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      Perspectives of US women participating in a candidate PrEP study: adherence, acceptability and future use intentions

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          Abstract

          Introduction

          Limited data exist on acceptability of candidate pre‐exposure prophylaxis (PrEP) regimens among US women. We evaluated PrEP experiences, attitudes and future use intentions among sexually active women who completed the US‐based HIV Prevention Trials Network 069/AIDS Clinical Trials Group 5305 study.

          Methods

          Women participated in the study between March 2013 and November 2015. We analysed computer‐assisted self‐interview (CASI) surveys among 130 women and conducted in‐depth interviews among a subset of 26 women from three sites. Interviews were conducted in mid/late‐2015.

          Results

          Most women (57%) reported very good/excellent PrEP adherence on CASI, although 21% acknowledged over‐reporting adherence at least some of the time. Commitment to preventing HIV infection, a sense of ownership of the study, and keeping pills stored in a visible location facilitated adherence. Adherence barriers included “simply forgetting” and being away from home. Most women interviewed did not intend to use PrEP in the future because of lack of perceived need due to their own (as opposed to their partners’) low‐risk behaviour and concerns about affordability – but not because of side effects or other characteristics of the regimens.

          Discussion

          Improving HIV prevention options for US women will require access to affordable PrEP as well as expanding women's understanding of relationship‐ and community‐level factors that increase their risk of acquiring HIV.

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          Most cited references30

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          Rigour and qualitative research.

          N Mays, C Pope (1995)
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            From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City.

            This study examined potential facilitators and barriers to pre-exposure prophylaxis (PrEP) use and their association with PrEP acceptability and motivations for adherence among 184 MSM and transgender women living in New York City. Participants were presented with educational information about PrEP and completed a computerized survey. Overall, 55.4% of participants reported willingness to take PrEP. The most highly endorsed barriers to PrEP use were health concerns, including both long-term impacts and short-term side effects, questions about PrEP's impact on future drug resistance, and concerns that PrEP does not provide complete protection against HIV. The most highly endorsed facilitator was free access to PrEP, followed by access to support services such as regular HIV testing, sexual health care/monitoring, and access to one-on-one counseling. Participants of color rated both barriers and facilitators as more important than their White counterparts. In multivariate models, barrier and facilitator scores significantly predicted not only PrEP acceptability, but also motivation for PrEP adherence among those who were likely to use PrEP. PrEP implementation programs should consider addressing these barriers and facilitators in protocol and policy development. Findings underscore the importance of support services, such as sexual health counseling, to the success of PrEP as a prevention strategy.
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              Women’s Experiences with Oral and Vaginal Pre-Exposure Prophylaxis: The VOICE-C Qualitative Study in Johannesburg, South Africa

              Background In VOICE, a multisite HIV pre-exposure prophylaxis (PrEP) trial, plasma drug levels pointed to widespread product nonuse, despite high adherence estimated by self-reports and clinic product counts. Using a socio-ecological framework (SEF), we explored socio-cultural and contextual factors that influenced participants’ experience of daily vaginal gel and oral tablet regimens in VOICE. Methods In Johannesburg, a qualitative ancillary study was concurrently conducted among randomly selected VOICE participants assigned to in-depth interviews (n = 41), serial ethnographic interviews (n = 21), or focus group discussions (n = 40). Audiotaped interviews were transcribed, translated, and coded thematically for analysis. Results Of the 102 participants, the mean age was 27 years, and 96% had a primary sex partner with whom 43% cohabitated. Few women reported lasting nonuse, which they typically attributed to missed visits, lack of product replenishments, and family-related travel or work. Women acknowledged occasionally skipping or mistiming doses because they forgot, were busy, felt lazy or bored, feared or experienced side effects. However, nearly all knew or heard of other study participants who did not use products daily. Three overarching themes emerged from further analyses: ambivalence toward research, preserving a healthy status, and managing social relationships. These themes highlighted the profound and complex meanings associated with participating in a blinded HIV PrEP trial and taking antiretroviral-based products. The unknown efficacy of products, their connection with HIV infection, challenges with daily regimen given social risks, lack of support–from partners and significant others–and the relationship tradeoffs entailed by using the products appear to discourage adequate product use. Conclusions Personal acknowledgment of product nonuse was challenging. This qualitative inquiry highlighted key influences at all SEF levels that shaped women’s perceptions of trial participation and experiences with investigational products. Whether these impacted women’s behaviors and may have contributed to ineffective trial results warrants further investigation.
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                Author and article information

                Contributors
                ramico@umich.edu
                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                10.1002/(ISSN)1758-2652
                JIA2
                Journal of the International AIDS Society
                John Wiley and Sons Inc. (Hoboken )
                1758-2652
                14 March 2019
                March 2019
                : 22
                : 3 ( doiID: 10.1002/jia2.2019.22.issue-3 )
                : e25247
                Affiliations
                [ 1 ] University of Michigan School of Public Health Ann Arbor MI USA
                [ 2 ] University of North Carolina at Chapel Hill School of Medicine Chapel Hill NC USA
                [ 3 ] David Geffen School of Medicine at UCLA Los Angeles CA USA
                [ 4 ] University of Arkansas for Medical Sciences College of Public Health Little Rock AR USA
                [ 5 ] Johns Hopkins School of Nursing Baltimore MD USA
                [ 6 ] West Virginia University School of Medicine Morgantown WV USA
                [ 7 ] West Virginia Clinical and Translational Science Institute Morgantown WV USA
                [ 8 ] Rutgers New Jersey Medical School Newark NJ USA
                [ 9 ] Fred Hutchinson Cancer Research Center Seattle WA USA
                [ 10 ] FHI360 Washington DC USA
                [ 11 ] Fenway Health and Harvard Medical School New York NY USA
                [ 12 ] Weill Cornell Medicine New York NY USA
                Author notes
                [*] [* ] Corresponding author: K Rivet Amico, Department of Health Behavior and Health Education, 3830 School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan 48109‐2029, USA. Tel: +1 810 360 8716. ( ramico@ 123456umich.edu )
                Author information
                https://orcid.org/0000-0002-4458-6934
                https://orcid.org/0000-0001-8034-5110
                Article
                JIA225247
                10.1002/jia2.25247
                6416666
                30869200
                e8743a0e-266b-42a0-9aa6-467cbd4c23c1
                © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 September 2018
                : 18 January 2019
                Page count
                Figures: 0, Tables: 6, Pages: 10, Words: 8899
                Funding
                Funded by: Division of AIDS
                Funded by: Division of AIDS, National Institute of Allergy and Infectious Diseases
                Funded by: National Institutes of Health
                Award ID: UM1‐AI068619
                Award ID: UM1‐AI068613
                Award ID: UM1‐AI068617
                Funded by: AIDS Clinical Trials Group
                Award ID: UM1‐AI‐068636
                Funded by: Gilead Sciences
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                jia225247
                March 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.1 mode:remove_FC converted:14.03.2019

                Infectious disease & Microbiology
                prep,hiv prevention,women,united states,risk perception
                Infectious disease & Microbiology
                prep, hiv prevention, women, united states, risk perception

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