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I think of a people, warm and friendly, and proud of a rich cultural heritage. Mildmay International delivers pioneering HIV services, and in Tanzania the focus is on training and health systems strengthening, in particular for orphans, vulnerable children and prisoners. I have learned much through the partnership and get satisfaction and motivation from seeing the achievements of the students and the contribution they make to their communities as a result of the course. With the support of funding through THET, Mildmay has supported the development of the infrastructure at KCMC with up to date text books and a computer suite giving students access to the internet. Teaching and learning workshops focusing on adult approaches to learning for KCMC staff have been shared with teachers from other faculties.

Introduction

BoxKilifi, Kenya. This paper used qualitative methods to explore experiences of men who have sex with men and female sex workers in Nairobi and Mtwapa, Kenya, who used oral preexposure prophylaxis PrEP for HIV prevention as part of a four-month trial of safety, acceptability and adherence. Fifty-one of 72 volunteers who took part in a randomized, placebo-controlled, blinded trial that compared daily and intermittent dosage of PrEP underwent qualitative assessments after completing the trial.

Analyses identified three themes: These themes resonated across dosing regimens and gender, and while most participants Hiv christian dating in kenya IT Infrastructure the intermittent dosing Hiv christian dating in kenya IT Infrastructure, those in the intermittent group noted particular challenges in Best online dating tips Contact Points to the post-coital dose.

Culturally appropriate and consistent counseling addressing these issues may be critical for PrEP effectiveness. A phase III randomized controlled trial tested the efficacy of once-daily oral dose of emtricitabine—tenofovir Truvada versus placebo on HIV incidence among men and transgender women who have sex with men in Peru, Ecuador, South Africa, Brazil, Thailand, and the United States [ 5 ]. There were fewer infections among volunteers with higher adherence to PrEP compared to those who had poor adherence, indicating the importance of following prescribed Hiv christian dating in kenya IT Infrastructure schedules.

Two other randomized controlled trials assessing the efficacy of PrEP in HIV-negative heterosexual men and women showed similar results. Behavioral research can help to identify factors that might determine adherence to PrEP Cell phone dating apps Aras Innovator Demo Series Self-Service Reporting (27 Minutes) therefore, drug effectiveness in real-world settings.

Importantly, few studies Hiv christian dating in kenya IT Infrastructure assessed acceptability and use of PrEP, and most are based on hypothetical scenarios presented to participants [ 89 ]. Similar findings were observed in a study of female sex workers, male-to-female transgendered persons, and MSM in Peru [ Hiv christian dating in kenya IT Infrastructure ].

A study of intentions to use PrEP among African Hiv christian dating in kenya IT Infrastructure and Caucasian women in the United States found that individuals who had engaged in high risk behavior were more likely to find PrEP acceptable Hiv christian dating in kenya IT Infrastructure those who had not [ 11 ]. Another study among truck drivers in India demonstrated that motivation to use PrEP was associated with intentions to engage in at-risk behaviors, drug efficacy, and source of information about PrEP that is, a physician was perceived as a more legitimate source than a public service announcement [ 12 ].

Relationship factors were also associated with improved adherence and thus, greater effectiveness. For example partner support of PrEP use in discordant couples was understood as a function of the desire to reduce risk while preserving a partnered relationship [ 13 ].

Such intentions, however, may or may not equate to actual behavior among PrEP users. Because PrEP represents a significant Hiv christian dating in kenya IT Infrastructure new addition to our arsenal of HIV prevention strategies, we need to better understand factors influencing PrEP pill-taking behavior that might determine real-world effectiveness.

Little is known about acceptability and adherence to intermittent, or less than daily PrEP regimens which might be more feasible and affordable in some settings. Insight into social and behavioral factors that influence the acceptability, use of, and adherence to PrEP can inform the development of drug regimens and PrEP counseling strategies for individuals initiating a course of this prevention medication in the future.

