Experiences of taking antiretroviral medication as pre-exposure prophylaxis amongst men who have sex with men attending sexual health clinics in Wales: a nested qualitative study

Problem

HIV pre-exposure prophylaxis (PrEP) is an antiretroviral medication which has been demonstrated to be highly effective against reducing HIV in key populations. It has been available through the NHS in Wales since July 2017 to anyone considered at-risk from contracting HIV. There has been considerable work studying the uptake of PrEP in key populations, with relatively less attention directed to how PrEP is taken when it is prescribed. This is particularly true in the UK, where PrEP has until recently only been available through research studies or online purchase. The aim of this work therefore was to gain an in-depth understanding of the contextual factors which act as barriers and facilitators for the initiation, consumption and continuation (or discontinuation) of PrEP amongst men who have sex with men (MSM).

Approach

We conducted a qualitative study nested within an ecological momentary assessment (EMA) study of PrEP use and sexual behaviour in Wales. Semi-structured interviews were carried out via video call with MSM who were accessing PrEP through sexual health clinics across Wales. We aimed to include individuals who had discontinued PrEP during the EMA study. Interview questions were developed with groups of academics and key stakeholders, and were focused primarily to align with key processes around medication use (initiating, implementation, and persistence). Question probes related to components of the theory of planned behaviour model, and questions were also asked on the extent to which PrEP use influenced sexual behaviour. Interviews concluded with questions around the support individuals received around their PrEP use as well as the ways in which PrEP has changed their life (to elicit key outcomes for future research). Interviews were professionally transcribed verbatim, coded by the lead author (with double coding taking place to assess to validity of the coding frame and subsequently for reliability of coding), and analysed thematically.

Findings

Twenty-one interviews were conducted between 13th May 2020 and 6th November 2020. Participants were from two of the four sexual health clinics included in the overarching study, with four participants discontinuing PrEP use during the course of the study. Analysis is ongoing, but an initial theme includes the role of self-efficacy and control around an individual’s sex life (be that through their change in relationship with their sexual health clinic, their communication with sexual partners, or the importance of habit formulation when it comes to PrEP use). Key experiences around initiating and stopping PrEP will also be described. The ways in which the COVID-19 pandemic has impacted PrEP use will also be described.

Consequences

These findings will provide a detailed account of contextual factors influencing PrEP use amongst MSM in Wales and indicate areas in which additional support for optimising PrEP use may be needed.