Lived experiences with pre-exposure prophylaxis uptake and adherence among transgender women in Thailand: a qualitative study

被引:1
|
作者
Janamnuaysook, Rena [1 ,2 ]
Guo, Yan [3 ]
Yu, Yeon Jung [4 ]
Phanuphak, Nittaya [1 ,2 ]
Kawichai, Surinda [5 ]
MacDonell, Karen [6 ]
Jupimai, Thidarat [5 ]
Rongkavilit, Chokechai [7 ]
Wang, Bo [8 ]
机构
[1] Inst HIV Res & Innovat, Bangkok, Thailand
[2] Chulalongkorn Univ, Ctr Excellence Transgender Hlth CETH, Bangkok, Thailand
[3] CUNY, Grad Sch Publ Hlth & Hlth Policy, New York, NY USA
[4] Western Washington Univ, Dept Anthropol, Bellingham, WA USA
[5] Chulalongkorn Univ, Ctr Excellence Pediat Infect Dis & Vaccines, Bangkok, Thailand
[6] Florida State Univ, Ctr Translat Behav Res, Tallahassee, FL USA
[7] Univ Calif San Francisco, Dept Pediat, Fresno Branch Campus, Fresno, CA USA
[8] Univ Massachusetts Chan Med Sch, Dept Populat & Quantitat Hlth Sci, Worcester, MA 01605 USA
基金
美国国家卫生研究院;
关键词
adherence; barriers; facilitators; HIV prevention; in-depth interview; pre-exposure prophylaxis; PrEP uptake; Thailand; transgender women; HIV PREVENTION; PREP; SEX; ACCEPTABILITY; THERAPY; MEN; GAY;
D O I
10.1071/SH23102
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW's experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation.Methods We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis.Results Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers' stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk.Conclusions The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand. This study aimed to provide a deeper understanding of transgender women's experiences of pre-exposure prophylaxis (PrEP) uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation. We interviewed 20 young transgender women and 10 health care providers from two HIV clinics in Bangkok, Thailand. Our findings deepen the current understanding of barriers to PrEP use, and inform the development of effective interventions to promote PrEP use.
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页数:11
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