Introduction
Methods
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examined acceptability of oral PrEP and/or TasP as HIV prevention options in the context of sexual transmission;
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described primary data collection with current or potential oral PrEP or TasP users (including empirical studies, embedded studies in larger RCTs and process evaluations);
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were published in English; and
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were published between January 2008 (in order to capture research related to recent ARV developments) up to December 2012.
MESH terms used | Free text search terms used |
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‘HIV infections’ ‘HIV infections/prevention & control*’ ‘Antiretroviral therapy, highly active’ ‘Patient acceptance of health care’ | HIV ‘Human immunodeficiency virus’ ‘human-immunodeficiency-virus’ HIV prevention TAP TASP ‘Treatment as prevention’ ‘treatment-as-prevention’ PREP ‘pre-exposure prophylaxis’ ‘pre exposure prophylaxis’ ‘preexposure prophylaxis’ ‘Highly active antiretroviral treatment’ HAART ‘treatment outcome’ feasib* acceptab* adoption attitude* |
Results
Study | Participants | Setting | Type of intervention | Study aims | Study design and methods | Study size | Measures of acceptability | Key results | Interpretations |
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Aghaizu et al. [55] | Men who have sex with men (MSM) | London, UK | Daily PrEP | Assess current and intended future use of PrEP | Cross-sectional survey Self-administered survey | 842 | Asked: if likely to take a daily dose (oral) of PrEP if available; used 5 point Lickert scale | Half reported likely to use PrEP; associated with <35 years, UAI with casual partners and previous use of PEP | PrEP in form of daily pill acceptable to half of sexually active MSM in London |
Amico et al. [70] | Heterosexual and MSM Sero-discordant couples (SDCs) | Brazil, Ecuador, Peru, South Africa, Thailand, and the US | Daily oral PrEP | Refine/improve adherence reporting and support mechanisms in iPrEX study sites | RCT-embedded (iPrEX) Needs assessment and intervention development with trial participants and staff | n/a | n/a | Social stigma affects adherence reporting | Suggests separation of reporting and counselling could improve reporting and adherence |
Barash and Golden [45] | MSM | Seattle, US | Daily oral PrEP | Explore men’s willingness to use PrEP | Cross-sectional survey Self and interview administered questionnaires at Gay Pride event and STI Clinic | 215 | Asked: if taking HIV medicines helped prevent HIV, would you take them everyday?; yes/no question | 44 % were willing to take daily PrEP; no association between risk behaviour and interest in PrEP; low income, <40 years and recruitment from STI clinic associated with interest in PrEP | MSM are aware of PrEP and interested in the intervention |
Brooks et al. [46] | MSM SDCs | Los Angeles, US | Daily oral PrEP | Identify factors that may facilitate or impede future adoption of PrEP amongst MSM in serodiscordant relationships | Cross-sectional study Semi-structured interviews with MSM recruited from community settings | 50 | Participants were informed PrEP was 90 % effective and asked a range of questions around: opinions of PrEP; reasons why they might/might not want to use PrEP; if they had concerns with taking PrEP; perceptions of transmission risk; feelings about safer sex while taking PrEP; information desired about PrEP; feelings about non-infected partner taking PrEP | Motivators for adoption included protection against HIV infection, the opportunity to engage in unprotected sex. Concerns and barriers to adoption included the cost of PrEP, short- and long-term side effects, adverse effects of intermittent use or discontinuing PrEP, and limited accessibility | Need for carefully planned and implemented PrEP delivery programme which includes education and counselling interventions |
Brooks et al. [47] | Se MSM SDCs | Los Angeles, US | Daily oral PrEP | Examine risk behaviour, acceptability and potential adoption of PrEP | Cross-sectional study Mixed methods: semi-structured interview and survey with 25 couples recruited from community settings | 50 | PrEP described as 90 % effective. Survey questions had participants agree/disagree with range of statements relating to: PrEP for HIV prevention; risk compensation/disinhibition; HIV stigma; PrEP adoption intentions in relation to PrEP use by others | 64 % of participants indicated a likely increase in sexual risk behaviour, and 60 % indicated an abandonment of condom use when using PrEP | PrEP should only be offered as part of a comprehensive HIV prevention strategy which includes risk reduction counselling to help moderate risk compensation |
