Barriers and Facilitators to Pre-Exposure Prophylaxis by Men Who Have Sex with Men and Community Stakeholders in Malaysia

Aviana O. Rosen, Jeffrey A. Wickersham, Frederick L. Altice, Antoine Khati, Iskandar Azwa, Vincent Tee, Alma Jeri-Wahrhaftig, Jeffrey Ralph Luces, Zhao Ni, Adeeba Kamarulzaman, Rumana Saifi and Roman Shrestha ()
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Aviana O. Rosen: Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
Jeffrey A. Wickersham: Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
Frederick L. Altice: Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
Antoine Khati: Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
Iskandar Azwa: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Vincent Tee: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Alma Jeri-Wahrhaftig: Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
Jeffrey Ralph Luces: Master of Health Research Ethics (MOHRE), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Zhao Ni: Yale School of Nursing, Yale University, Orange, CT 06477, USA
Adeeba Kamarulzaman: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Rumana Saifi: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Roman Shrestha: Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA

IJERPH, 2023, vol. 20, issue 9, 1-13

Abstract: Background: Men who have sex with men (MSM) in Malaysia are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy; yet, uptake remains low among Malaysian MSM, who have a limited understanding of barriers to PrEP. Methods: We employed the nominal group technique (NGT), a structured mixed-methods strategy to understand the barriers and facilitators to PrEP use among Malaysian MSM, combined with a qualitative focus group. Six virtual focus group sessions, three among MSM ( n = 20) and three among stakeholders ( n = 16), were conducted using a video-conferencing platform. Rank-ordering of barriers from NGT was recorded, and thematic analysis was conducted for content. Results: Similar barriers were reported by MSM and community stakeholders, with aggregated costs associated with PrEP care (e.g., consultation with a clinician, medication, laboratory testing) being the greatest barrier, followed by limited knowledge and awareness of PrEP. Additionally, the lack of access to PrEP providers, the complex clinical protocol for PrEP initiation and follow-up, and social stigma undermined PrEP delivery. Qualitative discussions identified potential new strategies to overcome these barriers, including expanded outreach efforts to reach hard-to-reach MSM, a ‘one-stop’ delivery model for PrEP services, a patient-centered decision aid to guide PrEP uptake, and easy access to LGBT-friendly PrEP providers. Conclusion: Current barriers may be overcome through governmental subsidy for PrEP and evidence-informed shared decision aids to support both MSM and PrEP providers.

Keywords: HIV; men who have sex with men; pre-exposure prophylaxis; nominal group technique; patient preferences; Malaysia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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