk compared to the general population[18, 19].

We included adults aged 18 and above who had been residents at the Ggaba landing site for at least 3 months and provided informed consent to participate in the study. We excluded individuals who were too ill to participate in the study.

For this component, we used one proportion (Kish Leslie formula of 1965) to estimate the acceptability of using PrEP. For associated factors, we used a comparison of two proportions (Fleiss formula)[20]. Based on Jayakumaran et al., 2016 and Frankis et al., 2016, we calculated a sample size of 283 participants.

We used a systematic sampling method for the survey. We estimated a population of 1000 adults at the landing site and generated a sampling fraction of four with a random number between one to four used to generate the sampling interval of three. We, therefore, included every fourth adult was included in the survey beginning with the third adult until the sample size was attained.

Trained interviewers administered a semi-structured questionnaire with both open and closed-ended questions using Open Data Toolkit (ODK) in English and/or Luganda, the local language. The questionnaire was adopted from previous literature about acceptability of PrEP use and pretested on 15 random participants who were not included in the study. Acceptability was defined as self-reported willingness to use PrEP when provided, and was measured using “Yes” and “No”.

To facilitate exploration of disparate views and generate point-counterpoint discussion and resolutions, we used FGDs for general discussion on the subject. We ensured relative homogeneity in age, sex, and duration of stay at the landing site when recruiting the 16 participants for each of the two FGDs (8 per FGD).

Statistical Analysis

We produced descriptive statistics such as proportions and mean ± standard deviations for all variables.

Acceptability to use PrEP was measured as a proportion with its 95% confidence interval. A modified Poisson regression was used to estimate the prevalence ratios (PR) for bivariate and and adjusted prevalence ratios (aPR) for multivariate analysis after assessing for assumptions of multicollinearity (by estimating VIF and leverage) and outliers were then tested. The adjusted prevalence ratios were assessed for confounding by 10% change in the crude and adjusted prevalence ratios. Analyses were done using Stata Version 15.1/MP.

Qualitative data from the FGDs were transcribed and entered into Atlas.ti 8.3 for analysis. The lead author (BS) read all transcripts and used an inductive, iterative approach to analyze their content, applying three cycles of coding according to the study purpose statement. Emerging themes on perceptions about PrEP were grouped and discussed with other authors (MAH, AK) between each coding cycle.

Description of study participants

Of the 283 participants, 80.9% were male and 82.7% were employed (Table 1). The mean age of participants was 31 ± 8 years. Self-reported HIV prevalence was 6.4% and 64% had not tested in the past 6 months, while 62.4% had concerns about acquiring HIV.

Table 1
Sociodemographic characteristics of the 283 participants from fisherfolk communities in Kampala
Characteristic	Frequency (n)	Proportion (%)
Age
18–39 (Young adult)	232	82.0
40–62 (Middle aged)	51	18.0
Gender
Male	229	80.9
Female	54	18.1
Location
Semi-urban	271	95.8
Rural	12	4.2
Education
None	39	13.8
Primary	89	31.5
Secondary	145	51.2
Tertiary	10	3.5
Employment status
Employed	234	82.7
Marital status
Not married	137	48.4
Married or in a casual relationship	146	51.6
HIV status awareness
Yes	207	73.1
HIV test in the past 6 months
Yes	102	36.0
HIV status
Negative	188	66.4
Positive	18	6.4
Not-aware	77	27.2
Condom use
Always	50	17.7
Sometimes	125	44.2
Never	108	38.1
HIV risk perception
No	36	12.7
Yes	247	87.3
HIV infection concern
Not really	36	12.7
Yes	182	64.3
Sometimes	65	23.0

Factors associated with willingness to use PrEP

A high proportion (80.6%, 95% CI 75.5–85.0) of participants reported that they were willing to use PrEP if it were provided. In bivariate analyses, age (P = 0.001), location (P = 0.047), and education level (P < 0.001) were significantly associated with willingness to use PrEP (Table 2). Those who reported regularly testing for HIV were more likely to say they were willing to use PrEP compared to who tested irregularly (92.2% vs 74.0%, P < 0.001). The proportion of men who were willing to use PrEP was higher than that of women (83.0% vs 70.4%, P = 0.078). Having tested for HIV in the last 6 months (P < 0.001), HIV status, perception of HIV risk (P < 0.001), concern about HIV (P < 0.001), condom use (P = 0.002), and awareness of PrEP (P = 0.024) were also associated with willingness to use PrEP.

