article · HIV/AIDS - Research and Palliative Care
Female bar workers in Ubungo municipality, Tanzania, face high risks of HIV transmission, yet adherence to daily oral pre-exposure prophylaxis pills remains low. A qualitative study examined preferences and concerns regarding long-acting injectable pre-exposure prophylaxis through in-depth interviews with seventeen female barmaids. Women who already used oral prophylaxis showed a strong preference for the injectable alternative, citing greater discretion, extended protection, fewer side effects, and freedom from the daily burden of taking large pills. Most participants favoured injections scheduled every three months, although some preferred monthly visits to monitor side effects. Healthcare facilities were the favoured delivery setting due to privacy and stigma reduction, alongside some interest in community-based distribution. While most reported minimal worries, a few raised concerns about potential side effects, experimental testing, cancer risks, and possible increases in risky sexual behaviour.
Daily oral pills for HIV prevention often fail due to stigma, side effects, and poor adherence among high-risk groups. Understanding how female bar workers perceive long-acting injectable alternatives helps public health planners design prevention programmes that better fit real-world needs, potentially improving uptake and reducing new HIV infections in sub-Saharan Africa.
The findings provide early-stage implementation insights for healthcare providers, pharmaceutical distributors, and public health agencies planning the rollout of long-acting injectable prophylaxis in Tanzania. While the biomedical product itself exists, operational deployment in this setting remains at an exploratory research stage, highlighting that product introduction must factor in preferred delivery channels such as clinics, tailored dosing intervals, and targeted education to address safety misperceptions.
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Background: Oral HIV pre-exposure prophylaxis (PrEP) has been introduced globally, but women in sub-Saharan Africa frequently experience challenges in uptake and adherence. Female barmaids are at HIV risk due to transactional sex. However, uptake and adherence to oral PrEP pills is poor. Long-acting injectable (LAI) PrEP has the potential to increase prevention by improving adherence. Nevertheless, LAI PrEP is yet to be initiated in Tanzania. We explored preferences and concerns about LAI PrEP use among female barmaids in Ubungo municipality. Methods: We conducted in-depth interviews with 17 purposefully selected female barmaids. Interviews were conducted using a guide with semi-structured questions. We adopted an inductive approach for analyzing data. Findings: The majority of PrEP non-users expressed no preference for any form of PrEP, while oral PrEP-users preferred LAI PrEP. Overall, LAI PrEP was preferred due to its discretion, fewer side effects, prolonged prevention, and reduced fatigue compared to oral pill PrEP with concerns about large pill size, side effects, and the burden of daily use. Most interviewees indicated a three-month PrEP injection preference, though some preferred a monthly PrEP injection for effective monitoring and control of potential side effects. Regarding the delivery model, the healthcare facility was mostly preferred for timely services, convenience more privacy and reduced stigma. Community spots were preferred for convenience and friendlier services from providers. The majority reported no major concerns about using LAI PrEP, though a few expressed concerns about its trial phase, potential links to cancer, risky sexual behaviours, and side effects such as fatigue, dizziness. Conclusion: The majority of the interviewees expressed strong interest in LAI PrEP and reported fewer concerns, emphasizing more convenience and discretion. Our findings suggest that since LAI can address challenges of adherence associated with daily PrEP pills, it is important to introduce it to expand HIV prevention options for barmaids and other women at risk of HIV in Tanzania.
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DOI: 10.2147/hiv.s523674
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