Knowledge, perceptions and factors associated with acceptability of Pre-exposure prophylaxis in HIV Key-Populations, Kampala District.

Abstract

Introduction: Globally, the incidence of HIV was 1.8 million new infections in 2018. In Uganda, HIV incidence was 52,000 new infections in 2016, 64% of whom were key populations. WHO recommends use of PrEP in key populations which has been found to reduce HIV incidence by 96% depending on user’s adherence and acceptability. However, gaps in knowledge and negative perceptions regarding PrEP in communities are associated with low acceptability of PrEP have been observed in these key-populations in other countries. This study therefore aimed to evaluate the knowledge, perceptions and factors associated with acceptability of PrEP in key-populations. Methods: We conducted a conceptually linked sequential explanatory mixed methods study among fishing community members, men who have sex with men (MSM) and female sex workers (FSW) in Gaba, Makindye and Rubaga divisions of Kampala district. We conducted a survey, 3 focus group discussions and 10 in-depth interviews. Quantitative was entered using Epidata 4.2 and exported to STATA 15.1, clustered prevalence ratios were measured using a modified Poisson regression with robust standard errors. Transcripts from the qualitative data were imported into Atlas.ti 8.3 where they were coded and the emerging themes identified. Results: A total of 497 participants were recruited, the mean age ± standard deviation was 29±7.6 years . Out of these, 257 (51.7%) reported having sex with women, 157 (31.6%) with men and 83 (16.7%) with both men and women. The biggest proportion (76.5%) had poor knowledge about PrEP although the overall acceptability was as high as 77.7% (95%CI 73.8-81.1); acceptability among fishing communities was 80.6%, 82.8% among MSM and 66.9% among FSWs. The factors that were associated with the acceptability PrEP in the fishing communities were; primary education (PR=1.61, P=0.009), secondary education (PR=1.72, P=0.002), Tertiary education (PR=1.97, P<0.001) and in FSWs were HIV test in the past 6 months (PR=1.85, P=0.007), age (PR=0.95, P<0.001), while for MSM were sex orientation (PR= 0.84, P=0.029) and sometimes concerned about acquiring HIV (PR=1.79, P=0.020) and always concerned (PR=1.83, P=0.016). Perceptions about advantages of PrEP, stigma and discrimination, concerns about the side effects of PrEP explained the poor knowledge although the acceptability was high. Conclusion: Acceptability for PrEP is high in key population communities and is influenced by education background, HIV testing behavior, age and perceptions about PrEP. In order to scale-up PrEP use, the implementing bodies should integrate PrEP awareness in HIV testing services, do community sensitization about PrEP and address issues of social stigma and discrimination. Key words: key populations, pre-exposure prophylaxis, acceptability