Dombrowski et al. [67] | HIV-positive patients | Seattle, US | TasP | Evaluate the acceptability of including prevention considerations in decision-making about ART initiation and to gauge the population’s interest in starting ART for prevention | Cross-sectional survey Anonymous, self-administered questionnaire in STI clinic | 136 | Participants were asked: if they would take HIV medicines in order to make it less likely that they would pass the virus on to others; if doctors should offer HIV medicine to patients to decrease transmission; if being on treatment means PLHA are less likely to pass the virus on in unprotected sexual encounters | 56 % expressed interest in starting ART specifically to decrease the risk of transmitting HIV to sexual partners; majority believed doctors should offer patients ART for this purpose (61 %); 35 % reported having UAVI with partner of negative or unknown status in preceding year; respondents interested in early start ART were more likely to report non concordant UAVI; >50 years associated with lower interest in early start; knowledge of ART as prevention was not widespread | Public health efforts should be designed to ensure that patients have an opportunity to consider early initiation of ART, including the potential prevention benefits of treatment as this would be acceptable to many PLHA |
Eisingerich et al. [64] | Female sex workers (FSW), MSM, intravenous drug users (IDU), serodiscordant couples (SDC) | Peru, Ukraine, Kenya, Uganda, Botswana, South African and India | Daily oral PrEP; Intermittent PrEP; Injectable PrEP | Explore attitudes, preferences towards hypothetical and known attributes of PrEP programs and medication (oral/parenteral) and future acceptability | Cross-sectional survey Interview and self-administered questionnaires | 1,790 | Asked questions using 4-point Lickert scale around: adherence to other medications; willingness to take PrEP and associated key feelings; potential barriers to use. Conjoint analysis used to assess preferred: PrEP route; access; time spent accessing PrEP; frequency of testing | 61 % reported a willingness to use PrEP, even if they have to pay for it and in spite of potential side effects, cost and frequent HIV testing | Willingness among key populations to use PrEP if it was efficacious and affordable; long lasting injection would be a good target for PrEP |
Galea et al. [63] | FSW, Male–Female transgendered persons (TG) and MSM | Lima, Peru | Daily oral PrEP; Intermittent PrEP | Explore social issues associated with PrEP acceptability and preference for PrEP delivery | Cross-sectional qualitative study Focus groups and conjoint analysis with 8 hypothetical PrEP scenarios | 45 | Focus group questions asked about: PrEP knowledge and attitudes to daily use; reasons for/against willingness to take PrEP; social and health provider concerns with PrEP use; concerns with PrEP access, cost, side effects, etc.; potential behavioural change. Presented range of efficacy 75–95 %. Applied conjoint analysis to assess preferences for 7 PrEP characteristics | Little awareness of PrEP; general acceptance of PrEP as an option, most affected by cost and side-effects; TG and MSM described potential decrease in condom use if PrEP available; stigma and discrimination associated with PrEP use, along with and mistrust of health-care professionals | Acceptability of PrEP as HIV prevention method; need to consider the distinct needs and concerns of FSW versus TG and MSM through deeper exploration |
Galindo et al. [53] | MSM, Male–female TG | California | Daily oral PrEP | Examined acceptability of PrEP and barriers to community uptake amongst communities most affected by HIV in the US | Cross-sectional qualitative study Semi-structured interviews | 30 | Authors reported on willingness to take daily ARV and concerns about: following medical monitoring; side effects; long-term health risks; associated cost and financial considerations; reasons for starting/stopping PrEP; and perceived effects of PrEP in the community | General interest expressed in PrEP. Barriers include: lack of community awareness of and confusion about PrEP; concerns about PrEP use; concerns about how a PrEP intervention could be packaged and marketed appropriately | Authors suggest: need to consider importance of how PrEP information framed and accurately delivered; recommend community mobilization strategies in PrEP delivery; PrEP delivery can help address mistrust of medical setting if combined with sociobehavioural approaches; need to consider if PrEP is actually cost-effective and equitable option for diverse populations |
