My Eighteen-Year Old Girl Will Start Going in for Men, Knowing She Can't Contract HIV: Ugandan Health Care Workers' knowledge and Attitudes on PrEP a Mixed Methods Study
Summary:
Despite its availability, few people start using PrEP, partly because health care providers are not offering it systematically. In this PEPFAR-funded study we explored the PrEP-related knowledge and behavioral characteristics of health care providers from Mukono, Uganda, to better understand provider prescribing practices. We used a mixed methods approach to collect data from health care providers working in Mukono district between August 2018 February 2019. A quantitative survey collected data on PrEP knowledge, beliefs, attitudes, perceived social norms, and intention to use and to prescribe PrEP. Descriptive analysis was conducted and independent associations with the outcome variable intention to prescribe PrEP were identified through logistic regression. Qualitative data was collected from 19 providers through two focus group discussions (FGDs) using a semi-structured discussion guide. Among the 100 providers who completed the questionnaire, almost all heard of PrEP, but only 10% had perfect knowledge of PrEP, potential side effects being the least well known. Mean scores varied from 2.6/4 for beliefs related to PrEP to 3.8/4 for intention to offer PrEP. Perceived social norms and intention to use PrEP were independently associated with the intention to offer PrEP. The main challenges to PrEP dispensing, as identified in the FGDs, were social norms, adherence, risk of STIs and unwanted pregnancies. The participating providers expressed willingness to prescribe PrEP to young female sex workers, but persistent gaps in knowledge, erroneous beliefs, and perceived social norms suggest that further training and social and behavior change interventions are needed.
Background/Objectives:
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method for people at high risk. Despite PrEP being available in health facilities and recommended as a prevention method by the Ugandan national guidance (2017), health care providers are not offering it systematically and only a small percentage of people who would benefit from it start PrEP. To better understand provider prescribing practices, we explored PrEP-related knowledge and behavioral characteristics of health care providers in Mukono district, Uganda, as part of a PEPFAR-funded demonstration project on the feasibility and acceptability of a PrEP program targeting young female sex workers.
Description of Intervention and/or Methods/Design:
We used a mixed methods approach to collect data from a convenience sample of health care providers working in Mukono district between August 2018 February 2019. We administered a structured quantitative questionnaire in English which collected sociodemographic data, PrEP knowledge, beliefs, attitudes, perceived social norms, and intention to use and to prescribe PrEP. A semi-structured discussion guide was used to elicit perspectives from 19 providers through 2 focus group discussions (FGDs) in English. Verbatim transcripts were analyzed for emerging themes regarding knowledge, willingness to prescribe PrEP, potential benefits and challenges. Behavioral questions were presented as Likert scales and results for the different domains were aggregated into combined scores. Bivariate analyses using Chi-squared tests were used to assess significant associations between sociodemographic and quantitative characteristics and intention to prescribe PrEP. Unadjusted binomial logistic regression was used to estimate odds ratios, to assess predictors of intention to prescribe PrEP.
Results/Lessons Learned:
Among the 100 providers who completed the questionnaire, mean age was 38 years, 70% were females and 48% were nurses. While almost all had heard of PrEP, only 10% had perfect knowledge of PrEP, with potential side effects being the least well known. Mean score for social norms was 3.31/4, for beliefs related to PrEP it was 2.6/4, for attitudes 3.45/4, for perceived availability it was 3.25/4, the score for intention to use PrEP was 3.4/4 and the intention to offer PrEP was 3.82/4. In the multivariate model, perceived social norms and intention to use PrEP were independently associated with the intention to prescribe PrEP. While expressing interest in prescribing PrEP to individuals at high risk (key populations, serodiscordant couples, the healthcare workers participating in FGDs acknowledged gaps in knowledge and emphasized challenges to PrEP, such as social norms, adherence, the risk of sexually transmitted infections and unwanted pregnancies.
Discussion/Implications for the Field:
While the majority of the participating providers expressed willingness to prescribe PrEP to young female sex workers, persistent gaps in their knowledge, erroneous beliefs, and perceived social norms suggest that further training and social and behavior change interventions are needed, as PrEP is being rolled out in Uganda. The PrEP program would also benefit from targeted demand creation, particularly for key populations, and development of standardized adherence counseling tools. As PrEP provision is being scaled up, periodic monitoring of community social norms and provider behavior would be necessary, until its acceptance as a standard intervention in the HIV prevention toolkit.