In this paper, we report on the first qualitative findings of PrEP acceptability and adherence among MSM and female sex workers who participated in a clinical trial testing safety and adherence to daily and intermittent oral PrEP regimen in Nairobi and Mtwapa, Kenya. Aims of analyses were to: Data for this study came from a randomized, placebo-controlled blinded trial Clinical trials.

Intermittent use involved self-administering emtricitabine—tenofovir Truvada twice weekly on Mondays and Fridays, and within 2 h post-coitally with a maximum of one dose per day. Research was conducted between October and April in two cities in Kenya, Nairobi the capital city and Mtwapa a mid-size coastal town in Kilifi District. All participants provided written informed consent for interviews and focus group discussions.

Although most sex partners of MSM were men, sex with both men and women was also reported [ 15 ]. Overall 72 volunteers were recruited into the PrEP trial across the two sites: The average age of the trial participants was 26 years range: All participants identified as Kenyan and had primary education or higher, with three participants reporting tertiary education. The selection of volunteers for the qualitative component of the study was based on post-trial evaluation of completion and adherence rates i.

Volunteers who could not be reached because of change in circumstances e. At enrollment to the PrEP trial, participants completed face-to-face interviews using standardized questionnaires to record socio-demographic information, recent sexual behavior, and health status. A standardized physical exam was performed, and specimens were collected for STI screening. All participants received HIV prevention counseling, condoms and lubricants, basic information about PrEP adherence, potential side effects, and the dosage schedule.

These procedures were repeated at monthly follow-up visits. Seventy-two eligible cohort participants were randomly assigned to either active drug or an identical placebo pill in one of two dosage conditions: Participants were instructed to follow the assigned dosage schedule for 16 weeks. Sexual activity data were collected through daily electronic short message service SMS. Adherence and sexual activity data were also collected by self-report using a monthly follow back calendar.

Focus group discussions were held for those study participants who completed the trial. Participants were not identified by name and Dating kostenlos test.

Dating app kostenlos test – free to decline participation in the focus group discussion or in-depth interview. Focus group discussions and Hiv christian dating in kenya IT Infrastructure in-depth interviews took place after the final week of study participation and included topics such as likes and dislikes of the study pill, study dosing scheduling and adherence measures, and experiences with study procedures.

The discussion guides were piloted with a subset of PrEP trial volunteers before commencing the study to ensure coherence and flow of questions. Most discussions were conducted in Kiswahili and some in English based on participant preference. All discussions and interviews were audio-taped, transcribed, and those conducted in Kiswahili were translated into English. Discussion facilitators were Kenyan study staff familiar with the trial aims, who had received training in qualitative interviewing skills.

Focus groups were held separately for those who used intermittent versus daily PrEP, and for men and women prior to unblinding. The only participant who became HIV-infected during the PrEP trial at the last visit was included in a focus group discussion.

NVivo 8 was used for coding data. Data were coded by two independent qualitative researchers at each site to ensure that interpretations of quotes were consistent and that data quality was rigorous and transparent; differences between coding were resolved by group discussion involving other members Hiv christian dating in kenya IT Infrastructure the research team.

Recurring issues, concepts and patterns were identified using both inductive and deductive reasoning. Of the 72 PrEP trial participants, 51 volunteers participated in the qualitative study: Overall 10 FGDs, with a range of 2—8 participants per group, and 7 in-depth interviews were conducted.

Of these, one focus group discussion and one interview was conducted with Hiv christian dating in kenya IT Infrastructure sex workers. A similar number of group discussions [ 5 ] and individual interviews [ 3 ] were conducted with Hiv christian dating in kenya IT Infrastructure on intermittent and daily regimens. Overall, acceptability of PrEP was high in this group of participants accompanied by suggestions for how best to improve the pill characteristics to make it easy to take and make more nondescript to prevent potential misperceptions among, and discrimination from Hiv christian dating in kenya IT Infrastructure members and peers.

In addition, a number of barriers and facilitators to adhering to the PrEP regimens were identified including concerns around stigma and discrimination, life styles, dosing regimens and possible side effects although the last was noted as being easily overcome in time. Participants also mentioned that counseling and commitment to using the product enhanced their ability to adhere to the regimens despite the challenges. Participants, regardless of dosage schedule, gender, or adherence rates indicated that oral PrEP is a feasible and acceptable form of Hiv christian dating in kenya IT Infrastructure prevention.