Golub et al. [33] | HIV-negative MSM | New York, US | Daily oral PrEP | Explore awareness of and attitudes toward PrEP in high-risk population; aims to understand the psycho-social and behavioural factors which enhance/reduce motivation for risk reduction in relation to PrEP | Cross-sectional survey Audio computer assisted self-interview administer survey; with semi-structured interview to assess substance use and sexual risk | 180 | Instructed to presume PrEP 80 % effective; using 5-point Lickert scale, asked participants: if they would take PrEP; how taking PrEP would affect condom use | 23 % had heard of PrEP; 68.5 % likely to use PrEP with no association in age, income or education; 35 % said they would decrease condom use | PrEP could be used by MSM already engaging in high risk activity who are unlikely to use condoms; findings support both behavioural disinhibition and risk compensation models; highlights importance of developing behavioural interventions to accompany any wide-scale provision of PREP to high-risk populations |
Guest et al. [38] | Heterosexual women, 18–35 years | Tema, Ghana | Daily oral PrEP | Assess acceptability of daily PREP | RCT-embedded; part of the TDF West African oral PrEP trial Structured survey and in-depth interview | 361 (survey); 24 (interview) | Acceptability (to daily pills) measured through adherence rates | Self-reported adherence—82 %; identified social relationships and travel constraints as barriers to adherence | PrEP acceptability high if efficacious and few side effects; need to consider how social and structural factors will affect adherence |
Guest et al. [37] | Heterosexual women, 18–35 years | Tema, Ghana | Daily oral PrEP | Explore risk disinhibition and compensation; maps changes in sexual risk behaviour | RCT-embedded; part of the TDF West African oral PrEP trial Structured survey and in-depth interviews | 361 (survey); 24 (interview) | Acceptability measured through daily adherence rates and completion of 12 follow up visits | Number of sexual partners and rate of unprotected sex acts decreased across the 12-month, with some exceptions; adherence support through counselling deemed effective | HIV prevention does not lead to risk disinhibition; counselling can be effective in supporting adherence and risk behaviour; need to consider how structural factors cannot be addressed through individual interventions |
Holt et al. [58] | MSM | Australia | Daily oral PrEP; Intermittent oral PrEP | Investigate the willingness of PrEP use and likelihood of decreased condoms use | Cross-sectional survey Online survey | 1,161 | Survey asked 25 attitudinal questions relating to PrEP using 5-point Lickert scale; established a 7-item scale assessing willingness to use PrEP, including statements relating willingness to: if PrEP was considered, when PrEP was taken, effectiveness of HIV prevention, and payment for PrEP | 28 % of participants willing to use PrEP, associated with younger age, having anal intercourse with casual partners; 8 % of men who were willing to use PrEP were less likely to use condoms; decreased condom use independently associated with older age, UAI with casual partners and perception of increased risk of HIV | MSM cautiously optimistic about PrEP; minority of men who expressed willingness appear to be appropriate candidates given they engage in UAI and perceive themselves at risk of HIV |
Holt et al. [69] | MSM | Australia | TasP | Assessed attitudes towards medicines, HIV treatment and ARV-based prevention amongst HIV-positive and HIV-negative MSM | Cross-sectional survey Online survey | 1041 (919 HIV-neg; 122 HIV-pos) | Survey asked about attitudes to treatment and treatment as prevention, including beliefs about: role of viral load in transmission; role of being on treatment in transmission; concerns with side-effects; ease of taking medication daily | HIV-neg and HIV-pos MSM have similar views of PrEP as effective; MSM sceptical that treatment for HIV-pos men can reduce onward transmission risks, especially HIV-neg men | MSM in general are supportive of PrEP being made available; MSM more sceptical of ARV-based prevention for HIV-positive MSM; suggests a bias towards prevention tools for HIV-negative MSM |
