IDENTIFICATION OF BARRIERS AND FACILITATORS TO HIV PRE-EXPOSURE PROHYLAXIS (PREP) USE IN GAY AND BISEXUAL MEN

Abstract

Background: Objectives: The COM-B model of capability, motivation, and opportunity was used to estimate the determinants of PrEP usage intention among men who have sex with men (MSM). Methods: Fourteen semi-structured interviews were conducted with MSM recruited through snowball sampling. The interviews lasted 30-60 minutes and were conducted via Zoom or telephone. The data were analyzed using Atlas Ti v.8 and mapped to capability, motivation, and opportunity domains. Results: Potential facilitators identified were the skills and interest in seeking information about PrEP (capability), social support and peer opinion (opportunity), and motivations to use PrEP as an additional tool in HIV prevention. The main barriers identified were stigma towards homosexuality and HIV (opportunity); healthcare system organization and financing (opportunity); perceived lack of ability to adhere to PrEP usage (capability); and monitoring of PrEP that could be attributed to personal and healthcare system factors (capability and opportunity). Conclusions: Four strategies are suggested to address these barriers: 1) adaptation of interventions that promote knowledge and skills for PrEP; 2) development of navigator interventions to engage organizations and leaders; 3) education and skills training for primary care physicians; and 4) improvement of sexual health care systems.