Barriers and levers to HIV post-exposure prophylaxis

International audience; Introduction: In the context of emerging combined prevention of HIV in France, post-exposure prophylaxis (PEP) appears to be poorly known and underutilized. This study was designed to investigate the representations and perceived barriers to PEP use and PEP follow-up. Methods: A qualitative, semi-directed interview-based exploratory study was conducted in the Rhone-Alpes region (2015) among individuals who had used PEP during the previous 12 months (n=11), individuals in whom PEP was indicated, but was not administered (n = 9), and healthcare professionals involved in PEP management (n = 9). Data were submitted to textual analysis (Iramuteq) and thematic/categorical analysis (Nvivo). Results: Data analysis indicated that the barriers to PEP access and follow-up were delayed management, a feeling of being judged, treatment adherence difficulties, inconsistent mastery of the protocol and heterogeneous professional practices. In contrast, the quality of the doctor-patient relationship and the presence of support (partner, association, doctor) appeared to be facilitating factors. The participants proposed more diverse access to PEP and training of healthcare providers. Conclusion: Two challenges were identified to improve the place of PEP in combined prevention: (1) improvement of healthcare professionals' knowledge, practices and attitudes; and (2) revision of the guidelines concerning first-line prescription, the conditions for access to PEP, and sexual health support.