“Belt and braces approach; added benefit and … extra reassurance”: a multi-stakeholder examination of the challenges to effective provision of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Northern and Central England

ABSTRACT Pre-exposure prophylaxis (PrEP) involves HIV negative individuals taking antiretroviral drugs to reduce the probability of infection if exposed and is available through the IMPACT trial in England. This study aimed to explore men who have sex with men (MSM) and service provider (SP) perspectives on provision and accessibility of PrEP in Northern and Central England. Twenty MSM and 25 SPs from four Northern cities and one city in the West Midlands region were recruited for semi-structured interviews (December 2018 to October 2019). Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Three key themes emerged: “Self-sourcing PrEP”; “Service delivery learnings”; and “Impact of using PrEP”. Problems with equity of access and accessibility were noted, and recommendations for the future of PrEP programming and equitable service delivery were also presented. The study highlighted divergence in PrEP service experience from patients and providers, with results informing policy, practice and professional training.

[1]  B. Vuylsteke,et al.  The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review , 2020, BMC Health Services Research.

[2]  J. McVeigh,et al.  Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming , 2020, AIDS and Behavior.

[3]  Christina Nicolaidis,et al.  HIV Pre-exposure Prophylaxis in Practice Settings : a Qualitative Study of Sexual and Gender Minority Adults ’ Perspectives , 2019 .

[4]  L. Bekker,et al.  Global PrEP roll-out: recommendations for programmatic success. , 2019, The lancet. HIV.

[5]  P. Sullivan,et al.  Getting pre-exposure prophylaxis (PrEP) to the people: opportunities, challenges and emerging models of PrEP implementation. , 2018, Sexual health.

[6]  D. Klepser,et al.  Midwest pharmacists’ familiarity, experience, and willingness to provide pre-exposure prophylaxis (PrEP) for HIV , 2018, PloS one.

[7]  R. Horne,et al.  The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour , 2018, AIDS and Behavior.

[8]  M. Hellard,et al.  Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  W. Powderly,et al.  Missed Opportunities to Prescribe HIV Pre-Exposure Prophylaxis by Primary Care Providers in Saint Louis, Missouri. , 2018, LGBT health.

[10]  K. Cranston,et al.  Factors Associated with Pre-exposure Prophylaxis in a Highly Insured Population of Urban Men Who Have Sex with Men, 2014 , 2018, AIDS and Behavior.

[11]  A. Bourne,et al.  What qualities in a potential HIV pre-exposure prophylaxis service are valued by black men who have sex with men in London? A qualitative acceptability study , 2018, International journal of STD & AIDS.

[12]  S. Beougher,et al.  Facilitators and Barriers to Pre‐Exposure Prophylaxis Willingness Among Young Men Who Have Sex with Men Who Use Geosocial Networking Applications in California , 2017, AIDS patient care and STDs.

[13]  C. Portillo,et al.  Does pre‐exposure prophylaxis for HIV prevention in men who have sex with men change risk behaviour? A systematic review , 2017, Journal of clinical nursing.

[14]  J. Richardus,et al.  Behavioral interventions to reduce HIV risk behavior for MSM and transwomen in Southeast Asia: a systematic review , 2017, AIDS care.

[15]  S. Golub,et al.  Enhancing PrEP Access for Black and Latino Men Who Have Sex With Men , 2016, Journal of acquired immune deficiency syndromes.

[16]  J. Fox,et al.  Pre-exposure Prophylaxis for HIV Prevention: Why, What, Who and How , 2016, Infectious Diseases and Therapy.

[17]  J. Dovidio,et al.  Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers’ Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care , 2016, PloS one.

[18]  P. Ghys,et al.  What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach , 2016, PloS one.

[19]  A. Nardone,et al.  Healthcare providers' knowledge of, attitudes to and practice of pre‐exposure prophylaxis for HIV infection , 2016, HIV medicine.

[20]  Sheena McCormack,et al.  Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial , 2016, The Lancet.

[21]  David Thompson,et al.  On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. , 2015, The New England journal of medicine.

[22]  J. Parsons,et al.  Willingness to Take PrEP and Potential for Risk Compensation Among Highly Sexually Active Gay and Bisexual Men , 2015, AIDS and Behavior.

[23]  N. Ford,et al.  Adherence to HIV postexposure prophylaxis: a systematic review and meta-analysis , 2014, AIDS.

[24]  L. Eaton,et al.  Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event. , 2014, Sexual health.

[25]  P. Sainsbury,et al.  Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[26]  J. Eyles,et al.  Developing and Implementing a Triangulation Protocol for Qualitative Health Research , 2006, Qualitative health research.

[27]  R. Foster,et al.  Addressing Epistemologic and Practical Issues in Multimethod Research: A Procedure for Conceptual Triangulation , 1997, ANS. Advances in nursing science.

[28]  Gerald Prein,et al.  Triangulation: Validity and empirically-based hypothesis construction , 1997 .

[29]  Dawn Joseph,et al.  Qualitative research methods in mental health and psychotherapy: A guide for students and practitioners , 2011, QMiP Bulletin.

[30]  Jonathan A. Smith,et al.  A practical guide to using Interpretative Phenomenological Analysis in qualitative research psychology , 2014 .