Chimukuche et al.
BMC Health Services Research
(2022) 22:1336
https://doi.org/10.1186/s12913-022-08730-8
Open Access
RESEARCH
Examining oral pre-exposure prophylaxis
(PrEP) literacy among participants in an HIV
vaccine trial preparedness cohort study
Rujeko Samanthia Chimukuche1* , Rachel Kawuma2 , Nteboheleng Mahapa1, Smanga Mkhwanazi3,
Nishanta Singh4, Samantha Siva4, Eugene Ruzagira5,6 , Janet Seeley1,2,7 and On behalf of the PrEPVacc
Study Group
Abstract
Background: PrEP literacy is influenced by many factors including the types of information available and how it is
interpreted. The level of PrEP literacy may influence acceptability and uptake.
Methods: We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what
participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP
literacy using the individual and interpersonal constructs of the SEM.
Results: We found that PrEP awareness is strongly influenced by external factors such as social media and how
much participants know about HIV treatment and prevention in the local community. However, while participants
highlighted the importance of the internet/social media as a source of information about PrEP they talked of low
PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV
vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried
about side effects. Participants commented that at the community level PrEP was associated with being sexually
active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that
one could feel judged by the health workers for asking for PrEP at health facilities in the community.
Conclusion: The information collected in this study provided an understanding of the different layers of influence
around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform
strategies to address the barriers to PrEP uptake, particularly at structural and community levels.
Trial registration: https://clinicaltrials.gov/ct2/show/NCT04066881
Keywords: HIV, Pre-exposure prophylaxis, PrEP literacy
*Correspondence: Rujeko.Chidawanyika@ahri.org
1
Africa Health Research Institute, KwaZulu-Natal, South Africa
Full list of author information is available at the end of the article
Introduction
In 2022 HIV prevalence in South Africa is approximately
13.9%, with the total number of people living with HIV
(PLWHIV) estimated to be approximately 8,45 million [1]. South Africa became the first country in Africa
to register and provide oral pre-exposure prophylaxis
(PrEP) for HIV prevention in 2016 [2], beginning with
the provision of PrEP to sex workers [3]. The 2017-2022
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Chimukuche et al. BMC Health Services Research
(2022) 22:1336
National Strategic Plan proposes to expand PrEP distribution to other people who are at high risk of HIV infection such as men who have sex with men (MSM) and
adolescent girls and young women [4, 5]. In the course
of this roll-out a number of studies have been conducted
on the attitudes to, knowledge, acceptability and use of
PrEP among young people, women, and girls in South
Africa [6–11]. Globally, almost a million people initiated
oral PrEP by the end of 2020, with over 100,000 people in
South Africa [12].
PrEP effectiveness largely depends on having accurate,
up to date information about the forms of PrEP and its
availability and PrEP adherence [13]. Whilst individuals
may be aware of PrEP, they may understand and interpret
its use differently depending on the information that is
provided or conveyed to them as well as their own personal interpretation [14]. Research on factors influencing
PrEP uptake reveal that knowledge does not necessarily translate into acceptance and behaviour change [2,
15–17].
To increase uptake of PrEP in South Africa, efforts have
been made to raise awareness and increase PrEP literacy
by distributing information nationally [5]. For example,
the National Department of Health has used a phased
approach to distribute information through communication programmes in schools, health facilities, workplaces,
and community centres [5]. Information, Education and
Communication (IEC) materials with information about
PrEP are distributed via interpersonal communication,
mass and social media communications by ward-based
outreach teams and community-based organisations
facilitating a knowledge sharing platform for educating and communicating between health providers and
patients [5]. Despite these efforts, and the availability
of PrEP at clinical research centres, health facilities and
pharmacies, knowledge and community awareness of
PrEP in South Africa is still limited [2, 9, 18, 19].
Health literacy is the extent to which individuals have
the capacity to acquire, process, and understand information and services available and how this influences
their health decisions and uptake [20]. When assessing
whether an individual will take up PrEP, it is important
to not only consider how much information they have
attained but also whether that knowledge influences their
decision to either use or not use the drug. We recognise,
however, that PrEP knowledge is one factor amongst
other indicators of PrEP use, and that increasing functional knowledge about PrEP may not be sufficient for
increasing their decision to use PrEP [21]. For example,
DiTullio and colleagues showed that providing information about PrEP did not translate into increased use
among MSM, and there was a need to devise more end
user focused approaches for PrEP promotion [22].
