Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda
A qualitative analysis
Bibliographic Data
| ID | 21881690 |
|---|---|
| Authors | Simon Mwima (0000-0003-2745-2026, University of Illinois Urbana-Champaign), Laura M Bogart (0000-0003-3182-5542, RAND Corporation), William Musoke (Mildmay Uganda), Semei Christopher Mukama (0000-0003-1370-6056, Mildmay Uganda), Stella Allupo (Infectious Diseases Institute), Herbert Kadama (Ministry of Health), Rose Naigino (San Diego State University), Barbara Mukasa (0000-0001-6825-5024, Mildmay Uganda), Rhoda K Wanyenze (0000-0001-5864-3314, Makerere University) |
| Year | 2025 |
| Volume | 10 |
| Issue | 1 |
| Pages | e017368 |
| Publication date | 2025-01-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | BMJ Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2059-7908 • E-ISSN: 2059-7908 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/bmjgh-2024-017368 |
| PMID | 39848638 |
| OpenAlex | W4406759050 |
| Language | EN |
| References cited | 36 |
INTRODUCTION: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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
Discontinuation · Family medicine · Men who have sex with men · Pill · Pre-exposure prophylaxis · Psychiatry · Psychological intervention · Adolescent Sexual and Reproductive Health · Health Policy Implementation Science · HIV/AIDS Research and Interventions · Medicine · Nursing
The updated Consolidated Framework for Implementation Research based on user feedback
Information bias in health research
Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women
Preexposure Prophylaxis for HIV Prevention in a Large Integrated Health Care System
The Association Between HIV Infection and Alcohol Use
Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa
Perceived Risk of HIV Infection and Acceptability of PrEP among Men Who Have Sex with Men in Brazil
A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S
Acceptability and Predictors of Uptake of Anti-retroviral Pre-exposure Prophylaxis (PrEP) Among Fishing Communities in Uganda
HIV Pre-exposure Prophylaxis (PrEP) Uptake and Retention Among Men Who Have Sex with Men in a Community-Based Sexual Health Clinic
Factors Associated with Short and Long Term Mobility and HIV Risk of Women Living in Fishing Communities Around Lake Victoria in Kenya, Tanzania, and Uganda
Enhanced Oral Pre-exposure Prophylaxis (PrEP) Implementation for Ugandan Fisherfolk
Barriers to Linkage to HIV Care in Ugandan Fisherfolk Communities
You Never Know What Could Happen”
Three Approaches to Qualitative Content Analysis
| Highly cited | No |
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