Hosek et al. [43] | MSM, 18–22 | Chicago | Oral PrEP | Examined acceptability and feasibility of PrEP and PrEP study | Behavioural and biomedical HIV intervention trial. Questionnaire (study-design); time-line follow-back interview (adherence) | 58 | Adherence was measure of PrEP acceptability within the trial; HIV risk behaviour/compensation assesses with 6-item scale | Acceptability of study design was high; lower acceptability of drug and regimen; higher acceptability of PrEP with non-pill group; | PrEP use amongst young MSM will require behavioural interventions to maintain/support adherence; future studies should begin on the effectiveness of PrEP amongst adolescents under 18 at risk of HIV |
Jackson et al. [61] | MSM | China | Oral PrEP | Identify predictors of lower vs higher willingness to use PrEP to reduce HIV amongst MSM | Cross-sectional survey Self-report questionnaire, recruited through community outreach organisations, locations and events | 570 | Asked range of questions relating to: beliefs about HIV severity; personal HIV risk; PrEP related stigma, benefits and self-efficacy in taking PrEP | Degree of willingness to use PrEP was related to previous consultation about HIV, barriers to condom use, increased depressive symptoms; belief that intervention was low in stigma and was high in potential benefits | Highlights the importance of intervention-specific beliefs as well as how psychological status, sexual behaviour and demographic factors influence willingness to adopt prevention strategies |
Kalichman et al. [68] | Men, women and transgendered people living with HIV (PLHA) | Atlanta, Georgia | TasP | Explore sexual behaviour amongst HIV + people recently diagnosed with an STI; explore knowledge of viral load and treatment optimism | Cross-sectional survey Audio-computer assisted structured interviews in AIDS service organisations, health care providers, social service agencies and infectious disease clinics | 490 | 4 questions, using 6-point Lickert scale, asked about: levels of infectiousness; role of treatment in prevention; feelings around treatment and condom use | 14 % of PLHA in study diagnosed with STI in previous 6 months; individuals with new STI had more sexual partners, including serodiscordant partners; participants with STIs more likely to have detectable viral loads and less likely to know their viral loads than participants who did not contract an STI; believing in an undetectable viral load leading to lower infectiousness was associated with a new STI | Need to integrate STI diagnostics and treatment into routine clinical services; patients should be taught how to recognize early STI symptoms; scale-up of TasP will need to address infectiousness beliefs and rapid detection and treatment of STIs |
Krakower et al. [49] | MSM | Boston, US | Daily oral PrEP | Aims to assess knowledge of PrEP amongst MSM in light of iPrEX study findings | Cross-sectional survey Cross-sectional internet-based survey through MSM social networking site before and after publication of iPrEX results were published | 398 pre-iPrEX; 4558 post-iPrEX | Participants were asked questions relating to PrEP knowledge, interest and experience in PrEP use, adapted from Mimiaga et al. [51] (See below) | Limited awareness of PrEP before (11 %) and after (19 %) publications; interest in PrEP high before (76 %) and after (79 %); awareness of PrEP associated with awareness of PEP; interest in PrEP use associated with older age, UAI, more than one partner in 3 months and perceiving oneself to be at increased risk of HIV | Need for information campaigns to raise PrEP awareness and facilitate dialogue amongst MSM and their health providers; need to learn more about barriers to discussing HIV risk behaviours and starting PrEP in a clinical setting |
Leonardi et al. [56] | Men (mostly MSM) | Toronto, Canada | Oral PrEP | Assess current levels of awareness and usage of PrEP amongst ‘high risk’ men | Cross-sectional survey Self-administered questionnaire by men undergoing rapid HIV test in sexual health clinic | 256 (195MSM; 61 non-MSM) | Survey questions asked about willingness to use PrEP using a 4-point Lickert scale | 11.7 % were aware of PrEP (more MSM than non MSM); willingness to consider PrEP amongst MSM was 66 % and 49 % amongst non-MSM; willingness was associated with high-risk activities | PrEP appears to be acceptable to high-risk MSM; need further, multistakeholder research on how to best roll out PrEP |