When asked, participants were in favor of PrEP being more widely available to the public should studies prove the medication Herne bay Dating Herne bay singles Herne bay chat at POF.com™ in HIV prevention.

They should be in plenty and given to other people who did not participate in the study. Although at the beginning is hard but with time you catch up. We too were not sure if we would make it, but we did so. Participants were particularly in favor of promoting PrEP in at-risk populations.

Because most participants were actively involved in sex work, and often faced challenges to HIV prevention including convincing paying partners to use condoms, PrEP offered them a more convenient, discrete, and controllable strategy for reducing HIV risk compared with regular Landshut Dating Site, 100 Free Online Dating in Landshut, use.

Furthermore, participants in this highly religious setting, where Christian, Catholic, and Muslim faiths inform many cultural practices, also noted that PrEP might be more Hiv christian dating in kenya IT Infrastructure than other prevention methods due to the non-contraceptive nature of PrEP. So if such a drug is made available then it would be best and acceptable to such people because one would not be breaking any rules.

So it will be very acceptable. Although participants endorsed PrEP in principle, they offered several suggestions for improving its acceptability among potential users. One major theme for increasing acceptability focused on improving the physical characteristics of the pill that is, the size, shape, color, and taste, all of which affected comfort and ease of use. All participants noted that the pill was large, and associated some discomfort when swallowing.

The angular shape of the Hiv christian dating in kenya IT Infrastructure may have contributed to this discomfort, with participants suggesting a rounded capsule shape.

Despite these concerns, participants noted that over time, they grew accustomed to the slight discomfort of ingesting the PrEP pill. At first I feared the pill, that it was big like a bean. But as I continued swallowing it I got used to it. When I used to swallow, it used to scratch the throat for some time when I started. But when I got used to it, was okay.

There was also concern that people would think that the pills were ARVs. The color should be white. When people see you using a blue …you know blue is a unique color, so when they see you taking a blue pill they start thinking that you are sick [HIV]. Opinions on the taste of the PrEP medication varied among participants. While some noted that the pill did not have a taste, others thought that the pill had a smell and taste that induced nausea.

Overall, these comments indicate that these characteristics would not pose significant barriers to the use of PrEP by similar populations in Kenya at-risk of HIV infection due to its potential to prevent HIV infection, discrete and personally controllable nature, and cultural tolerance of this form of preventative behavior.

Recommendations to improve the size, shape, color, and taste of the pill could facilitate wide acceptance amongst potential users. Participants reported a number of side effects when using PrEP including: Many side effects abated over time, and participants expressed greater tolerance Hiv christian dating in kenya IT Infrastructure the first initial Hiv christian dating in kenya IT Infrastructure of discomfort and after consultations with study counselors. At first I was worried when I was told about the side effects, but I continued swallowing them.

For me I may say Start an online dating conversation Company I liked taking them after some time.

When I started taking them they actually affected me a bit. For the first week, there is that paper that we read saying that there were some things that were minor like diarrhea — so for me my first symptom I realized was diarrhea, and with time, when I continued swallowing it disappeared for good so I continued without any problems.

When I swallowed them, I had diarrhea for three days then my head started aching. But when I called, they told me to come but after the three days I was okay. Some participants, especially those on the daily schedule, mentioned being encouraged by the perceived positive side effects, including an increase in appetite:.

It helped me coz at times I was not having any appetite to eat but when I started taking the pill, I was now eating a lot…It was an advantage to me because I was able to eat more and more.

It was okay to me because when you go home, you feel like making love to your friend but when I stopped taking the pill, that morale faded. Outside the context of a trial, there is a chance that PrEP users might discontinue use due to early side effects. However, participants acknowledged that the information provided at trial enrollment encouraged adherence and regular use:.

The way the study was organized by protocols and it went through steps which were good… It taught me to organize myself and it also taught me to keep time.

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