Acceptability of prescription and use of long acting injectable PrEP among health workers and key populations at the MARPI and KCCA clinics providing HIV prevention services

Abstract

Background:HIV is still a major public health concern, with are over 32.2–38.8 million HIV-positive cases globally and 71% of these live in Sub-Saharan with Uganda having a prevalence of 6.2% among adults. Pre Exposure Prophylaxis (PrEP) as prevention to HIV infections was approved by Food and Drugs Authority (FDA), and Long-acting Injectable PrEP (LAI-PrEP), was developed to overcome some of the barriers with oral PrEP. Oral PrEP has been introduced to high-risk populations to prevent HIV infections. But its acceptance has been limited due to stigma, unproven fears around the increased spread of antiretroviral resistance, pill burden, high cost, forgetting refill dates, high frequency, and physiological challenges associated with the daily dose. Therefore, this study aims at determining the acceptability of injectable PrEP use among key populations attending MARPI clinic and other HIV clinics in Kampala and the acceptability of LAI-PrEP administration among health workers. Methods: A cross-sectional study was conducted. Overall, 344 participants were enrolled in the study from four different categories (health workers, those that are currently on oral PrEP, oral PreP dropouts and naïve key propulsions). Results: Majority of oral PrEP dropouts were females constituting 62.4%. The median age was 28 (IQR 19-45) years. 57.89% of them were female sex workers. The majority of those currently on oral PreP were either female sex workers (33.33%), truck drivers (23.52%), or people who inject drugs (23.52%). The majority of the respondent naïve about PrEP were females (64.0%). The median age was 29 (IQR 20-38) years. The majority of the people in all key populations had ever heard about PrEP and heard about PrEP from a health worker. Majority of the oral PrEP drop outs were willing to use long acting injectable PrEP (77.19%) followed by naïve and those currently on oral PrEP at 63.73%. There was a statistically significant association between willingness to use LAI-PrEP among those that are currently on Oral PrEP and key population (FSW, MSM, PWID, Truck drivers) (P value 0.011)). 93.07% of health workers that had ever been asked by a patient about PrEP were found to accept administration LAI-PrEP, (P value <0.001). Health workers who were comfortable with giving injections were also more likely to accept the administration of LAI-PrEP (P-value <0.001). Conclusions: The key population is quite knowledgeable about PrEP, and there is a potentially high demand for LAI-PrEP among female sex workers, men who have sex with men, people who inject drugs, and truck drivers, among other high-risk groups.