Lorente et al. [57] | MSM | France | Intermittent oral PrEP | Assess interest in participating in an ‘on-demand’ PrEP trial and identify individual and structural barriers | Cross-sectional survey Self-administered questionnaires in gay venues and online | 527 | Questions asked relating to future study participation and potential PrEP use based on 4-point Lickert scale; questions focused on willingness to take PrEP, clinical follow up preferences, impact on condom use, and problems with taking medication | 40 % said they would be interested in participating in a PrEP trial; of these men, most concentrated sexual activity 2–3 days a week; only 19 % of these men said they would not know that they would have sex 24 h before the event; lower education levels and higher-risk sexual behaviour with multiple partners associated with willingness | Significant acceptability for participation in ‘on-demand’ PrEP trial; encouraging for research aimed at testing additional HIV prevention methods which are potentially less toxic, less expensive and improved adherence than daily PrEP |
Mansergh et al. [50] | MSM | Chicago, Los Angeles, New York and San Francisco, US | Oral PrEP | Examine use and sharing of ARVs for the purposes of PrEP and PEP among high-risk substance using MSM | Behaviour Intervention Trial (Project MIX) Baseline and 12-month follow-up assessments | 1,011 | n/a | PEP and PrEP being used by 2-4 % of HIV-negative MSM or given to sexual partners by a similar percentage of HIV-positive men to prevent infection; optimism about HIV treatment was predictive of later PrEP and PEP use for HIV-negative men | Research will be needed to determine the best behavioural messages and counselling approaches that combine condom use with PrEP |
Mimiaga et al. [51] | HIV-negative MSM | New England | Oral PrEP | Assess prior PrEP use and awareness and future intent to use PrEP | Cross-sectional survey Interview-administered survey | 227 | Participants were asked a range of questions relating to awareness and willingness to use PrEP, including awareness and use of PrEP. Participants were also presented with specific hypothetical scenarios to identify under which conditions they would be more likely to use PrEP | 19 % heard of PrEP; knowledge of PrEP was associated with higher income; 74 % intended to use PrEP if available once made aware of what it was; willingness to use PrEP was associated with lower levels of education; high numbers of men willing to take PrEP daily, or intermittently and for all UAI | PrEP would be acceptable to MSM in this study; findings suggest need for tailored educational messages to ensure appropriate PrEP if rolled-out |
Minnis et al. [40] | HIV-negative women | South Africa, Uganda and United States | Daily oral PrEP and Topical PrEP | Compared short-term adherence to and acceptability of three PrEP regimens | Acceptability Trial Interviews: face-to-face at 6 weeks into trial; in-depth interviews with 25 % participants | 168; 36 in-depth interviews | Self reported adherence on 5-point Lickert scale; future willingness asked using 4-point Lickert scale; from interviews, authors reported on: product characteristics, partner relations, stigma associated with taking tablets and sexual pleasure | 93 % reported future use of daily tablet; 83 % likely to use gel; 82 % likely to use dual products; preference for mode of delivery varied according to location; participants identified HIV and illness stigma, product characteristics, male partners as barriers | Need to consider geographic and cultural experience with formulation, male partner involvement and broader sexual health benefits |
Mutua et al. [41] | MSM and FSW | Kenya | Daily and intermittent oral PrEP | Compare safety and drug adherence between daily and intermittent PrEP | Clinical trial Followed for 4 months; sexual activity data collected via daily text and interview | 67 MSM; 5 FSW | Main outcome measures included: willingness to use study regimen if effective; adherence rates for daily and intermittent dosing | 83 % adherence for daily PrEP, 55 % for intermittent and 26 % for post-coital; change in regular routine, alcohol use, social stigma and travel identified as barriers to adherence | Adherence to intermittent dosing regimens, fixed doses and in particular coitally-dependent doses may be more difficult than adherence to daily dosing |
