PEP Manuscript Tables and Figures 26.03.25.xlsx

<b>Introduction:</b> The World Health Organization (WHO) recently updated its guidelines for HIV post-exposure prophylaxis (PEP) (1). These guidelines recommend community delivery and task-sharing for PEP administration and suggest enhanced adherence counseling (2,3). This work provides insights into considerations for optimizing people’s knowledge, demand, use and adherence regarding PEP. This mixed-method study examined five research questions concerning perceptions and experiences of various groups regarding accessing and utilizing PEP and explored opinions on alternative delivery options to broaden access.<br><b>Methods</b>: We spoke with a total of 1,156 end-users: 236 through qualitative Focus Groups (FGs) and in-depth interviews (IDIs), and 920 surveyed via questionnaire in Kenya, Nigeria and Zimbabwe, including members of key populations (Female Sex Workers, Members of the LGBTQ+ Community, People Who Inject Drugs).<br><b>Results:</b> Prompted awareness of PEP varied across the study countries (56.2% overall). Healthcare providers (doctors and nurses) were cited by end-users as primary sources of information on HIV and PEP. PEP information evaluation revealed that condomless sex or condom malfunction were the emergency situations that resonated most with end-users. Most (86.4%) cited a perceived likelihood to use PEP if exposed to HIV. A general hospital was deemed most acceptable for PEP access by end-users in all countries (81.2%); clinical routes were preferable to alternative routes (such as vending machines or websites) for accessing PEP, with key reasons being convenience (68.2%), trustworthiness (56.5%) and knowledge (56.5%). End-users emphasized the need for consistent, correct, and supportive interaction points with healthcare providers to complete PEP treatment and follow-up.<br><b>Conclusions:</b> PEP uptake is dependent on confidentiality and privacy of services and on increasing awareness and knowledge of the PEP pathway. Provision of PEP needs to incorporate multiple end-user touch/access-points with emotional support for greater adherence, and our study highlights the different preferences and access contexts among end-users for PEP.