Mwima Simon, Bogart Laura M, Musoke William, Mukama Semei C, Allupo Stella, Kadama Herbert, Naigino Rose, Mukasa Barbara, Wanyenze Rhoda Kitti
Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
Prevention, Bukedi Prevenion Institute, Mbale, Uganda.
BMJ Glob Health. 2025 Jan 22;10(1):e017368. doi: 10.1136/bmjgh-2024-017368.
In Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influencing PrEP continuation and discontinuation among fisherfolk in Uganda using the Consolidated Framework for Implementation Research (CFIR).
Participants were recruited from two fishing communities near Entebbe, Uganda. One community received enhanced PrEP support (adherence support, educational workshops and check-in calls), while the other received standard healthcare outreach. Forty fisherfolk (20 who continued PrEP and 20 who discontinued PrEP) were interviewed 6 months after initiating PrEP. Data were analysed using directed content analysis, with high inter-rater consistency. Ethical approval and informed consent were obtained.
Findings highlighted several determinants of PrEP continuation and discontinuation across the CFIR domains. Intervention characteristics such as side effects and the pill burden were significant barriers, particularly for women who reported nausea and stomach issues. Individual characteristics revealed that perceived HIV risk influenced PrEP use, with women's decisions often influenced by their partners' behaviours and mobility. However, insufficient information and education, especially among women, led to misunderstandings and discontinuation. Inner-setting factors like mobility issues and the distance to healthcare clinics posed significant barriers exacerbated by the geographical isolation of fishing communities. In the outer setting, high HIV prevalence motivated PrEP initiation, but stigma, particularly the misconception that PrEP is an antiretroviral drug used by people living with HIV, led to discontinuation.
Fisherfolk in Uganda encounter multiple barriers to PrEP continuation, with women facing more significant challenges. Enhanced support strategies are essential for improving PrEP adherence and informing future HIV prevention interventions in high-risk populations.
在乌干达，渔民中的艾滋病毒感染率在15%至40%之间，显著高于全国平均水平5.5%。暴露前预防（PrEP）在预防艾滋病毒方面有效，但在渔民中推广和持续使用面临挑战。本研究使用实施研究综合框架（CFIR）探讨影响乌干达渔民PrEP持续使用和停药的因素。
参与者从乌干达恩德培附近的两个渔业社区招募。一个社区接受强化PrEP支持（依从性支持、教育讲习班和随访电话），另一个社区接受标准的医疗保健外展服务。40名渔民（20名继续使用PrEP和20名停止使用PrEP）在开始PrEP 6个月后接受访谈。使用定向内容分析法进行数据分析，评分者间一致性高。获得了伦理批准和知情同意。
研究结果突出了CFIR各领域中PrEP持续使用和停药的几个决定因素。副作用和服药负担等干预特征是重大障碍，尤其是对报告有恶心和胃部问题的女性而言。个体特征表明，感知到的艾滋病毒风险影响PrEP的使用，女性的决定往往受其伴侣行为和流动性的影响。然而，信息和教育不足，尤其是在女性中，导致了误解和停药。流动性问题和到医疗诊所的距离等内部环境因素构成了重大障碍，渔业社区的地理隔离加剧了这些障碍。在外部环境中，高艾滋病毒感染率促使开始使用PrEP，但耻辱感，特别是认为PrEP是艾滋病毒感染者使用的抗逆转录病毒药物的误解，导致停药。
乌干达渔民在持续使用PrEP方面面临多重障碍，女性面临的挑战更为严峻。加强支持策略对于提高PrEP依从性和为未来高危人群的艾滋病毒预防干预提供信息至关重要。
