I am on PrEP: A systematic review of barriers to effective PrEP utilisation among men who have sex with men in sub-Saharan Africa
Abstract
Despite extensive research that recognises the potential of Pre-exposure prophylaxis (PrEP) as a highly effective HIV prevention strategy, particularly for men who have sex with men (MSM) in sub-Saharan Africa, a region with a high HIV burden, as reported in previous studies, there is a dearth of research that synthesises the misconceptions, misuse, and significant barriers that limit its optimal utilisation. This phenomenological systematic review synthesises misconceptions, misuse patterns, and barriers to effective PrEP use among MSM in sub-Saharan Africa. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to incorporate the papers considered for this review. A comprehensive search was conducted across PubMed, Scopus, and African Journals Online databases to identify studies published between 2000 and 2024. Two hundred seventy (270) studies were screened based on predefined inclusion criteria, and 20 studies were ultimately selected for inclusion. After completing thematic analysis of the included studies, findings revealed that there are misconceptions about PrEP’s side effects and the necessity to use it during periods of perceived low HIV risk. Misuse was characterised by inconsistent adherence and self-administration, without medical oversight. Barriers, such as stigma, inadequate healthcare access, and misinformation, were prevalent. Addressing these issues is critical to improving PrEP uptake and adherence among MSM in the region. Public health interventions and policies must target these barriers to ensure that MSM populations can fully benefit from PrEP's potential in reducing HIV transmission.
How to Cite
References
- Abu-Ba’are, G. R., Shamrock, O. W., Apreku, A., & Torpey, K. (2023). Awareness and willingness to use condoms and pre-exposure prophylaxis among gay, bisexual, and other cisgendered men who have sex with men in slum communities in Ghana. Journal of the International Association of Providers of AIDS Care, 22(4), 12–33. https://doi.org/10.1177/23259582231209649
- Ahouada, C., Diabaté, S., Gning, N. N., Hessou, S., & Alary, M. (2020). Acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men in Benin: A qualitative study. AIDS Care, 32(2), 242–248. https://doi.org/10.1080/09540121.2019.1622643
- Ahouada, C., Diabaté, S., Mondor, M., Hessou, S., Guédou, F. A., & Alary, M. (2020). Acceptability of pre-exposure prophylaxis for HIV prevention: Facilitators, barriers, and impact on sexual risk behaviors among men who have sex with men in Benin. BMC Public Health, 20(4), 1–17. https://doi.org/10.1186/s12889-020-09363-4
- Begnel, E. R., Escudero, J., Mugambi, M., Mugwanya, K., Kinuthia, J., Beima-Sofie, K., ... & Pintye, J. (2020). High pre-exposure prophylaxis awareness and willingness to pay for pre-exposure prophylaxis among young adults in Western Kenya: results from a population-based survey. International journal of STD & AIDS, 31(5), 454–459. https://doi.org/10.1177/0956462420912141
- Bekker, L. G., Giovenco, D., Baral, S., Dominguez, K., Valencia, R., Sanchez, T., … Sullivan, P. S. (2022). Oral pre-exposure prophylaxis uptake, adherence, and adverse events among South African men who have sex with men and transgender women. Southern African Journal of HIV Medicine, 23(1), 14–35. https://doi.org/10.4102/sajhivmed.v23i1.1405
- Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage.
- Critical Appraisal Skills Programme (CASP). (2018). CASP qualitative checklist. Retrieved from https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf
- Delany-Moretlwe, S., Hughes, J. P., Bock, P., Ouma, S. G., Hunidzarira, P., Kalonji, D., ... & Gaffoor, Z. (2022). Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial. The Lancet, 399(10337), 1779-1789. https://doi.org/10.1016/S0140-6736(22)00538-4
- Eakle, R., Weatherburn, P., & Bourne, A. (2019). Understanding user perspectives of and preferences for oral PrEP for HIV prevention in the context of intervention scale-up: A synthesis of evidence from sub-Saharan Africa. Journal of the International AIDS Society, 22(1), e25306. https://doi.org/10.1002/jia2.25306
- Eubanks, A., Coulibaly, B., Keïta, B. D., Anoma, C., Dah, T. T. E., & Teyssier, L. (2022). Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa. BMC Public Health, 22(1), 16–36. https://doi.org/10.1186/s12889-022-14211-8
- Finfgeld-Connett, D., & Johnson, E. D. (2013). Literature search strategies for conducting knowledge-building and theory-generating qualitative systematic reviews. Journal of Advanced Nursing, 69(1), 194–204. https://doi.org/10.1111/j.1365-2648.2012.06037.x
- Fonner, V. A., Dalglish, S. L., Kennedy, C. E., Baggaley, R., O’reilly, K. R., Koechlin, F. M., ... & Grant, R. M. (2016). Effectiveness and safety of oral HIV pre-exposure prophylaxis for all populations. AIDS, 30(12), 1973-1983. https://doi.org/10.1097/QAD.0000000000001145