Women’s Experiences with Oral and Vaginal Pre-Exposure Prophylaxis: The VOICE-C Qualitative Study in Johannesburg, South Africa

摘要: Background: In VOICE, a multisite HIV pre-exposure prophylaxis (PrEP) trial, plasma drug levels pointed to widespread product nonuse, despite high adherence estimated by self-reports and clinic counts. Using socio-ecological framework (SEF), we explored socio-cultural contextual factors that influenced participants’ experience of daily vaginal gel oral tablet regimens in VOICE. Methods: Johannesburg, qualitative ancillary study was concurrently conducted among randomly selected VOICE participants assigned in-depth interviews (n=41), serial ethnographic (n=21), or focus group discussions (n=40). Audiotaped were transcribed, translated, coded thematically for analysis. Results: Of the 102 participants, mean age 27 years, 96% had primary sex partner with whom 43% cohabitated. Few women reported lasting which they typically attributed missed visits, lack replenishments, family-related travel work. Women acknowledged occasionally skipping mistiming doses because forgot, busy, felt lazy bored, feared experienced side effects. However, nearly all knew heard other who did not use products daily. Three overarching themes emerged from further analyses: ambivalence toward research, preserving healthy status, managing social relationships. These highlighted profound complex meanings associated participating blinded PrEP trial taking antiretroviral-based products. The unknown efficacy products, their connection infection, challenges regimen given risks, support–from partners significant others–and relationship tradeoffs entailed using appear discourage adequate use. Conclusions: Personal acknowledgment nonuse challenging. This inquiry key influences at SEF shaped women’s perceptions participation experiences investigational Whether these impacted behaviors may have contributed ineffective results warrants investigation.