TY - JOUR
T1 - Pre-exposure prophylaxis for transgender women and men who have sex with men
T2 - Qualitative insights from healthcare providers, community organization-based leadership and end users in coastal Kenya
AU - Kimani, Makobu
AU - Sanders, Eduard J
AU - Chirro, Oscar
AU - Mukuria, Nana
AU - Mahmoud, Shally
AU - Rinke de Wit, Tobias F
AU - Graham, Susan M
AU - Operario, Don
AU - van der Elst, Elise M
N1 - Publisher Copyright: © 2021 The Author(s). Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Transgender women (TW) and men who have sex with men (MSM) in Kenya are disproportionately affected by human immunodeficiency virus (HIV) and would benefit substantially from pre-exposure prophylaxis (PrEP). We conducted focus group discussions (FGDs) with healthcare providers (HCPs) and TW/MSM leadership and in-depth interviews (IDIs) with PrEP-experienced MSM and TW to learn about perceived and actual barriers to PrEP programming. Eleven HCP and 10 TW/MSM leaders participated in FGDs before PrEP roll-out (January 2018) and 12 months later. Nineteen PrEP end-users (11 MSM and 8 TW) participated in IDIs. Topic guides explored PrEP knowledge, HIV acquisition risk, gender identity, motivation for PrEP uptake and adherence and PrEP-dispensing venue preferences. Braun and Clarke thematic analysis was applied. Four themes emerged: Limited preparedness of HCPs to provide PrEP to TW and MSM, varied motivation for PrEP uptake and persistence among end users, lack of recognition of TW by HCPs and suggestions for PrEP programming improvement from all stakeholders. Providers' reluctance to prescribe PrEP to TW and distrust of TW towards providers calls for interventions to improve the capacity of service environments and staff HIV preventive care. Alternative locations for PrEP provision, including community-based sites, may be developed with TW/MSM leaders.
AB - Transgender women (TW) and men who have sex with men (MSM) in Kenya are disproportionately affected by human immunodeficiency virus (HIV) and would benefit substantially from pre-exposure prophylaxis (PrEP). We conducted focus group discussions (FGDs) with healthcare providers (HCPs) and TW/MSM leadership and in-depth interviews (IDIs) with PrEP-experienced MSM and TW to learn about perceived and actual barriers to PrEP programming. Eleven HCP and 10 TW/MSM leaders participated in FGDs before PrEP roll-out (January 2018) and 12 months later. Nineteen PrEP end-users (11 MSM and 8 TW) participated in IDIs. Topic guides explored PrEP knowledge, HIV acquisition risk, gender identity, motivation for PrEP uptake and adherence and PrEP-dispensing venue preferences. Braun and Clarke thematic analysis was applied. Four themes emerged: Limited preparedness of HCPs to provide PrEP to TW and MSM, varied motivation for PrEP uptake and persistence among end users, lack of recognition of TW by HCPs and suggestions for PrEP programming improvement from all stakeholders. Providers' reluctance to prescribe PrEP to TW and distrust of TW towards providers calls for interventions to improve the capacity of service environments and staff HIV preventive care. Alternative locations for PrEP provision, including community-based sites, may be developed with TW/MSM leaders.
KW - Kenya
KW - MSM
KW - pre-exposure prophylaxis
KW - transgender women
UR - http://www.scopus.com/inward/record.url?scp=85129998314&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/inthealth/ihab043
DO - https://doi.org/10.1093/inthealth/ihab043
M3 - Article
C2 - 34325469
SN - 1876-3413
VL - 14
SP - 288
EP - 294
JO - International Health
JF - International Health
IS - 3
ER -