Nodin et al. [52] | MSM | New York, US | Oral PrEP, microbicides | Explore knowledge and acceptability of four biomedical products/technologies, as alternatives to condoms | Cross-sectional qualitative study Semi-structured interviews | 72 | Authors report on knowledge of and response to PrEP; issues raised include: ease of use, use as an alternative prevention strategy, concern with side effects and efficacy, and concerns with behavioural impact | Almost no knowledge of PrEP; limited knowledge of microbicides and some information about PEP; reaction to all products were positive and men were willing to take part in research, with the exception of PrEP; responses to PrEP were polarized as either enthusiastic of negative; negative reactions focused on presumed efficacy and side-effects; concern that these products would encourage barebacking | PrEP will require the most work of all prevention methods explored in this study to improve acceptability amongst MSM who engage in UAI so as not to increase risk factors |
Poynten et al. [59] | HIV-negative MSM | Sydney | Rectal microbicides and PrEP | Explore the awareness of rectal microbicides and willingness to participate in rectal microbicides and PrEP trials | Cross-sectional study Structured face to face interviews; quantitative sexual behaviour data on unprotected insertive and receptive anal sexual collected | 1,427 | Participants were asked two questions about PrEP, using 5-point Lickert scale, including: if they had used ARVs for prevention; if they would participate in a trial | 43 % men willing to participate in PrEP drugs trials; higher among those who reported unprotected anal intercourse with HIV-positive partners; no evidence of current PrEP use | Extensive community around PrEP and any potential role it might play in HIV prevention, would be required before PREP could be trialled amongst MSM |
Saberi et al. [54] | MSM SDCs | San Francisco | PrEP | Explore PrEP awareness, concerns relating to PrEP provision and establish uptake by HIV-negative partner | Cross-sectional study Mixed methods: Audio computer Assisted self Interview survey and semi-structured face to face interviews | 164 couples (328 men); 16 SDCs interviewed (32 men) | Survey questions asked: how likely would it be for you/your partner to take PrEP; should PrEP be offered to anyone who wants to take it. Qualitative interviews explored: knowledge of PrEP; source of knowledge; experience of taking PrEP; PrEP discussions with partner; if PrEP should be offered and potential issues | 62 % heard of PrEP (1/4 mistook PEP for PrEP); low endorsement of PrEP uptake and 40 % uncertain if PrEP should be offered; uptake of PrEP by couples associated with insertive UAI and negatively associated with receptive UAI | Suggests need for further PrEP education within communities; need to determine appropriate groups within which PrEP can have the highest impact |
Smith et al. [66] | African–American heterosexual men and women, 18–24; African–American MSM | Atlanta, Georgia | Daily oral PrEp | Explored attitudes and service access preference for daily PrEP | Cross-sectional qualitative study Focus groups | 8 FG with heterosexual men and women (n = 58); 2 FG with MSM (n = 19) | Authors reported on concerns regarding: rapid HIV testing; dispensing location and cost; side effects and burden of taking daily medication; effectiveness; risk perception; social response of peers; risk compensation | Participants reported significant interest in PrEP. Interest was associated with low cost, PrEP effectiveness and ease of accessing services and medication; regular, oral testing was not seen as a barrier to PrEP use | Education and counselling efforts to accompany PrEP will need to address: sharing or borrowing of ARVs for PrEP use; reduced adherence; and providing accurate information about the efficacy and necessary duration for PrEP use |
