Infectious Diseases Institute Makerere University, Kampala, Uganda.
Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
PLoS One. 2020 Oct 28;15(10):e0241399. doi: 10.1371/journal.pone.0241399. eCollection 2020.
Scale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Uganda began with serodiscordant couples (SDC) and has expanded to other most at-risk populations (MARPs). We explored knowledge, acceptability, barriers and facilitators of PrEP use among potential PrEP users in four MARPs (SDC; men who have sex with men [MSM]; female sex workers [FSW], and fisher folk).
We administered quantitative surveys to potential PrEP users in multiple settings in Central Uganda at baseline and approximately 9 months after healthcare worker (HCW) training on PrEP.
The survey was completed by 250 potential PrEP users at baseline and 125 after HCW training; 55 completed both surveys. For these 250 participants, mean age was 28.5 years (SD 6.9), 47% were male and 6% were transgender women, with approximately even distribution across MARPs and recruitment locations (urban, peri-urban, and rural). Most (65%) had not heard about PrEP. After HCW training, 24% of those sampled were aware of PrEP, and the proportion of those who accurately described PrEP as "antiretrovirals to be used before HIV exposure" increased from 54% in the baseline survey to 74% in the second survey (p<0.001). The proportion of participants who reported HCW as a source of PrEP information increased after training (59% vs 91%, p<0.001). In both surveys, nearly all participants indicated they were willing to take PrEP if offered. The most common anticipated barriers to PrEP were stigma, transportation, accessibility, busy schedules, and forgetfulness. Closeness to home was a common facilitator for all participant categories.
Initial awareness of PrEP was low, but PrEP knowledge and interest increased among diverse MARPs after HCW training. Demand creation and HCW training will be critical for increasing PrEP awareness among key populations, with support to overcome barriers to PrEP use. These findings should encourage the acceleration of PrEP rollout in Uganda.
乌干达开始扩大针对艾滋病毒预防的口服暴露前预防（PrEP），最初针对的是血清不一致的伴侣（SDC），后来扩大到了其他高危人群（MARPs）。我们探讨了在四个 MARPs（SDC；男男性行为者 [MSM]；性工作者 [FSW]和渔民）中的潜在 PrEP 用户对 PrEP 使用的知识、可接受性、障碍和促进因素。
我们在乌干达中部的多个地点，在医疗保健工作者（HCW）接受 PrEP 培训前后，对潜在的 PrEP 用户进行了定量调查。
基线时有 250 名潜在的 PrEP 用户完成了调查，HCW 培训后有 125 名完成了调查；其中 55 人完成了两次调查。对于这 250 名参与者，平均年龄为 28.5 岁（SD 6.9），47%为男性，6%为跨性别女性，在 MARPs 和招募地点（城市、城市周边和农村）的分布大致均匀。大多数（65%）没有听说过 PrEP。在 HCW 培训后，抽样中有 24%的人知道 PrEP，并且准确描述 PrEP 为“在 HIV 暴露前使用的抗逆转录病毒药物”的比例从基线调查的 54%增加到第二次调查的 74%（p<0.001）。报告 HCW 是 PrEP 信息来源的参与者比例在培训后增加（59%比 91%，p<0.001）。在两次调查中，几乎所有参与者都表示，如果提供 PrEP，他们愿意服用。PrEP 的常见预期障碍是污名化、交通、可及性、繁忙的日程安排和健忘。离家近是所有参与者类别的常见促进因素。
初步对 PrEP 的认识较低，但 HCW 培训后，多样化的 MARPs 对 PrEP 的知识和兴趣有所增加。创造需求和 HCW 培训对于提高关键人群对 PrEP 的认识至关重要，需要支持来克服 PrEP 使用的障碍。这些发现应该鼓励在乌干达加速推广 PrEP。