Page 2 of 8
In this study, we assessed the concept of ‘PrEP literacy’ through gathering data on the knowledge accessed,
the use made of PrEP and people’s perceptions of PrEP,
which may have an impact on uptake.
The Socio-Ecological Model (SEM) provides a framework to consider the complex interplay across individual,
community, societal and structural factors which influence people’s behaviour. Using the SEM we focus on
health literacy beyond the individual, looking at the delivery of health information, the type of knowledge provided
to the public, the communication skills of healthcare professionals, and the health policies that surround an individual [23, 24]. We have used a modified version of the
SEM in this study to analyse data from participants in
the HIV vaccine trial preparedness cohort. The cohort
was established in preparation for the PrEPVacc trial, a
phase IIb three-arm, two-stage HIV prophylactic vaccine
trial with a second randomisation to compare Tenofovir
alafenamide (TAF) plus emtricitabine (FTC) (TAF/FTC)
to Tenofovir desoproxil fumarate/emtricitabine (TDF/
FTC) as PrEP [25]. The SEM provides a framework to
illustrate how PrEP use behaviour is influenced by different social systems on multiple levels [21]. We adapted
the SEM to explain that while information is available
on PrEP, individual and interpersonal factors play a part
in explaining the level of understanding of PrEP and the
PrEP uptake among cohort participants (Fig. 1).
Using this modified SEM, and focusing on individual and interpersonal levels, we were able to understand the different factors that influence knowledge and
Fig. 1 Modified Socio-Ecological Model levels of influence on PrEP
literacy
Chimukuche et al. BMC Health Services Research
(2022) 22:1336
perceptions of PrEP and the impact on PrEP literacy. It
was an important part of the preparation for the HIV vaccine trial to determine the uptake and adherence to PrEP
to inform the development of tools to support adherence.
During the vaccine trial study participants can access
PrEP during the first 40 weeks of the trial to support the
immunisation period.
Methods
Study design and setting
This qualitative methods study was nested in an ongoing prospective HIV vaccine trial preparedness study in
Durban, South Africa. Individuals who were HIV negative (18 to 45 years) at high risk of HIV acquisition were
recruited into the cohort between 2019 and 2021. Cohort
participants were recruited from two areas in Durban
known to have a high burden of HIV, referred to here as
‘Site A’ and ‘Site B’. HIV risk was measured at baseline
using a questionnaire that included items on the number
of sexual partners, condom use, use of alcohol and recreational drug use and history of sexually transmitted
infections. Cohort participants are followed every three
months for at least 12 months.
Participants, sample selection and data collection
Participants were purposively selected on the basis of
gender, age, location and occupation to take part in the
in-depth interviews (IDIs). Data collection was conducted
at cohort enrolment between July and October 2019
at Site A and between November 2020 and February
2021 (delayed by the COVID-19 pandemic) at site B.
A semi-structured topic guide was used to encourage
participants to respond to questions on broad areas
of the study such as knowledge and perceptions of
PrEP.
Two experienced social science researchers (initially
both men, and then part way through the study a woman
replaced one man) conducted the IDIs face to face at
the clinical research site in IsiZulu (the main local language). Each interview lasted between 45-60 minutes.
Participants were briefed on the purpose of the study and
the research assistants checked on participants understanding of the study before seeking informed consent.
Participants reviewed the participant information documentation prior to giving their written informed consent
to be involved. All interviews were digitally recorded,
transcribed and translated into English. Debriefing meetings were conducted after each interview between the
interviewers and the lead author of this paper to improve
probing, provide clarity on emerging themes and also
refine the topic guide where necessary.
Page 3 of 8
Data analysis and interpretation
Data analysis was done manually, led by the first author
(RSC), and supported by (RK), and the research assistants who collected the data. The coding framework was
developed by the team based on four scripts which the
entire team read and used to identify emerging codes. To
increase inter-rater reliability and validity, the main codes
were reviewed, discussed and agreed upon by consensus. For this paper the codes with similar meanings were
merged to form the two major themes identified namely:
knowledge about PrEP and perceptions of PrEP. Thereafter, for this particular analysis a matrix coding framework
was developed in excel on to which data were manually
coded by pasting illustrative quotes from the interviews
against matching themes. All data were anonymised, and
participants are identified only by their sex and age in
this paper.
