HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Physiology Research Center, Department of Medical-Surgical Nursing, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.
BMC Health Serv Res. 2024 Nov 19;24(1):1433. doi: 10.1186/s12913-024-11933-w.
Pre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran.
We conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants' experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs.
We interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator's theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier's theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers).
We identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.
暴露前预防（PrEP）可显著降低 HIV 传播，但在伊朗并未广泛应用。因此，本研究旨在确定伊朗四个关键人群（KPs）使用 PrEP 的促进因素和障碍。
我们对性工作者（FSW）、男男性行为者（MSM）、注射吸毒者（PWID）和 HIV 感染者的性伴侣（PLHIV）进行深入的定性访谈，以深入了解参与者的经验、信念和观点。我们还包括 HIV 专家，包括 HIV 控制部门的工作人员、有 HIV 经验的医疗保健提供者、卫生政策制定者、传染病专家和大学教授。我们进行了内容分析，以确定 KPs 中实施 PrEP 的促进因素和障碍。
我们采访了七名 FSW、七名 MSM、四名 PWID、四名 PLHIV 的性伴侣和 18 名 HIV 专家。促进因素的主题出现在四个主要类别中，包括八个不同的因素：1）个人和人际因素（动机、对 HIV 检测呈阳性的恐惧以及安全网和财务支持）；2）年龄和性别差异；3）组织因素（适当的 PrEP 分配、信息共享和获得高质量服务）；4）PrEP 的功效。障碍的主题出现在三个主要类别中，包括四个因素：1）个人因素（知识和意识不足以及脆弱的信任）；2）文化障碍；3）组织因素（基础设施不足和组织障碍）。
我们确定了伊朗 KPs 中成功实施 PrEP 的关键促进因素和障碍。通过解决这些障碍，伊朗有机会将 PrEP 纳入其针对 KPs 的 HIV 预防工作中。