Table 2
Bivariate analysis for sociodemographic factors associated with willingness of PrEP in fishing communities
Characteristic		Total		Willingness to use PrEP			Crude PR	P-value
				Unwilling	Willing
Age
18–39 (Young adult)		232		200 (86.2)	32 (13.8)		1.00
40–62 (Middle aged)		51		28 (54.9)	23 (45.1)		0.64	0.001**
Location
Semi-urban		271		48 (17.7)	223 (82.3)		1.00
Rural		12		7 (58.3)	5 (41.7)		0.51	0.047*
Education
None		39		23 (59.0)	16 (41.0)		1.00
Primary		89		15 (16.9)	74 (83.2)		2.03	< 0.001**
Secondary		145		17 (11.7)	128 (88.3)		2.15	< 0.001**
Tertiary		10		0	10 (100)		2.44	< 0.001**
Employment status
Not employed		49		8 (16.3)	41 (83.7)		1.00
Employed		234		47 (20.1)	187 (79.9)		0.96	0.519
Marital status
Not married		137		27 (19.7)	110 (80.3)		1.00
Married/in a casual relationship		146		28 (19.2)	118 (80.8)		1.01	0.911
Gender
Male		229		39 (17.0)	190 (83.0)		1.00
Female		54		16 (29.6)	38 (70.4)		0.85	0.078
HIV status awareness
No	76		16 (21.1)			60 (79.0)	1.00
Yes	207		39 (18.8)			168 (81.2)	1.03		0.685
HIV test in the past 6 months
Yes	102		8 (7.8)			94 (92.2)	1.24		< 0.001**
HIV status
Negative	188		18 (9.6)			170 (90.4)	1.00
Positive	18		16 (88.9)			2 (11.1)	0.12		0.002*
Not-aware	77		21 (27.3)			56 (72.7)	0.80		0.003*
Condom use
Always	50		4 (8.0)			46 (92.0)	1.00
Sometimes	125		23 (18.4)			102 (81.6)	0.89		0.044*
Never	80		28 (25.9)			80 (74.1)	0.81		0.002*
HIV risk perception
Yes	247		32 (13.0)			215 (87.0)	2.41		< 0.001**
HIV infection concern
Not really	36		27 (75.0)			9 (25.0)	1.00
Yes	182		13 (7.1)			169 (92.9)	3.71		< 0.001**
Sometimes	65		15 (23.1)			50 (76.9)	3.08		< 0.001**
PrEP awareness
Yes	153		22 (14.4)			131 (85.6)	1.15		0.024*
HIV status, HIV infection concern, and condom use were dropped at multivariate due to multicollinearity

In the final multivariable model, three factors were significantly associated with willingness to use PrEP among fishing communities: higher levels of education, perceived risk for HIV, and history of testing for HIV within the last six months (Table 3). Compared to those with no formal education, participants who had attained tertiary education were nearly twice as likely to say they were willing to use PrEP (aPR 1.97, 95%CI 1.39–2.81, p < 0.001) while participants who had attained secondary education were 1.72 times as willing to use PrEP (aPR 1.72, 95%CI 1.22–2.44, p = 0.002) and those with primary education were 1.61 times more willing to use PrEP (aPR 1.61, 95%CI 1.12–2.29, p = 0.009). Compared to those who had not tested for HIV in the past 6 months, participants who had tested were 13% more willing to use PrEP (aPR 1.13, 95%CI 1.03–1.24, p = 0.007). Participants who perceived themselves at a risk of getting HIV were almost twice more willing to use PrEP than those who had no HIV risk perception (aPR 1.99, 95%CI 1.31–3.02, p = 0.001).

Table 3
Multivariate analysis for factors associated with willingness of PrEP in fishing communities
Characteristic	Adjusted PR	95% Confidence Interval		P-value
		Lower limit	Upper limit
HIV test in the past 6 months
No	1.00
Yes	1.13	1.03	1.24	0.007
Education
None	1.00
Primary	1.61	1.12	2.29	0.009
Secondary	1.72	1.22	2.44	0.002
Tertiary	1.97	1.39	2.81	< 0.001
HIV risk perception
No	1.00
Yes	1.99	1.31	3.02	0.001

Perceptions of PrEP

In focus group discussions, fisherfolk explained the reasons behind the high acceptability of PrEP. Participants favored the introduction of PrEP because they believed it would protect them against HIV. Some participants described it as a good drug that they anticipated could be used as a means of saving their lives. Two ladies from the landing site explained,

“The drug should be provided to private hospitals because we are badly off on these islands. But if you bring the drug you would have helped us a lot.” (R4/FGD3)

