Background: Pre-exposure prophylaxis (PrEP) became available in Brazil in 2018 to populations at substantial risk of HIV infection as an additional prevention tool under a combination prevention strategy. The Implementation PrEP Project (ImPrEP) aims to generate evidence to support the incorporation of PrEP in Brazil. There is scarce qualitative evidence around PrEP implementation globally. This abstract presents initial findings from a qualitative study conducted with key PrEP stakeholders to gather insight on facilitators and barriers to PrEP implementation within a public health context.
Methods: Qualitative study, based on in-depth structured interviews conducted face-to-face with 4 categories of HIV stakeholders in 6 capital cities implementing ImPrEP. Views, perceptions and experiences regarding PrEP and PrEP service incorporation were collected. Interviewees signed consent forms. Interviews were recorded and transcribed, organized and categorized using NVivo 12 Plus software. Discourse was systematized and analyzed based on narrative categories to extract meanings, perceptions and concerns of PrEP policy, its related conceptions, and experiences of key public health HIV program managers, civil society leaders and PrEP users as interlocutors of PrEP policy implementation.
Results: A total of 60 interviews have been conducted: 15 service managers; 14 health professionals; 16 PrEP users; 7 MSM and 7 Transgender community leaders, and 1 HIV+ leader. All health service managers, community leaders and PrEP users expressed prior knowledge of PrEP. Stigma and discrimination were cited as the main obstacle for most vulnerable populations to access PrEP services. Service providers and community leaders highlighted that transgender people are the ones who least frequent PrEP services. There is a narrative consensus that combined HIV prevention including PrEP is a step forward in public health policy. An aspect emphasized by health professionals and service managers was that PrEP puts HIV prevention under the individual''s control. Structural health service issues standout as a restriction to meet increasing demand such as limited business hours and number of health professionals.
Conclusions: Perceptions about PrEP and difficulties of implementation were raised, particularly access barriers of populations at greater risk. Study findings point-out that PrEP scale-up within a public health context has culturally specific needs to be addressed.