Results
A total of 45 participants with ages ranging from 18 to
36 years were enrolled (site A, 20; site B, 25). Of these, 23
(51.1%) were female, 44 (97.7%) were single, 33 (73.3%)
were unemployed and 21 (46.7%) had completed either
their school leaving qualification or tertiary education.
As noted above, two main themes provide the focus for
the data used in this paper: knowledge of PrEP and perceptions of PrEP. We present the findings against each
theme below using illustrative quotes.
Knowledge about PrEP
Understanding of PrEP at the individual level
Individual level factors are biological characteristics that
are associated with one’s own vulnerability [26]. These
factors either positively or negatively influence the individual’s decision-making about taking PrEP.
In this study, at the individual level the participants
indicated that they had knowledge of PrEP and understood that it should be taken to prevent sexual transmission of HIV but were not sure about its effectiveness.
Information on PrEP was available, but participants had
different understandings regarding its effectiveness as
illustrated below:
“It prevents you from having it, as they say, although
I wouldn’t know if it is 100% working, or if it’s in testing or but I heard that, that there is a pill that helps
you not to get infected”. Male, 22 years old.
Participants indicated that they had little exposure to
PrEP information prior to enrolment in the HIV vaccine
trial preparedness study:
Chimukuche et al. BMC Health Services Research
(2022) 22:1336
“…The first time I heard about it was when I started
the study with [xxx]. So no - there is no other place
where I heard about it. So [the study] was my first
time, which is last year”. Male, 22 years old.
The information that participants gained about PrEP
contributed to the opinion they formed around it. For
instance, some commented that PrEP is meant for sexually active individuals who are at high risk of getting
infected with HIV, as expressed below:
“...in my knowledge ehh it is used by someone who
knows that they are sexually active or is at high risk
so that they do not get infected with STIs, such a person ehh would be able to get in from the clinic, they
said it is available, they can get it from there so that
they can use it”. Female, 29 years old.
Concerns about PrEP
These opinions were formed by participants through discussions within their communities where they were able
to express their fear of PrEP side effects based on the
information they had gained during the study preparation. Participants mentioned persistent side effects as
being among possible barriers to uptake of oral PrEP.
“…Yah we also learned that like you don’t have to
rely on them because they have side effects, I had
personally posed a question, then they explained
that if you are taking them for the first time they
have side effects, others get semi-dizzy, others say
you shouldn’t take them, they make you nauseous
you see” Female, 27 years old.
Sources of PrEP information
Interpersonal factors are the person to person contacts
in their social networks that individuals are exposed to
around them. Interpersonal factors can provide social
support and reinforce social norms and behaviour that
serve as protective factors, although they can also have
a negative influence, and a person may, as a result of the
influence of others, stop doing something that is protective and desirable.
We found that participants talked of low PrEP literacy
in their communities, which they said was attributed to
limited exposure to information about PrEP and the lack
of PrEP champions in the areas they stayed. In this way,
participants highlighted that the community is deprived
of the social networks, and interpersonal communication, that could provide information that would assist
them in deciding about their own sexual health.
Page 4 of 8
“…I think it’s going to take a while, they will not just
accept it [PrEP] If they don’t have lots of information
about it.” Male, 22 years old.
“…Yah they don’t trust it [PrEP], they don’t know it
because it has not been, ah-ah it is not yet popular/public, it has not been spoken about, there is
no one, nothing like….No, the community, many
people don’t know about PrEP, in my neighbourhood they don’t know about PrEP you see.” Male,
26 years old.
Some participants highlighted the internet/social
media as a source of knowledge about PrEP [27]. One
participant mentioned the way in their community that
social media was used for information to be circulated
among friends:
“…We read on social media and the internet as well
we do get in, even friends we chat and say have you
heard about something like this, yah. Yah something
like that. Okay, so your friends are so informed? Yah
they have knowledge” Female, 29 years old.
Accessibility of PrEP
Structural factors, in particular, played a part in influencing the accessibility of PrEP at health facilities [26]; while
the provision of PrEP may be among the services, it was
not always necessarily straightforward to access. Some
participants, for example, while acknowledging that PrEP
is available at local health facilities, said that one had to
request it from the health providers.
