Facilitators and barriers affecting PrEP adherence among Thai men who have sex with men (MSM) in the HPTN 067/ADAPT Study

ABSTRACT

The HPTN 067/ADAPT Study evaluated the feasibility, acceptability, patterns of adherence and coverage for three randomly assigned oral FTC/TDF pre-exposure prophylaxis (PrEP) dosing regimens to prevent HIV infection. Using qualitative methods, we explored facilitators and barriers among a subset of men who have sex with men (MSM) participants in Bangkok, Thailand. Between August 2013 and March 2014, 32 HPTN 067/ADAPT participants joined in 6 focus group discussions, and 6 attended key informant interviews. Facilitators of PrEP adherence included use of strategies to have PrEP available when needed, simplicity in regimen requirements with recognition that more complex regimens may take some time to master, ability to plan for sex, receipt of social and technology support, ability to use a PrEP regimen that best matches to one’s own patterns of sex, and experiences with PrEP as a part of health and well-being. Challenges to PrEP adherence included perceptions of no or low HIV risk, difficulties following regimens when intoxicated, concerns about side effects, experience of HIV stigma, and affordability of PrEP outside of study context influencing uptake and use in the community. Preferences for regimens varied, suggesting that multiple PrEP effective regimen options should be available to fit those with different needs.

KEYWORDS:

• HIV
• PrEP
• men who have sex with men
• young
• Thailand

Acknowledgements

We would like to thank the staff at Silom Community Clinic @TropMed and TUC for their assistance. We also would like to thank the HPTN 067 Study Team, the NIH Division of AIDS (DAIDS), U.S. National Institute of Allergy and Infectious Diseases (NIAID), U.S. National Institute for Mental Health (NIMH), Gilead Sciences, Inc., Thailand MOPH, and U.S. Centers for Disease Control and Prevention, for their support. We are deeply grateful to MSM participants from the Silom Community Clinic @TropMed for their time and contributions. Lastly, we would like to dedicate this work to the memory of Ms Supaporn Chaikummao and Patrick J. Flaherty, who devoted their professional lives to investigating new methods of HIV prevention.

Disclaimer: The findings and conclusions presented in this paper are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Tareerat Chemnasiri http://orcid.org/0000-0001-9718-5280

K. Rivet Amico http://orcid.org/0000-0002-4458-6934

Additional information

Funding

This work was supported by award number UM1AI069418 from the Division of AIDS (DAIDS), U.S. National Institute of Allergy and Infectious Diseases (NIAID), U.S. National Institute of Mental Health (NIMH), U.S. National Institutes of Health (NIH). Gilead Sciences provided study drug for the HPTN 067 study. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.