|dc.identifier.citation||Ssuna, B., Katahoire, A., Armstrong-Hough, M., Kalibbala, D., Kalyango, J. N., & Kiweewa, F. M. (2021). Factors Associated With Willingness to Use Oral Pre-exposure Prophylaxis (Prep) Among Fishing Communities in Peri-urban Kampala, Uganda. https://doi.org/10.21203/rs.3.rs-265902/v1||en_US
|dc.description.abstract||The World Health Organization (WHO) recommends the use of pre-exposure prophylaxis
(PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual
HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit
from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with
willingness to use PrEP among key populations at risk of HIV, such as members of communities with
exceptionally high HIV prevalence.
Objective: To examine the perceptions and factors associated with willingness to use oral PrEP among
members of fishing communities in Uganda, a key population at risk of HIV.
Methods: We conducted an explanatory sequential mixed-methods study at Ggaba fishing community
from February to June 2019. Survey data were collected from a systematic random sample of 283
community members. We carried out bivariate tests of association of willingness to use PrEP with
demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for
willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson
regression model to describe factors associated with willingness to use PrEP. We purposively selected 16
participants for focus group discussions to contextualize survey findings, analysing data inductively and
identifying emergent themes related to perceptions of PrEP.
Key results: We enrolled 283 participants with a mean age of 31±8 years. Most (80.9%) were male. The
majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months.
Self-reported HIV prevalence was 6.4%. Most (80.6%, 95%CI 75.5-85.0) were willing in principle to use
PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99,
95%CI 1.31-3.02, P= 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03-1.24,
P=0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39-2.81, P<0.001). In focus group
discussions, participants described pill burden, side-effects, drug safety, and accessibility as potential
barriers to PrEP use.
Conclusions and recommendations: Oral PrEP was widely acceptable among members of fishing
communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV
testing services with sensitization about PrEP and also address issues of access to drugs.||en_US