Abstract submitted by:
Eniko Akom
Xiaofang Song - HIV Research
Francis Kiweewa - Makerere University Walter Reed Project
Sanyukta Mathur - Population Council
Hannah Kibuuka - Makerere University Walter Reed Project
Despite its availability, few people start using PrEP, partly because health care providers are not offering it systematically. In this PEPFAR-funded study we explored the PrEP-related knowledge and behavioral characteristics of health care providers from Mukono, Uganda, to better understand provider prescribing practices. We used a mixed methods approach to collect data from health care providers working in Mukono district between August 2018 February 2019. A quantitative survey collected data on PrEP knowledge, beliefs, attitudes, perceived social norms, and intention to use and to prescribe PrEP. Descriptive analysis was conducted and independent associations with the outcome variable intention to prescribe PrEP were identified through logistic regression. Qualitative data was collected from 19 providers through two focus group discussions (FGDs) using a semi-structured discussion guide. Among the 100 providers who completed the questionnaire, almost all heard of PrEP, but only 10% had perfect knowledge of PrEP, potential side effects being the least well known. Mean scores varied from 2.6/4 for beliefs related to PrEP to 3.8/4 for intention to offer PrEP. Perceived social norms and intention to use PrEP were independently associated with the intention to offer PrEP. The main challenges to PrEP dispensing, as identified in the FGDs, were social norms, adherence, risk of STIs and unwanted pregnancies. The participating providers expressed willingness to prescribe PrEP to young female sex workers, but persistent gaps in knowledge, erroneous beliefs, and perceived social norms suggest that further training and social and behavior change interventions are needed.
Background/Objectives:
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method for people at high risk. Despite PrEP being available in health facilities and recommended as a prevention method by the Ugandan national guidance (2017), health care providers are not offering it systematically and only a small percentage of people who would benefit from it start PrEP. To better understand provider prescribing practices, we explored PrEP-related knowledge and behavioral characteristics of health care providers in Mukono district, Uganda, as part of a PEPFAR-funded demonstration project on the feasibility and acceptability of a PrEP program targeting young female sex workers.
Description of Intervention and/or Methods/Design:
We used a mixed methods approach to collect data from a convenience sample of health care providers working in Mukono district between August 2018 February 2019. We administered a structured quantitative questionnaire in English which collected sociodemographic data, PrEP knowledge, beliefs, attitudes, perceived social norms, and intention to use and to prescribe PrEP. A semi-structured discussion guide was used to elicit perspectives from 19 providers through 2 focus group discussions (FGDs) in English. Verbatim transcripts were analyzed for emerging themes regarding knowledge, willingness to prescribe PrEP, potential benefits and challenges. Behavioral questions were presented as Likert scales and results for the different domains were aggregated into combined scores. Bivariate analyses using Chi-squared tests were used to assess significant associations between sociodemographic and quantitative characteristics and intention to prescribe PrEP. Unadjusted binomial logistic regression was used to estimate odds ratios, to assess predictors of intention to prescribe PrEP.
Results/Lessons Learned:
Among the 100 providers who completed the questionnaire, mean age was 38 years, 70% were females and 48% were nurses. While almost all had heard of PrEP, only 10% had perfect knowledge of PrEP, with potential side effects being the least well known. Mean score for social norms was 3.31/4, for beliefs related to PrEP it was 2.6/4, for attitudes 3.45/4, for perceived availability it was 3.25/4, the score for intention to use PrEP was 3.4/4 and the intention to offer PrEP was 3.82/4. In the multivariate model, perceived social norms and intention to use PrEP were independently associated with the intention to prescribe PrEP. While expressing interest in prescribing PrEP to individuals at high risk (key populations, serodiscordant couples, the healthcare workers participating in FGDs acknowledged gaps in knowledge and emphasized challenges to PrEP, such as social norms, adherence, the risk of sexually transmitted infections and unwanted pregnancies.
Discussion/Implications for the Field:
While the majority of the participating providers expressed willingness to prescribe PrEP to young female sex workers, persistent gaps in their knowledge, erroneous beliefs, and perceived social norms suggest that further training and social and behavior change interventions are needed, as PrEP is being rolled out in Uganda. The PrEP program would also benefit from targeted demand creation, particularly for key populations, and development of standardized adherence counseling tools. As PrEP provision is being scaled up, periodic monitoring of community social norms and provider behavior would be necessary, until its acceptance as a standard intervention in the HIV prevention toolkit.
Abstract submitted by:
Eniko Akom
Xiaofang Song - HIV Research
Francis Kiweewa - Makerere University Walter Reed Project
Sanyukta Mathur - Population Council
Hannah Kibuuka - Makerere University Walter Reed Project
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)