Advertisement

Acceptability and Predictors of Uptake of Anti-retroviral Pre-exposure Prophylaxis (PrEP) Among Fishing Communities in Uganda: A Cross-Sectional Discrete Choice Experiment Survey

  • Monica O. KuteesaEmail author
  • Mathew Quaife
  • Sam Biraro
  • Kenneth R. Katumba
  • Janet Seeley
  • Anatoli Kamali
  • Damalie Nakanjako
Original Paper

Abstract

We used a discrete choice experiment to assess the acceptability and potential uptake of HIV pre-exposure prophylaxis (PrEP) among 713 HIV-negative members of fishing communities in Uganda. Participants were asked to choose between oral pill, injection, implant, condoms, vaginal ring (women), and men circumcision. Product attributes were HIV prevention effectiveness, sexually transmitted infection (STI) prevention, contraception, waiting time, and secrecy of use. Data were analysed using mixed multinomial logit and latent class models. HIV prevention effectiveness was viewed as the most important attribute. Both genders preferred oral PrEP. Women least preferred the vaginal ring and men the implant. Condom use was predicted to decrease by one third among men, and not to change amongst women. Oral PrEP and other new prevention technologies are acceptable among fishing communities and may have substantial demand. Future work should explore utility of multiple product technologies that combine contraception with HIV and other STI prevention.

Keywords

Fisherfolk HIV prevention Discrete choice experiment Pre-exposure prophylaxis Uganda 

Notes

Authors’ contribution

MOK, DN, SB, AK, contributed to the study design. MOK, MQ, DN, SB developed the study tools, MOK, DN, KK, oversaw implementation of the study. MOK, DN, and KK, and AK oversaw the data collection. MOK, and MQ, did the data analysis. MOK, and MQ, wrote the first draft of the manuscript. All authors contributed to the interpretation of the results and revision of the manuscript for coherence, and intellectual content.

Funding

This study was funded by the Health Resources & Service Administration U91HA06801B) and University of Washington Center for AIDS Research (CFAR), an NIH funded program (P30 AI027757) which is supported by the following NIH Institutes and Centers (NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA). The International Partnership for Microbicides (IPM) provided dummy vaginal rings for demonstration purposes.

Compliance with Ethical Standards

Conflict of interest

The authors have declared that no competing interests exist.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2019_2418_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)