“…. if it’s saving my life, I have to take it so that I defend my life.” (R2/FGD3)

Another male fisherman explained;

“I was happy when I heard about the drug because it will help us most especially adolescents who are sexually active.”(R8/FGD2)

However, participants expressed concerns about adverse effects from the drug, which they perceived to be likely. They anticipated that such side effects would stop them from carrying out their normal daily activities. On lady explained that such side effects could decrease motivation to continue using PrEP:

“Maybe if we use it makes us dizzy or when it exhausts your energy, you may say that am not sick why I am bothering to take it, but if it has no problem it brings to your body then I just swallow it and I eat my food.”(R5/FGD3)

Others were concerned about the long-term effects of a preventive medication. While asking them about the major concerns about the drug, another explained;

“… doctor, this is the reason why we may not take it, they told us that when you swallow that drug when you don’t have the disease you get cancer inside the stomach especially where that drug sits because it doesn’t have what to treat in your body.”(R4/FGD3)

Fishermen were also concerned about possible changes in lifestyle PrEP might introduce. They explained;

“I was told it makes you lose your appetite, loose sleep when you are start taking it.”(R8/FGD3)

“If they are to stop us from other foods and drinks like alcohol.”(R4/FGD3)

This is consistent with previous studies assessing the acceptability of PrEP among other key populations in East and Southern Africa[21]. In a discrete choice experiment to assess the acceptability and potential uptake of PrEP, others have also found oral PrEP to be highly acceptable in principle among fishing communities in Uganda [22].

In our study, PrEP was most likely to be acceptable among those who perceived themselves as being at high risk of exposure to HIV. This link between risk perception and acceptability to use PrEP also emerged in FGDs, where participants described their communities as being “badly off” with regard to HIV. High self-reported HIV risk perception among key population communities[23] could explain the high willingness to use oral PrEP among key populations.

We further found that having tested HIV in the past 6 months was associated with a 13% increase in likelihood of being willing to use PrEP. Similarly, perceiving oneself to be at risk of HIV infection was associated with a doubling of the likelihood of being willing to use PrEP compared to those who did not perceive themselves to be at risk.

This suggests that people in fishing communities who perceive themselves as being at risk of getting HIV and have regular HIV checkups are more likely to accept PrEP if provided to them. Indeed, we found regular HIV testing to be a predictor of PrEP acceptance in survey responses.

We also found that respondents who had completed primary education were 61% more likely to express willingness to use PrEP compared to those with no formal education. There was a stepwise relationship between educational attainment and willingness to use PrEP: secondary-level was associated with 72% increase in willingness while the tertiary level was associated with 97% increase in willingness. This is likely because those who were more educated had greater access to information and a better understanding of HIV risks, rendering them less prone to misconceptions from peers[24, 25].

Therefore, interventions to educate the communities on PrEP may be of importance to facilitate acceptance of the drug. This finding is consistent with studies conducted in other key populations where those who were more educated believed that PrEP would reduce HIV risk to their partners and would accept it and recommend it[12, 26, 27].

Our study has some limitations. The cross-sectional design we used could not be used to analyze behaviour or attitudes over a period of time.

Our study also has several strengths. First, the study participants were systematically sampled from its fishing sites to ensure high representativeness of the community.

Oral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. From the FGDs, we also learned that PrEP is considered as a life saver to the fishing communities due to their lifestyle. However, they also had concerns about side effects, change of their lifestyles when taking PrEP and interruption in their normal daily activities. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and address issues of access to drugs.

This work was presented in part at the 15th Joint Annual Scientific Health Conference (JASH), Hotel Africana, Uganda, Abstract-UAN-025

HIV - Humman Immunodeficiency Virus

PrEP - Pre-exposure Prophylaxis

SOMREC - School of Medicine Research and Ethics Committee

WHO - World Health Organization

Availability of data and materials

The datasets used and analyzed during this study are available from the corresponding author on reasonable request because it involved other key population groups which are criminalized in Uganda.

Author contributions

B.S: has been involved in proposal development and writing, data collection and analysis, as well as manuscript writing.

A.K: contributed to proposal development and writing, preparation of data collection tool, Data collection and interpretation, and manuscript writing.

M.A-H: contributed to proposal development and writing and preparation of data collection tool, reviewed and revised drafts

D.K: contributed to proposal development and writing and preparation of data collection tool, reviewed and revised drafts

J.N.K: Contributed to proposal development and writing, data analysis, and manuscript writing.

F.M.K: contributed to proposal concept development, data analysis, and interpretation.

