Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis
Introduction In Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influenc...
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| Format: | Article |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/1/e017368.full |
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| author | Simon Mwima Rhoda Kitti Wanyenze Rose Naigino Laura M Bogart William Musoke Semei C Mukama Stella Allupo Herbert Kadama Barbara Mukasa |
| author_facet | Simon Mwima Rhoda Kitti Wanyenze Rose Naigino Laura M Bogart William Musoke Semei C Mukama Stella Allupo Herbert Kadama Barbara Mukasa |
| author_sort | Simon Mwima |
| collection | DOAJ |
| description | Introduction In Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influencing PrEP continuation and discontinuation among fisherfolk in Uganda using the Consolidated Framework for Implementation Research (CFIR).Methods Participants were recruited from two fishing communities near Entebbe, Uganda. One community received enhanced PrEP support (adherence support, educational workshops and check-in calls), while the other received standard healthcare outreach. Forty fisherfolk (20 who continued PrEP and 20 who discontinued PrEP) were interviewed 6 months after initiating PrEP. Data were analysed using directed content analysis, with high inter-rater consistency. Ethical approval and informed consent were obtained.Results Findings highlighted several determinants of PrEP continuation and discontinuation across the CFIR domains. Intervention characteristics such as side effects and the pill burden were significant barriers, particularly for women who reported nausea and stomach issues. Individual characteristics revealed that perceived HIV risk influenced PrEP use, with women’s decisions often influenced by their partners' behaviours and mobility. However, insufficient information and education, especially among women, led to misunderstandings and discontinuation. Inner-setting factors like mobility issues and the distance to healthcare clinics posed significant barriers exacerbated by the geographical isolation of fishing communities. In the outer setting, high HIV prevalence motivated PrEP initiation, but stigma, particularly the misconception that PrEP is an antiretroviral drug used by people living with HIV, led to discontinuation.Conclusion Fisherfolk in Uganda encounter multiple barriers to PrEP continuation, with women facing more significant challenges. Enhanced support strategies are essential for improving PrEP adherence and informing future HIV prevention interventions in high-risk populations. |
| format | Article |
| id | doaj-art-89d084725295466a9c6bf39ff82ce554 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-89d084725295466a9c6bf39ff82ce5542025-01-28T12:45:14ZengBMJ Publishing GroupBMJ Global Health2059-79082025-01-0110110.1136/bmjgh-2024-017368Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysisSimon Mwima0Rhoda Kitti Wanyenze1Rose Naigino2Laura M Bogart3William Musoke4Semei C Mukama5Stella Allupo6Herbert Kadama7Barbara Mukasa8Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USASchool of Public Health, Makerere University, Kampala, UgandaDepartment of Disease Control and Environmental Health, San Diego State University, San Diego, California, USARAND Corporation, Santa Monica, California, USAMildmay Uganda, Kampala, UgandaMildmay Uganda, Kampala, UgandaInfectious Disease Institute Uganda, Kampala, UgandaMinistry of Health, Kampala, UgandaMildmay Uganda, Kampala, UgandaIntroduction In Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influencing PrEP continuation and discontinuation among fisherfolk in Uganda using the Consolidated Framework for Implementation Research (CFIR).Methods Participants were recruited from two fishing communities near Entebbe, Uganda. One community received enhanced PrEP support (adherence support, educational workshops and check-in calls), while the other received standard healthcare outreach. Forty fisherfolk (20 who continued PrEP and 20 who discontinued PrEP) were interviewed 6 months after initiating PrEP. Data were analysed using directed content analysis, with high inter-rater consistency. Ethical approval and informed consent were obtained.Results Findings highlighted several determinants of PrEP continuation and discontinuation across the CFIR domains. Intervention characteristics such as side effects and the pill burden were significant barriers, particularly for women who reported nausea and stomach issues. Individual characteristics revealed that perceived HIV risk influenced PrEP use, with women’s decisions often influenced by their partners' behaviours and mobility. However, insufficient information and education, especially among women, led to misunderstandings and discontinuation. Inner-setting factors like mobility issues and the distance to healthcare clinics posed significant barriers exacerbated by the geographical isolation of fishing communities. In the outer setting, high HIV prevalence motivated PrEP initiation, but stigma, particularly the misconception that PrEP is an antiretroviral drug used by people living with HIV, led to discontinuation.Conclusion Fisherfolk in Uganda encounter multiple barriers to PrEP continuation, with women facing more significant challenges. Enhanced support strategies are essential for improving PrEP adherence and informing future HIV prevention interventions in high-risk populations.https://gh.bmj.com/content/10/1/e017368.full |
| spellingShingle | Simon Mwima Rhoda Kitti Wanyenze Rose Naigino Laura M Bogart William Musoke Semei C Mukama Stella Allupo Herbert Kadama Barbara Mukasa Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis BMJ Global Health |
| title | Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis |
| title_full | Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis |
| title_fullStr | Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis |
| title_full_unstemmed | Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis |
| title_short | Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis |
| title_sort | applying implementation science frameworks to understand why fisherfolk continue or discontinue pre exposure prophylaxis for hiv prevention in uganda a qualitative analysis |
| url | https://gh.bmj.com/content/10/1/e017368.full |
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