References

  1. 1.
  2. 2.
    Seeley J, Nakiyingi-Miiro J, Kamali A, Mpendo J, Asiki G, Abaasa A, et al. High HIV incidence and socio-behavioral risk patterns in fishing communities on the shores of Lake Victoria, Uganda. Sex Transm Dis. 2012;39(6):433–9.Google Scholar
  3. 3.
    Kiwanuka N, Ssetaala A, Mpendo J, Wambuzi M, Nanvubya A, Sigirenda S, et al. High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria Uganda. J Int AIDS Soc. 2013;16(1):18621.Google Scholar
  4. 4.
    Kiwanuka N, Ssetaala A, Nalutaaya A, Mpendo J, Wambuzi M, Nanvubya A, et al. High incidence of HIV-1 infection in a general population of fishing communities around Lake Victoria, Uganda. PLoS ONE. 2014;9(5):e94932.Google Scholar
  5. 5.
    Ministry of Health. National HIV Prevention Strategy 2011–2015. http://www.aidsuganda.org/images/documents/NPS.pdf.
  6. 6.
    Kamali A, Price M, Lakhi S, Karita E, Inambao M, Sanders E, et al. Creating an African HIV clinical research and prevention trials network: HIV prevalence, incidence and transmission. PLoS ONE. 2014;10(1):e0116100.Google Scholar
  7. 7.
    Asiki G, Baisley K, Kamali A, Kaleebu P, Seeley J, Newton R. A prospective study of trends in consumption of cigarettes and alcohol among adults in a rural Ugandan population cohort, 1994–2011. Trop Med Int Health. 2015;20(4):527–36.Google Scholar
  8. 8.
    Opio A, Muyonga M, Mulumba N. HIV infection in fishing communities of Lake Victoria Basin of Uganda: a cross-sectional sero-behavioral survey. PLoS ONE. 2013;8(8):e70770.Google Scholar
  9. 9.
    Allison EH, Seeley J. Another group at high risk for HIV. Science. 2004;305:1104.Google Scholar
  10. 10.
    Kissling E, Allison EH, Seeley JA, Russell S, Bachmann M, Musgrave SD, et al. Fisherfolk are among groups most at risk of HIV: cross-country analysis of prevalence and numbers infected. AIDS. 2005;19(17):1939–46.Google Scholar
  11. 11.
    Kiwanuka N, Ssetaala A, Mpendo J, Wambuzi M, Nanvubya A, Sigirenda S, et al. High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria, Uganda. J Int AIDS Soc. 2013;16:18621.Google Scholar
  12. 12.
    Sileo K, Kintu M, Kiene S. History of sexual abuse, depression, and alcohol use as risk factors for HIV infection in high HIV prevalence fishing communities in rural Uganda. Ann Glob Health. 2015;1(81):134–5.Google Scholar
  13. 13.
    Tumwesigye NM, Atuyambe L, Wanyenze RK, Kibira SP, Li Q, Wabwire-Mangen F, et al. Alcohol consumption and risky sexual behaviour in the fishing communities: evidence from two fish landing sites on Lake Victoria in Uganda. BMC Public Health. 2012;12(1):1.Google Scholar
  14. 14.
    Kibengo FM, Ruzagira E, Katende D, Bwanika AN, Bahemuka U, Haberer JE, et al. Safety, adherence and acceptability of intermittent tenofovir/emtricitabine as HIV pre-exposure prophylaxis (PrEP) among HIV-uninfected Ugandan volunteers living in HIV-serodiscordant relationships: a randomized, clinical trial. PLoS ONE. 2013;8(9):e74314.Google Scholar
  15. 15.
    Kwena ZA, Camlin CS, Shisanya CA, Mwanzo I, Bukusi EA. Short-term mobility and the risk of HIV infection among married couples in the fishing communities along Lake Victoria, Kenya. PLoS ONE. 2013;8(1):e54523.Google Scholar
  16. 16.
    Nunan F. Mobility and fisherfolk livelihoods on Lake Victoria: implications for vulnerability and risk. Geoforum. 2010;41(5):776–85.Google Scholar
  17. 17.
    Nunan F, Luomba J, Lwenya C, Yongo E, Odongkara K, Ntambi B. Finding space for participation: fisherfolk mobility and co-management of Lake Victoria fisheries. Environ Manage. 2012;50(2):204–16.Google Scholar
  18. 18.
    Uganda HIV/AIDS knowledge management communications capacity. Most at risk populations-fishing communities and HIV in Uganda: synthesis of information and evidence to inform the response. 2014.Google Scholar
  19. 19.
    Buchbinder SP, Glidden DV, Liu AY, McMahan V, Guanira JV, Mayer KH, et al. HIV pre-exposure prophylaxis in men who have sex with men and transgender women: a secondary analysis of a phase 3 randomised controlled efficacy trial. Lancet Infect Dis. 2014;14(6):468–75.Google Scholar
  20. 20.
    Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.Google Scholar
  21. 21.
    Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.Google Scholar
  22. 22.
    Karim QA, Karim SSA, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–74.Google Scholar
  23. 23.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.Google Scholar
  24. 24.
    Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2013;381(9883):2083–90.Google Scholar
  25. 25.
    Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151.Google Scholar
  26. 26.
    McCormack S (ed) Pragmatic open-label randomised trial of preexposure prophylaxis: the PROUD study. Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 22LB2015.Google Scholar
  27. 27.
    Ministry of Health Uganda. Consolidated guidelines for prevention and treatment of HIV in Uganda. 2016. https://aidsfree.usaid.gov/sites/default/files/uganda_hiv_gl_2016.pdf.
  28. 28.
    Baeten JM, Palanee-Phillips T, Brown ER, Schwartz K, Soto-Torres LE, Govender V, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–32.Google Scholar
  29. 29.
    Nel A, van Niekerk N, Kapiga S, Bekker L-G, Gama C, Gill K, et al. Safety and efficacy of a dapivirine vaginal ring for HIV prevention in women. N Engl J Med. 2016;375(22):2133–43.Google Scholar
  30. 30.
    Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–18.Google Scholar
  31. 31.
    HIV Prevention Trials Network. HPTN: A phase 3 double blind safety and efficacy study of long-acting injectable Cabotegravir compared to daily oral TDF/FTC for pre-exposure prophylaxis in HIV-uninfected women. 2018. https://www.hptn.org/research/studies/hptn084.
  32. 32.
    Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet. 2007;369(9562):657–66.Google Scholar
  33. 33.
    Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet. 2007;369(9562):643–56.Google Scholar
  34. 34.
    Centre for Disease Control. Pre-exposure prophylaxis for the prevention of HIV INFECTION in the United States. 2014. http://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf.
  35. 35.
    World Health Organization. Consolidated guidelines on general HIV care and the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2013. http://www.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf.
  36. 36.
    Baeten J, Celum C, editors. Antiretroviral pre-exposure prophylaxis for HIV-1 prevention among heterosexual African men and women: the Partners PrEP Study. 6th IAS Conference on HIV Pathogenesis, treatment and Prevention; 2011.Google Scholar
  37. 37.
    Mugwanya K, Donnell D, Celum C, Mugo N, Thomas K, Ngure K, et al. Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: post-unblinding analysis of the partners PrEP study. Sex Transm Infect. 2013;89(Suppl 1):A46.Google Scholar
  38. 38.
    Ndase P, Celum C, Campbell J, Bukusi E, Kiarie J, Katabira E, et al. Successful discontinuation of the placebo arm and provision of an effective HIV prevention product after a positive interim efficacy result: the partners prep study experience. JAIDS J Acquir Immune Deficiency Syndr. 2014;66(2):206–12.Google Scholar
  39. 39.
    Mensch BS, van der Straten A, Katzen LL. Acceptability in microbicide and PrEP trials: current status and a reconceptualization. Curr Opin HIV AIDS. 2012;7(6):534.Google Scholar
  40. 40.
    Francis JM, Grosskurth H, Changalucha J, Kapiga SH, Weiss HA. Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa. Trop Med Int Health. 2014;19(4):476–88.Google Scholar
  41. 41.
    AVAC Global advocacy for HIV prevention. Ongoing and planned PrEP trials and demonstration projects. 2013. http://www.prepwatch.org/wp-content/uploads/2014/01/PrEP-Trials-and-Demo-Projects-December-2013.pdf.
  42. 42.
    Seeley J, Tumwekwase G, Grosskurth H. Fishing for a living but catching HIV: AIDS and changing patterns of the organization of work in fisheries in Uganda. Anthropol Work Rev. 2009;30(2):66–76.Google Scholar
  43. 43.
    Uganda Ministry of Agricultue, Animal Industry and Fisheries.(n.d). Departments: Fisheries Resources. http://www.agriculture.go.ug/index-page-departments-id-87.htm.
  44. 44.
    Boffito M, Jackson A, Owen A, Becker S. New approaches to antiretroviral drug delivery: challenges and opportunities associated with the use of long-acting injectable agents. Drugs. 2014;74(1):7–13.Google Scholar
  45. 45.
    Kuteesa MO, Weiss HA, Abaas A, Nash S, Nsubuga RN, Newton R, et al. Feasibility of conducting HIV combination prevention interventions in fishing communities in Uganda: a cluster randomised trial. 2018.Google Scholar
  46. 46.
    Birt L, Scott S, Cavers D, Campbell C, Walter F. Member checking: a tool to enhance trustworthiness or merely a nod to validation? Qual Health Res. 2016;26(13):1802–11.Google Scholar
  47. 47.
    Ager A, Stark L, Sparling T, Ager W. Rapid appraisal in humanitarian emergencies using participatory ranking methodology (PRM). New York: Program on Forced Migration and Health Columbia University Mailman School of Public Health; 2011.Google Scholar