Van der Elst et al. [42] | MSM and FSW | Kenya | Daily and Intermittent oral PrEP | Explore experiences of using PrEP for HIV prevention within a clinical trial | Clinical trial Focus groups and semi-structured interviews | 10 FG (n = 44); interviews (n = 7) | Authors reported on: likes and dislikes of pill; dosing schedules; adherence measures; experience with procedures | High acceptability of PrEP, but change to product characteristics would improve acceptability; concerns around the social consequences of PrEP, especially in relation to stigma; alcohol-use, transactional sex and travel challenges to daily and intermittent adherence | Identified wide range of creative and commonplace strategies to help adherence; behavioural adherence interventions will be very important for PrEP success; importance of providing information about partial efficacy in a clear way; PrEP needs to be accompanied by counselling to encourage risk reduction and regular testing |
van Griensven et al. [60] | HIV-negative MSM | Bangkok | Intermittent PrEP | Examine frequency and planning of sex. | Cohort study Audio-computer assisted self-interview | 823 | n/a | 86 % reported having sex on 2 days per week or less, and 65 % reported their last sex to have been planned; being aged 22–29 years, not identifying as homosexual, having receptive anal intercourse, and not engaging in group sex were associated with unplanned sex | Most men were exposed to HIV infection only intermittently, and had a window of opportunity to take PrEP prior to sexual activity; suggests intermittent PrEP more appropriate than daily regimen; those lacking opportunity to take intermittent PrEP were at high behavioural risk |
Ware et al. [39] | Heterosexual serodiscordant partners | Uganda | Daily PrEP | Explore PrEP adherence in stable HIV serodiscordant heterosexual couples, including barriers and facilitators to adherence | Part of Partners in PrEP RCT Qualitative Interviews | 60 (45 participants; 15 partners) | Authors reported on: experiences of taking study pills; descriptions of specific missed doses; descriptions of longer adherence lapses; impact of serodiscordance on the relationship | Adherence motivated by doing no harm to negative partner; relied on family and counselling support, as well as creative daily reminders; adherence lapses linked to breakdown of relationship; adherence links to cultural factors in relation to marriage, children and economic circumstances | PrEP adherence for SDCs may be linked to couples’ determination to resolve the discordance dilemma; use of PrEP in the context of partnered relationships may be associated with improved adherence and effectiveness |
Whiteside et al. [65] | Men and women (mostly heterosexual, African American) | South Carolina | Oral PrEP | Determine risk perception and attitudes about PrEP | Cross-sectional survey Self-administered survey in STI clinic | 405 | Survey questions asked about: risk factors/sexual history; knowledge of PrEP for HIV infection; attitudes and beliefs regarding the use of PrEP for HIV infection, including self-perceived risk of HIV infection and use of PrEP in conjunction with condoms | Most men did not perceive themselves to be at risk of HIV infection; MSM respondents more likely to have heard of PrEP; attitudes towards PrEP affected by gender, age and number of sexual partners in previous 3 months | Awareness and acceptability of PrEP significantly affected by gender, age and number of sexual partners; need to address the gap between self-perceived and actual levels of risk |
Zhou et al. [62] | MSM | Beijing, China | Daily PrEP | Investigate awareness and acceptability of PrEP | Cross-sectional survey Interview administered survey | 152 | Survey asked about willingness to use PrEP using a 4-point Lickert scale. Supplementary questions asked about: side effects, efficacy, HIV stigma, cost and sexual exclusion | 11.2 % had heard of PrEP; 67.8 % were willing to use PrEP. Willingness to use PrEP was associated with: inconsistent condom use; never heard of ARV side effects. 35 % of those willing to try PrEP reported a likely decrease in condom use | Sexual behaviour characteristics and knowledge about ARVs may affect willingness to accept PrEP |
PrEP Studies
Participants | Setting | No. of articles | No. of studies | |
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Clinical trial PrEP research | ||||
Heterosexual women | Africa | 4 | 3 | |
Men who have sex with men (MSM) | Africa | 2 | 1 | |
MSM | US | 1 | 1 | |
Heterosexual and MSM | Multi-country | 1 | 1 | |
Total | 8 | 6 | ||
Non-Clinical trial PrEP research | ||||
MSMa
| US | 10 | 9 | |
MSM | UK, Canada, France, Australia | 5 | 5 | |
MSMb
| China, Thailand, Peru | 4 | 4 | |
Serodiscordant Couples (SDC) MSM and Transgender (TG) | Multi-country studies | 1 | 1 | |
Heterosexual men and womenc
| US | 2 | 2 | |
Total | 22 | 21 |