Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Process evaluation and recommendation...

Area of Science:

• Public Health
• HIV Prevention
• Implementation Science

Background:

• HIV pre-exposure prophylaxis (PrEP) is a cornerstone of global HIV transmission elimination strategies.
• Effective PrEP implementation requires sustained adherence and retention in care, which presents significant challenges.
• Scotland's PrEP programme evaluation aimed to identify and address these challenges.

Purpose of the Study:

• To explore barriers and facilitators to PrEP adherence and retention in care within Scotland's PrEP programme.
• To systematically develop evidence-based, theoretically-informed recommendations to enhance PrEP programme effectiveness.
• To identify collaborative intervention points across public health, clinical, and community practices.

Main Methods:

• Semi-structured interviews and focus groups with PrEP users, healthcare professionals, and NGO staff.
• Thematic analysis to identify key barriers and facilitators.
• Application of implementation science tools (Theoretical Domains Framework, Intervention Functions, Behaviour Change Technique Taxonomy, APEASE criteria) and expert opinion for recommendation generation.

Main Results:

• Key barriers include complex on-demand dosing, premature cessation of PrEP, side-effects, inflexible appointments, and stigma.
• Facilitators identified include flexible scheduling, appointment reminders, and follow-up processes for non-attenders.
• Twenty-five recommendations were generated, focusing on individualized care, system reminders, partner support, clear dosing guidance, and side-effect management.

Conclusions:

• Challenges in PrEP adherence and retention can diminish its effectiveness at both individual and population levels.
• Collaborative interventions are essential to address identified barriers and enhance PrEP programme outcomes.
• The study provides actionable solutions to improve PrEP delivery and uptake.