Mwakilasa Magreth Thadei, Mwijage Alexander, Mushy Stella, Amour Maryam, Sirili Nathanael, Maziku Evaline, Likindikoki Samwel, Balandya Emmanuel, Kwesigabo Gideon, Kidenya Benson, Mshana Stephen E, Lyamuya Eligius, Mmbaga Blandina, Sunguya Bruno, Bartlett John
Department of Medical Botany, Plant Breeding and Agronomy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
School of Nursing, Midwifery and Health System, University College of Dublin, Dublin, Ireland.
PLoS One. 2025 Jan 8;20(1):e0313501. doi: 10.1371/journal.pone.0313501. eCollection 2025.
HIV poses a significant global health concern, affecting adolescents among other populations. This is attributed to various vulnerabilities including biological factors, gender inequalities and limited access to comprehensive sexual and reproductive health services in sub-Saharan Africa. In Tanzania, adolescent girls, and young women (AGYW) face double the risk of HIV infection compared to their male counterparts. The introduction of pre-exposure prophylaxis (PrEP) in early 2018 brought hope for changing the HIV cascade in the country. However, numerous challenges still hinder PrEP uptake. Therefore, this study explored experiences of PrEP uptake among vulnerable AGYW in Tanzania.
This study employed a phenomenological qualitative approach; 52 semi-structured interviews were carried out between May to November 2022 in the selected healthcare facilities in Tanzania. The study adopted inductive-deductive thematic analysis guided by the Social Ecological Model (SEM) to elicit the views of AGYW aged 15-24. Nvivo software was utilised to organise data.
This study has uplifted barriers and facilitators on PrEP uptake among AGYW in Tanzania. The barriers are categorized at individual, interpersonal, and institutional levels. The individual level barriers included pre-requisites for initiating PrEP, disbelief in the effectiveness of PrEP, interference of refill hours with working hours, financial constraints, and adherence to the pills. The interpersonal level barriers included misconceptions about PrEP pills, and labelling of PrEP users. The institutional level barriers included inadequate privacy, PrEP drug stockout, being turned away by health care facilities (HCF), long waiting times, and distance to the HCF. Facilitators included factors at individual level (experienced benefit of PrEP, adequate PrEP knowledge, having multiple partners, perceived risk due to the nature of the work, PrEP ensuring privacy), interpersonal level (support from social networks), and institutional level (Free availability of PrEP, receiving refill reminders).
To overcome barriers to PrEP uptake among AGYW, it is crucial to develop multi-level interventions that consider personal, social, and structural factors hindering PrEP uptake. Implementing strategies like prioritizing off-site PrEP delivery and expanding community outreach for PrEP awareness can help dispel misconceptions and enhance uptake.
艾滋病毒是全球重大的健康问题，对青少年及其他人群都有影响。这归因于多种脆弱性因素，包括生物因素、性别不平等以及撒哈拉以南非洲地区获得全面性健康和生殖健康服务的机会有限。在坦桑尼亚，青春期少女和年轻女性（AGYW）感染艾滋病毒的风险是男性同龄人的两倍。2018年初引入暴露前预防（PrEP）为该国改变艾滋病毒防治流程带来了希望。然而，众多挑战仍阻碍着PrEP的采用。因此，本研究探讨了坦桑尼亚弱势AGYW群体采用PrEP的经历。
本研究采用现象学定性研究方法；2022年5月至11月期间，在坦桑尼亚选定的医疗机构进行了52次半结构化访谈。该研究采用由社会生态模型（SEM）指导的归纳 - 演绎主题分析，以了解15 - 24岁AGYW的观点。利用Nvivo软件来组织数据。
本研究揭示了坦桑尼亚AGYW群体采用PrEP的障碍和促进因素。这些障碍分为个人、人际和机构层面。个人层面的障碍包括开始PrEP的先决条件、对PrEP有效性的怀疑、补药时间与工作时间的冲突、经济限制以及坚持服药。人际层面的障碍包括对PrEP药丸的误解以及对PrEP使用者的标签化。机构层面的障碍包括隐私不足、PrEP药物缺货、被医疗机构拒之门外、等待时间长以及到医疗机构的距离远。促进因素包括个人层面的因素（体验到PrEP的益处、具备足够的PrEP知识、有多个性伴侣、因工作性质感知到风险、PrEP确保隐私）、人际层面的因素（来自社交网络的支持）以及机构层面的因素（PrEP免费提供、收到补药提醒）。
为克服AGYW群体采用PrEP的障碍，制定考虑到阻碍PrEP采用的个人、社会和结构因素的多层次干预措施至关重要。实施诸如优先进行非现场PrEP给药以及扩大PrEP意识的社区宣传等策略，有助于消除误解并提高采用率。
