Healthy Families PrEP In-Depth Interviews

This study was a part of a larger mixed-methods study conducted in a rural referral hospital in southwestern Uganda, with 131 women who were over the age of 18; HIV-negative (based on onsite testing); likely to be fertile (based on reproductive history, Bunting and Boivin 2010); not pregnant (based on urine b-HCG testing); reported personal or partner pregnancy plans within the next year; partnered with a man living with HIV or otherwise felt at risk for acquiring HIV; lived within 60 kilometres of the referral hospital; and able to attend quarterly clinic visits during a 9-month follow-up period. Eligible participants were fluent in English or the local language, Runyankole, and able to consent. Participants attended quarterly study visits, which included HIV and pregnancy testing, questionnaire completion, and safer conception and adherence counselling sessions. Women could initiate PrEP (TDF/FTC) at any time during the 9-month study follow-up. Prior to February 2019, women with an incident pregnancy exited the study prior to the end of the maximum follow-up period; after February 2019, women were followed through to the end of pregnancy given concerns regarding the ethics of PrEP discontinuation during pregnancy. Female participants attended safer conception counselling sessions developed for HIV-negative women who wanted to conceive with a partner with HIV, offered at time of enrolment and quarterly intervals during the study. Counselling included messages about encouraging partners to test and disclose their serostatus, initiate ART if eligible, delay condomless sex until viral suppression had been achieved or until the partner used ART for 6 months, use contraception to delay pregnancies until safer conception strategies had been implemented, limit condomless sex to peak fertility, and/or consider donor sperm, adoption, or sperm washing as alternatives to conceiving. PrEP education and adherence counselling were offered to the women during individual support sessions at the time of enrolment and thereafter at quarterly visits. Forty-five women were invited to participate in exit in-depth interviews (IDIs) to explore barriers and promoters of safer conception strategies and PrEP use. The women were given the option to invite their male partners who were fluent in English or Runyankole and able to consent to participate in separate in-depth interviews. Participants who completed IDIs were selected from three samples with about 15 women per group: (1) women who chose not to initiate PrEP; (2) women who initiated PrEP and took less than 80% of their doses (measured by electronic pill cap); and (3) women who initiated PrEP and took 80% or more of their doses. Interview guides were informed by a conceptual framework for periconception risk reduction and adherence (van der Straten et al. 2014; Crankshaw et al. 2012). The guide explored topics like PrEP dosing behaviour and barriers to and promoters of safer conception strategy adherence over time. Male partners were invited to participate in a separate interview which covered their experiences with safer conception strategies. (2022-09-27)