Revista de SIDA e investigación clínica

A Survey of Stakeholder Perceptions towards Pre-Exposure Prophylaxes and Prospective HIV Microbicides and Vaccines in Kenya

Abstract

Prince Bahati Ngongo, Judie Mbogua, Jack Ndegwa, George Githuka, Bonnie Bender and Florence Manguyu

Understanding potential users' preferences for new HIV prevention options is an important component in designing effective roll-out and uptake plans. We surveyed opinions of 164 opinion leaders, health workers and key population representatives in five regions in Kenya to examine their preferences, concerns, perceived benefits and recommendations on Pre-exposure prophylaxes (PrEP) and potential HIV microbicides and vaccines. Data was captured via questionnaires and focus group discussions. We coded emerging themes in the data then extracted representative quotes. Cost, accessibility and efficacy were key determinants of acceptability and demand across prevention modalities. Myths, misconceptions, product associated stigma and anticipated societal resistance were identified as potential barriers to uptake, though the specifics of these varied from product to product. Vaccines elicited specific fears related to product-induced HIV infection and infertility. There was a strong preference for injectable over oral delivery of vaccines. There was also the perception that vaccines were more 'socially acceptable' and carried less stigma and concern around disinhibition than the other products. For microbicides, most groups favored the self-administered gel over ring or film because of individual's ability to control when to stop in case of side effect; however, health care providers showed a preference for the ring. Respondents expressed concern over potential sideeffects and the stigmatization of product users. With PrEP, there was a difference of opinion on the preferred mode of administration, with health care providers and MSM preferring oral PrEP and other respondents opting for longlasting injectable. Perceived benefit of PrEP was its demonstrated ability to protect against HIV. The primary concern associated with PrEP was safety and side effects. These included anxieties about the risk of taking drugs when one was not sick. Product design needs to proactively take into account community preferences and provide options that fit individual preferences as well as socio-cultural contexts.