Uptake of pre-exposure prophylaxis among men who have sex with men in Gulu district, Northern Uganda – a cross-sectional study

Abstract

Introduction: Uganda’s HIV prevalence was 5.8% among people aged 15-49 with 53,000 new infections in 2019. The burden of HIV is higher among the key populations. MSM have 22 times relative risk of HIV acquisition than the general population. PrEP has been found effective in protection against HIV infection, however, it still faces challenges with uptake. General objective: The study assessed the uptake of PrEP and associated factors among MSM in Gulu District. Methods: This was a cross-sectional study where both quantitative and qualitative study interviews were conducted. Self-reported HIV negative MSM were recruited into the study by snowballing technique in Gulu, northern Uganda. The quantitative data were collected using an electronic questionnaire and analysed using STATA version 16. Bivariable logistic regression analysis was conducted, but multivariable analysis was not done because most characteristics had less than five numbers in the cells after a bivariable analysis. The qualitative data were collected from 20 MSM immediately after their quantitative interviews. 5 PrEP service providers were interviewed. Qualitative data were collected using interview guides and analysed using Atlas.ti.9.3. Results: Out of the 151 MSM interviewed, 11 (7.3%) were HIV positive status and thus excluded from further analysis. Of the remaining 140 MSM, 119 (85%) were insertive partners. Of the 140 MSM, 36 (25.7%) had ever used PrEP; 12(8.6% [95%CI: 4.5-14.5]) were current PrEP users. Two thirds (66.7%) had discontinued PrEP of the 36 that had ever initiated. The lack of PrEP awareness at 30.8% (32 of 104) was the main reason for those that had never used PrEP, and fear of side effects was the main reason for PrEP discontinuation at 29.2% (7 of 24). Barriers to PrEP uptake included concerns about side-effects, stigma, pill burden and challenges in accessing health facilities. System factors included stigma to health workers, limited fund to reach MSM and mobility of MSM. Awareness of PrEP benefit facilitated its uptake. Conclusions and Recommendations: There is low uptake of PrEP among MSM in Gulu District with only 8.6% current PrEP users while two-thirds of those that initiate discontinue. Despite relatively a high PrEP awareness, they had negative perceptions about it. The study recommends that PrEP implementing partners and ministry of health to increase PrEP awareness and improve counselling of MSM on PrEP by service providers, training of MSM peers, and provision of PrEP in designated safe places easily accessible by the MSM