Barriers and Facilitators to Pre-Exposure Prophylaxis by Men Who Have Sex with Men and Community Stakeholders in Malaysia
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Published:2023-04-27
Issue:9
Volume:20
Page:5669
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ISSN:1660-4601
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Container-title:International Journal of Environmental Research and Public Health
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language:en
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Short-container-title:IJERPH
Author:
Rosen Aviana O.1ORCID, Wickersham Jeffrey A.2ORCID, Altice Frederick L.23, Khati Antoine2, Azwa Iskandar34, Tee Vincent3ORCID, Jeri-Wahrhaftig Alma1ORCID, Luces Jeffrey Ralph5, Ni Zhao6ORCID, Kamarulzaman Adeeba34, Saifi Rumana3, Shrestha Roman123ORCID
Affiliation:
1. Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA 2. Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA 3. Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia 4. Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia 5. Master of Health Research Ethics (MOHRE), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia 6. Yale School of Nursing, Yale University, Orange, CT 06477, USA
Abstract
Background: Men who have sex with men (MSM) in Malaysia are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy; yet, uptake remains low among Malaysian MSM, who have a limited understanding of barriers to PrEP. Methods: We employed the nominal group technique (NGT), a structured mixed-methods strategy to understand the barriers and facilitators to PrEP use among Malaysian MSM, combined with a qualitative focus group. Six virtual focus group sessions, three among MSM (n = 20) and three among stakeholders (n = 16), were conducted using a video-conferencing platform. Rank-ordering of barriers from NGT was recorded, and thematic analysis was conducted for content. Results: Similar barriers were reported by MSM and community stakeholders, with aggregated costs associated with PrEP care (e.g., consultation with a clinician, medication, laboratory testing) being the greatest barrier, followed by limited knowledge and awareness of PrEP. Additionally, the lack of access to PrEP providers, the complex clinical protocol for PrEP initiation and follow-up, and social stigma undermined PrEP delivery. Qualitative discussions identified potential new strategies to overcome these barriers, including expanded outreach efforts to reach hard-to-reach MSM, a ‘one-stop’ delivery model for PrEP services, a patient-centered decision aid to guide PrEP uptake, and easy access to LGBT-friendly PrEP providers. Conclusion: Current barriers may be overcome through governmental subsidy for PrEP and evidence-informed shared decision aids to support both MSM and PrEP providers.
Funder
National Institute on Drug Abuse Fogarty International Center
Subject
Health, Toxicology and Mutagenesis,Public Health, Environmental and Occupational Health
Reference49 articles.
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