Acknowledgments

We thank the Makerere University School of Medicine Implementation Science (MAK-ImS) Training program, and the Uganda Pulmonary Complications of AIDS Research Training Program (PART) at Makerere College of Health Science (MakCHS) Mixed Methods Fellowship for the various training and technical support offered to this study. We also thank Research Assistants Mr. Okot Philp and Ms. Nanteza Sharifah who conducted field data collection, and the respondents for participating in the study.

Funding

The research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43 TW010037 and D43 TW009607. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. S.B received the funding. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript

Ethics approval and consent to participate

This study was conducted in accordance to the Declaration of Helsinki and was approved by Makerere University and the School of Medicine Research and Ethics Committee (SOMREC) of Makerere University under approval number REC REF 2019-020. This study involved participants who were 18 years and above, written consent to participate in the study was obtained from the participants.

Consent for publication

Not applicable

Author information

Affiliations

¹Makerere College of Health Sciences, Department of Epidemiology and Biostatistics

Bashir Ssuna, Dennis Kalibbala, Joan N Kalyango, Flavia Matovu Kiweewa

²Uganda Tuberculosis Implementation Research Collaboration (U-TIRC)

Bashir Ssuna, Mari-Armstrong Hough

³Makerere College of Health Sciences, Child Health and Development Centre

Anne Katahoire

⁴New York University School of Global Public Health, Department of Social and Behavioral Sciences, Department of Epidemiology

Mari-Armstrong Hough

⁵Makerere University-John Hopkins University Research Collaboration (MU-JHU)

