Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study

Background: PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. Methods: We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. Results: We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. Conclusion: The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04066881

Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study

Background PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. Methods We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. Results We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. Conclusion The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. Trial registration https://clinicaltrials.gov/ct2/show/NCT0406688

Long-lasting insecticidal nets (LLINs) use among household members for protection against mosquito bite in Mogadishu districts.

Understanding long-lasting insecticidal nets (LLINs) utilization is important in monitoring and quantifying the impact of past and current prevention and control efforts of malaria. A cross-sectional study was carried out on a sample of 409 households in Mogadishu, to estimate the LLIN use and assess barriers to its utilization. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge, and the use of preventive measures. LLINs use was assessed using multivariable generalized estimating equations with adjustment for clustering of study participants within the same household. Out of 409 households only 155 (37.9%) owned LLINs. Out of 237 owned LLINs, 199 (84.0%) were used. Median household size being 6.0 (3.0), intra-household net accessibility was low, with one net (42.6%) frequent. Most nets were from mass distribution (55.7%) and obtained '12 months ago'. Un-partnered respondents (unadjusted odds ratio [OR] 0.34, 95% CI 0.14, 0.82; p = 0.017) compared with partnered (married) respondents, large-sized household (adjusted OR 0.83, 96% CI 0.74-0.94; p = 0.002). There was marginal evidence of a greater odds of LLIN utilization among respondents knowledgeable of the correct cause of malaria, that is, mosquito bites (AOR 3.19, 95% CI 0.77, 13.2; p = 0.11) but was not statistically significant. Among households owning nets, most of the LLINs were hung the night prior to the survey (7.9% versus 98%) and was associated with greater marginal odds of utilization (p<0.001). Ownership of LLINs is insufficient in Mogadishu districts affecting household-level access and utilization. If this is not checked, this could weaken the progress made on malaria control efforts. LLIN utilization was modest and largely driven by recently acquired nets showing a desire to utilize them despite low coverage. These imply that mass and facility-based distribution, and awareness campaigns will remain relevant, but efforts for willingness-to-pay for LLINs should be strengthened to sustain coverage and replacements of worn-out nets

“God Didn’t Make a Mistake in Creating Me”: Intrapersonal Resilience Processes among Gay and Bisexual Male Youth in Kenya

Gay and bisexual male youth in Kenya experience human rights violations, including pervasive stigma and discrimination, and these oppressive forces are associated with elevated rates of mental health concerns. Despite these challenges, many gay and bisexual male youth in Kenya are thriving during this critical developmental period. This study explored intrapersonal processes that gay and bisexual male youth in Kisumu, Kenya, highlight as important to developing, and demonstrating resilience in the face of adversity. We conducted qualitative in-depth interviews (IDIs) with 40 gay and bisexual male youth, ages 20–30 (mean = 26.4), and an additional 20 IDIs with gay and bisexual men, ages 22–45 (mean = 26.6), who were working as peer educators (total n = 60), all in Kisumu, Kenya. A total of nine primary themes emerged which describe various intrapersonal resilience processes enacted by gay and bisexual male youth, including sexual identity acceptance, self-confidence, self-love, religious/spiritual affirmation, adaptive coping, successful navigation, legal rights awareness, economic stability, and advocacy satisfaction. These data demonstrate the range of positive personal processes that promote mental health and wellbeing among gay and bisexual male youth in Kenya. We discuss implications of these findings for community-based interventions, and call for a research paradigm shift away from deficits and toward resilience