Tenofovir-based HIV Pre-Exposure Prophylaxis for Sub-Saharan African Women at High-risk of Acquisition: An Integrative Systematic Qualitative Evidence Synthesis of Factors Affecting Adherence

Women from Sub-Saharan Africa remain at substantial risk of HIV acquisition and require urgent interventions to mitigate this issue. Oral pre-exposure prophylaxis offers a viable option. Unfortunately, it was ineffective during clinical trials in this population due to poor adherence. This systematic review has been conducted in order to understand the factors uniquely affecting adherence in this population.

Five databases (Embase, Medline, CENTRAL, Web of Science and ClinicalTrials.gov) were searched for relevantobservational and qualitative studies reporting the factors affecting adherence. Titles and abstracts of returned articles were assessed for eligibility, leading to retrieval of full texts. Quality and risk of bias assessments were done before data extraction. Thematic qualitative evidence synthesis was done for factors affecting adherence.

Sub studies and ancillary studies of the three main clinical trials were retrieved, employing quantitative and qualitative methods to assess factors affecting adherence to tenofovir-based pre-exposure prophylaxis. Identified themes were grouped into five categories based on a modification of Ickovics and Meisler’s conceptual framework. These are individual, partner, social/community, product/drug and research related factors. Within each category, barriers and facilitators of adherence were placed. Significant barriers to uptake pre-exposure prophylaxis were identified.

The success of future clinical trials on HIV prevention methods among Sub-Saharan African women, and thesuccessful rollout of preventive public health interventions will depend on adequately addressing barriers to adherence.Therefore, clinical and public health researchers must aim to understand these factors, to optimise uptake and benefit from the interventions.