  48. 48.
    ChoiceMetrics. Ngene version 1.1.2. Sydney, Australia. 2012.Google Scholar
  49. 49.
    Hensher D, Rose J, Greene W. Applied choice analysis. 2nd ed. Cambridge: Cambridge University Press; 2015.Google Scholar
  50. 50.
    de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ. 2012;21(2):145–72.Google Scholar
  51. 51.
    Hess S, Bierlaire M, Polak JW. Estimation of value of travel-time savings using mixed logit models. Transp Res Part A. 2005;39(2–3):221–36.Google Scholar
  52. 52.
    Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV pre-exposure prophylaxis (PrEP) for all populations: a systematic review and meta-analysis. AIDS. 2016;30:1973.Google Scholar
  53. 53.
    Baeten JM, Palanee-Phillips T, Brown ER, Schwartz K, Soto-Torres LE, Govender V, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375:2121–32.Google Scholar
  54. 54.
    Davis KR, Weller SC. The effectiveness of condoms in reducing heterosexual transmission of HIV. Fam Plann Perspect. 1999;31(6):272–9.Google Scholar
  55. 55.
    Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66.Google Scholar
  56. 56.
    Delany-Moretlwe S, Mullick S, Eakle R, Rees H. Planning for HIV preexposure prophylaxis introduction: lessons learned from contraception. Curr Opin HIV AIDS. 2016;11(1):87–93.Google Scholar
  57. 57.
    Kouyoumdjian FG, Findlay N, Schwandt M, Calzavara LM. A systematic review of the relationships between intimate partner violence and HIV/AIDS. PLoS ONE. 2013;8(11):e81044.Google Scholar
  58. 58.
    Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, et al. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. Lancet Glob Health. 2015;3(1):e23–33.Google Scholar
  59. 59.
    Sileo KM, Kintu M, Kiene SM. The intersection of intimate partner violence and HIV risk among women engaging in transactional sex in Ugandan fishing villages. AIDS Care. 2018;30(4):444–52.Google Scholar
  60. 60.
    Wagman JA, King EJ, Namatovu F, Kiwanuka D, Kairania R, Semanda JB, et al. Combined intimate partner violence and HIV/AIDS prevention in rural Uganda: design of the SHARE intervention strategy. Health Care Women Int. 2016;37(3):364–87.Google Scholar
  61. 61.
    Idoko J, Ukpong MO, Dadem NY, Kolawole GO, Anenih J, Alhassan E. Why should I take drugs for your infection: outcomes of formative research on use of PrEP in Nigeria. AIDS Res Hum Retroviruses. 2014;30(S1):A80–1.Google Scholar
  62. 62.
    van der Straten A, Stadler J, Luecke E, Laborde N, Hartmann M, Montgomery ET, et al. Perspectives on use of oral and vaginal antiretrovirals for HIV prevention: the VOICE-C qualitative study in Johannesburg, South Africa. J Int AIDS Soc. 2014;17:19146.Google Scholar
  63. 63.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). The Gap Report. UNAIDS, Geneva, Switzerland. 2014. http://www.unaids.org/en/resources/documents/2014/20140716_UNAIDSgap_report.
  64. 64.
    Belluz J. The Truvada wars. BMJ. 2014;348:g3811.Google Scholar
  65. 65.
    Graham J. Target risk: dealing with the danger of death, disease and damage in everyday decisions. Inj Prev. 1998;4(2):162–3.Google Scholar
  66. 66.
    Mbonye M, Nalukenge W, Nakamanya S, Nalusiba B, King R, Vandepitte J, et al. Gender inequity in the lives of women involved in sex work in Kampala, Uganda. J Int AIDS Soc. 2012;15:17365.Google Scholar
  67. 67.
    Fernández-Romero JA, Deal C, Herold BC, Schiller J, Patton D, Zydowsky T, et al. Multipurpose prevention technologies: the future of HIV and STI protection. Trends Microbiol. 2015;23(7):429–36.Google Scholar
  68. 68.
    Quaife M, Terris-Prestholt F, Eakle R, Cabrera Escobar MA, Kilbourne-Brook M, Mvundura M, et al. The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa. J Int AIDS Soc. 2018;21(3):e25064.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
  2. 2.HIV Interventions Program, MRC/LSHTM and LSHTM Uganda Research UnitEntebbeUganda
  3. 3.Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
  4. 4.ICAP, Columbia University, Mailman School of Public HealthNew YorkUSA
  5. 5.Social Aspects of Health Program, MRC/LSHTM and LSHTM Uganda Research UnitEntebbeUganda
  6. 6.International AIDS Vaccine InitiativeNairobiKenya
  7. 7.Department of Internal MedicineMakerere University College of Health SciencesKampalaUganda
  8. 8.Infectious Diseases InstituteMakerere University College of Health SciencesKampalaUganda

Personalised recommendations