Dennis Kalibbala, Flavia Matovu Kiweewa

UNAIDS. Global HIV & AIDS statistics — 2020 fact sheet [Internet]. 2020 [cited 2021 Feb 12]. Available from: https://www.unaids.org/en/resources/fact-sheet
UAC. ACCELERATION OF HIV PREVENTION IN UGANDA: A road map towards zero new infections by 2030 [Internet]. 2018. Available from: https://uac.go.ug/sites/default/files/Prevention%20Road%20Map%20Final.pdf
UNAIDS. Uganda [Internet]. 2020 [cited 2021 Feb 12]. Available from: https://www.unaids.org/en/regionscountries/countries/uganda
Uganda AIDS Commission, MoH Uganda. The Uganda HIV and AIDS Country Progress Report [Internet]. 2016. Available from: uac.go.ug/sites/default/files/JAR%202016.pdf
International Organization for Migration. Ugandan Fishing Communities at High Risk of HIV / AIDS: IOM - Uganda [Internet]. ReliefWeb. 2014 [cited 2019 Nov 7]. Available from: https://reliefweb.int/report/uganda/ugandan-fishing-communities-high-risk-hiv-aids-iom
CDC. Pre-Exposure Prophylaxis (PrEP) | HIV Risk and Prevention | HIV/AIDS | CDC [Internet]. 2019 [cited 2019 Nov 7]. Available from: https://www.cdc.gov/hiv/risk/prep/index.html
Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012 Aug 2;367(5):399–410.
WHO. WHO | Pre-exposure prophylaxis [Internet]. WHO. 2015 [cited 2019 Nov 7]. Available from: http://www.who.int/hiv/topics/prep/en/
MoH Uganda. CONSOLIDATED GUIDELINES FOR THE PREVENTION AND TREATMENT OF HIV AND AIDS IN UGANDA. 2018.
PrEPWatch. Uganda: A snapshot of PrEP scale-up, registration and resources for Uganda. [Internet]. PrEPWatch. 2020 [cited 2020 Apr 25]. Available from: https://www.prepwatch.org/country/uganda/
Galea JT, Kinsler JJ, Salazar X, Lee S-J, Giron M, Sayles JN, et al. Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS. 2011 May;22(5):256–62.
Jayakumaran JS, Aaron E, Gracely EJ, Schriver E, Szep Z. Knowledge, Attitudes, and Acceptability of Pre-Exposure Prophylaxis among Individuals Living with HIV in an Urban HIV Clinic. Clark JL, editor. PLoS ONE. 2016 Feb 10;11(2):e0145670.
MTN VOICE 003. Final results of the HIV prevention study VOICE are published in NEJM | Microbicide Trials Network [Internet]. 2015 [cited 2019 Nov 8]. Available from: https://mtnstopshiv.org/news/final-results-hiv-prevention-study-voice-are-published-nejm
Escudero DJ, Kerr T, Wood E, Nguyen P, Lurie MN, Sued O, et al. ACCEPTABILITY OF HIV PRE-EXPOSURE PROPHYLAXIS (PREP) AMONG PEOPLE WHO INJECT DRUGS (PWID) IN A CANADIAN SETTING. AIDS Behav. 2015 May;19(5):752–7.
Yi S, Tuot S, Mwai GW, Ngin C, Chhim K, Pal K, et al. Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. Journal of the International AIDS Society. 2017;20(1):21580.
Bogart LM, Naigino R, Maistrellis E, Wagner GJ, Musoke W, Mukasa B, et al. Barriers to Linkage to HIV Care in Ugandan Fisherfolk Communities: A Qualitative Analysis. AIDS Behav. 2016 Oct;20(10):2464–76.
UBOS. Kampala Profiles: Makindye [Internet]. 2016. Available from: http://askyourgov.ug/request/37/response/37/attach/html/3/Makindye%20Municipality.pdf.html
USAID. HIV Prevalence Estimates from the Demographic and Health Surveys: Updated June 2010. ICF Macro; 2010. 32 p.
Kiwanuka N, Ssetaala A, Nalutaaya A, Mpendo J, Wambuzi M, Nanvubya A, et al. High Incidence of HIV-1 Infection in a General Population of Fishing Communities around Lake Victoria, Uganda. PLOS ONE. 2014 May 27;9(5):e94932.
Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. 3rd ed. Hoboken, N.J: J. Wiley; 2003. 760 p. (Wiley series in probability and statistics).
Eisingerich AB, Wheelock A, Gomez GB, Garnett GP, Dybul MR, Piot PK. Attitudes and Acceptance of Oral and Parenteral HIV Preexposure Prophylaxis among Potential User Groups: A Multinational Study. PLOS ONE. 2012 Jan 11;7(1):e28238.
Kuteesa MO, Quaife M, Biraro S, Katumba KR, Seeley J, Kamali A, et al. Acceptability and Predictors of Uptake of Anti-retroviral Pre-exposure Prophylaxis (PrEP) Among Fishing Communities in Uganda: A Cross-Sectional Discrete Choice Experiment Survey. AIDS Behav. 2019 Oct;23(10):2674–86.
Koss CA, Charlebois ED, Ayieko J, Kwarisiima D, Kabami J, Balzer LB, et al. Uptake, engagement, and adherence to pre-exposure prophylaxis offered after population HIV testing in rural Kenya and Uganda: 72-week interim analysis of observational data from the SEARCH study. The Lancet HIV. 2020 Apr 1;7(4):e249–61.
Mayer KH, Agwu A, Malebranche D. Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review. Adv Ther. 2020 May 1;37(5):1778–811.
Mack N, Odhiambo J, Wong CM, Agot K. Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: Results of a consultation with community stakeholders. BMC Health Services Research. 2014 May 21;14(1):231.
Nideröst S, Gredig D, Hassler B, Uggowitzer F, Weber P. The intention to use HIV-pre-exposure prophylaxis (PrEP) among men who have sex with men in Switzerland: testing an extended explanatory model drawing on the unified theory of acceptance and use of technology (UTAUT). J Public Health. 2018 Jun 1;26(3):247–59.
Yi S, Tuot S, Mwai GW, Ngin C, Chhim K, Pal K, et al. Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. Journal of the International AIDS Society. 2017;20(1):21580.

No competing interests reported.

Download PDF

Editorial decision: Major revision
15 Aug, 2021
Reviews received at journal
04 Jul, 2021
Reviewers agreed at journal
04 Jul, 2021
Reviews received at journal
18 Jun, 2021
Reviewers agreed at journal
07 Jun, 2021
Reviewers agreed at journal
04 Jun, 2021
Reviewers invited by journal
08 Mar, 2021
Editor assigned by journal
07 Mar, 2021
Editor invited by journal
03 Mar, 2021
Submission checks completed at journal
03 Mar, 2021
First submitted to journal
22 Feb, 2021

You are reading this latest preprint version

Factors Associated With Willingness to Use Oral Pre-exposure Prophylaxis (Prep) Among Fishing Communities in Peri-urban Kampala, Uganda

Status:

Version 1

Abstract

Introduction

Materials And Methods

Statistical Analysis

Results

Description of study participants

Factors associated with willingness to use PrEP

Perceptions of PrEP

Discussion

Conclusions And Recommendations

Abbreviations

Declarations

Availability of data and materials

Author contributions

Acknowledgments

Funding

Ethics approval and consent to participate

Consent for publication

Author information

Affiliations

References

Additional Declarations

Status:

Version 1