“Why should I take drugs for your infection?”: Outcomes of formative research on the use of HIV pre-exposure prophylaxis in Nigeria

Idoko, J; Oluwatoyin Folayan, M; Yusufu Dadem, N; Oluwatosin Kolawole, G; Anenih, J; Alhassan, E BMC Public Health, 2015; www.biomedcentral.com/1471-2458/15/349

Nigeria has the second highest number of new HIV infections annually, and prevention efforts have yet to significantly slow the epidemic. Therefore, it is important to explore new strategies for preventing new infections. The introduction of pre-exposure prophylaxis (PrEP) for use by persons at high risk of HIV infection has new potential in preventing new HIV infections.

This PrEP formative research is one of the three phases of the PrEP Study in Nigeria. The first phase of the Nigeria PrEP Study was to determine the best combination of interventions for achieving significant reduction in HIV transmission between serodiscordant couples, life gains, and the combination of interventions.

This exploratory descriptive study aims to explore public opinion, community interest, and perceptions about the use and access to PrEP in Nigeria. It explores and assesses:

  • civil society, community stakeholders, policy makers who are the appropriate target group for the PrEP demonstration study
  • community interest and perception about the use of PrEP as part of HIV prevention in Nigeria
  • best methods of communication about PrEP to different stakeholders before, during, and after the proposed PrEP feasibility study
  • best ways to engage the community before, during, and after the proposed PrEP feasibility study

This mixed method approach was conducted between October 2013 and February 2014 in Abuja, Edo, Cross River and Benue states. It included:

  • telephone interviews
  • in-depth interviews (IDIs)
  • focus group discussions (FGDs)
  • consultative meetings with critical stakeholders in HIV prevention, treatment, care, and
  • support programmes in Nigeria
  • an online survey to explore opinions on the design of a future PrEP demonstration project in Nigeria

The paper outlines a comprehensive description of the study’s participants.

Data Collection

Quantitative and qualitative data were collected during telephone interviews using a guide comprising 11 questions. Topics covered included:

  • knowledge about PrEP
  • suggested target groups for the PrEP clinical study
  • potential positive outcomes of PrEP
  • barriers to PrEP access
  • perceived challenges to PrEP use

Telephone interview questions

11 IDIs were conducted and 13 FGD transcripted were analysed. A total 70 responses comprising of 51.4% men, 44.3% women and 4.3% participants of unidentified gender were received from the online survey.

Data were inductively examined using a content analytic approach to construct descriptive categories. Results were compared and linkages made between these various data sources allowing for confirmation, corroboration, and validation of study results through a triangulation process.

Findings

  • 74.3% of the telephone interview respondents and 93.9% of the online survey respondents felt that the PrEP use would provide additional benefits for the country’s HIV response programme by helping to reduce the HIV incidence, increase lifespan, and preserve long-term relationships in serodiscordant couples.
  • Most respondents felt that PrEP use by key affected populations would help reduce the HIV incidence.
  • Stigma was identified as a major concern and a potential barrier for the acceptance and use of PrEP by HIV serodiscordant couples.
  • Electronic and print media were identified as important means for massive public education to prevent stigma and create awareness about PrEP.
  • In a male dominated society such as Nigeria, HIV-negative male partners in serodiscordant relationships may resist enrolment in PrEP programmes. This may be complicated by the fact that the identified index partner in most serodiscordant relationships in Nigeria is an HIV-positive woman, who is often diagnosed during pregnancy.

This study shows that there is high public interest and support for the use of PrEP as part of HIV-prevention in Nigeria. But much depends on the actions taken by multiple players including the capacity to conduct couple counselling and identify serodiscordant couples, motivation of HIV-negative male partners to use PrEP, adherence to the PrEP regimen and HIV monitoring, and effective public education addressing stigma. 

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