Pre-exposure prophylaxis (PrEP) knowledge, use, and discontinuation among Lake Victoria fisherfolk in Uganda: a cross-sectional population-based study.

Background: There are limited population-level data on the pre-exposure prophylaxis (PrEP) care continuum in eastern Africa. Here, we assessed the PrEP care continuum following PrEP rollout in a Ugandan community with ~40% HIV seroprevalence.
Methods: We used cross-sectional population-based data collected between September 3 and December 19, 2018 from a Lake Victoria fishing community in southern Uganda to measure levels of self-reported PrEP knowledge, ever use, and discontinuation following 2017 PrEP rollout via a U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported phased implementation program. Our analysis included HIV-seronegative persons reporting having ever received an HIV test result. We examined associations between demographic, behavioral, and health utilization factors with each outcome using age-adjusted modified Poisson regression.
Results: There were 1,401 HIV-seronegative participants, of whom 1,363 (97.3%) reported ever receiving an HIV test result. Median age was 29 years (IQR: 23-36), and 42.3% (n=577) were women. Most (85.5%; n=1,166) participants reported PrEP knowledge, but few (14.5%; n=197) reported ever using PrEP. Among 375 (47.7%) men and 169 (29.3%) women PrEP-eligible at time of survey, 18.9% (n=71) and 27.8% (n=47) reported ever using PrEP, respectively. Over half (52.3%, n=103) of those who had ever used PrEP, self-reported current use.
Conclusion: In this Lake Victoria fishing community, there were low levels of PrEP use despite high levels of PrEP awareness and eligibility, particularly among men. Efforts that enhance awareness of HIV risk and increase PrEP accessibility may help increase PrEP use among HIV-seronegative persons in African settings with high HIV burden.
Competing Interests: Conflicts of Interest and Source of Funding: The authors declare no conflicts of interest. The Rakai Community Cohort Study round 19 was supported by the National Institute of Mental Health (R01MH099733, R01MH105313, R01MH107275, R01MH115799), National Institute of Allergy and Infectious Diseases (R01AI114438, K25AI114461, R01AI123002, K01AI125086, R01AI128779, R01AI143333), National Institute on Alcohol Abuse and Alcoholism (K01AA024068), Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD091003) and the Bill and Melinda Gates Foundation (OPP1175094). The study was also supported in part by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases. KN received training and support from the National Institutes of Health Fogarty International Center (D43TW010557). The funders were not involved in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript. This study has also been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through CDC under the terms of NU2GGH002009.