“…you are the one who has to say that may I ask if
PrEP is available its only then that they issue it, but
it is available in my neighbourhood. It is at the clinic
and research sites only where I know it is available, I
have not heard of other places.” Female, 27 years
However, participants also indicated that PrEP is sometimes out of stock, owing to a lack of demand, in health
facilities and that prevented access.
“…Yah most of the clinics some of them don’t have
it to be honest. Even here at the local clinic sometimes when you get there they would tell you it is out
of stock because people do not use it …” Female 27
years
There was a view that some groups may face particular barriers accessing PrEP. Some participants expressed
the view that the attitude of health care workers to young
persons’ seeking PrEP, which may not be supportive, may
negatively impact young people’s decision to take it.
Chimukuche et al. BMC Health Services Research
(2022) 22:1336
“…Ehhh it is not easy because they ask you questions
as to why you need PrEP, where you learnt about it,
how you know about it, how old you are, they don’t
just take it out and give it to you”. Female, 27 years old
As this quote, and the quote below indicate, some participants felt judged by the health workers when they ask
about PrEP at their local health facilities.
“...that at the clinic you get judged, you are so young
like I mean 21 or 22, you already want to engage in
sex without a condom or what do you want to do, you
know.. so those are some of the things that prohibits us
from going to the clinic...” Male, 22 years old.
Perceptions of PrEP
Stigma associated with HIV, and the association of pill
taking with anti-retroviral therapy can limit the provision
and/or uptake of HIV prevention, treatment, and care
services. This stigma may exist at the interpersonal level,
but also be pervasive at the wider societal level, or be perceived as being so by people fearing an association with
HIV. Many participants highlighted the social stigmarelated misperceptions regarding PrEP. An example is
the perception that persons who take PrEP are living
with HIV. This was a key barrier to uptake as participants
feared this HIV related stigma.
“…Ey, most of them are afraid that people will laugh
at them. Ah, they are afraid that when people know
that they are HIV positive, some of them could laugh
at them and talk about them to other people. Yes,
they are afraid of such things” Male, 20 years old.
The environment in the community can either promote
health and wellbeing or be a source of stigma in using
and engaging in PrEP services. We found that misconceptions about PrEP were prevalent among participants’
friends and peers yet they were their primary source of
knowledge and support. These views could potentially
affect uptake and adherence to PrEP.
“...people have a belief that says, why would they
use pills when they do not have HIV....because other
people sometimes think crazy things, they would
say that the clinic wants to infect them with HIV
because they want to kill us that is why they have
brought us these PrEP pills..." Male 20 years old.
Discussion
Using the SEM we were able to highlight the influences
of PrEP literacy and knowledge on PrEP uptake at individual and interpersonal levels . Our findings indicate
that an understanding of the issues at the different levels
Page 5 of 8
of SEM regarding acceptability and uptake of PrEP can be
used to guide the development of interventions.
Our setting was an HIV vaccine trial preparedness
study and our findings provide insights into the PrEP
literacy among the participants of that study, where
the study team was their main source of PrEP information, although they were able to reflect on other possible
sources of information in their social context. Our analysis has shown that PrEP literacy needs to be considered as
more than simply the provision of information targeted
at the individual level because of the influences in the
wider environment that can affect uptake and adherence.
Interpersonal and societal factors influence individuals’ knowledge and how they use that knowledge, affecting their health behaviours and choices in terms of PrEP
acceptability and uptake. In this paper, we have shown
that the availability of PrEP knowledge to study participants has not been enough to translate into uptake. Thus,
an unwillingness to take PrEP, or to keep on taking PrEP,
may not always be the result of a lack of knowledge; it is
important to take account of the different influences on
individuals.
Participants attributed low PrEP literacy in their communities (beyond the study context) to having limited
access to information on PrEP within their communities.
Similar findings have been reported by studies among
MSM and other key populations [28–30]. Consistent
with those previous studies, and as we note above, our
participants reported they had little or no knowledge of
PrEP prior to joining in the study [31]. Even so, the information provided in the study needed to be coupled with
easy access to PrEP, and a supportive environment, where
those accessing PrEP did not feel that their action was
being judged.
Individual and interpersonal factors can be barriers
to accessing healthcare services in general [17, 32, 33].
In the case of PrEP, available evidence shows that low
PrEP literacy is caused by insufficient PrEP knowledge
circulating in the communities [33]. However, access to
knowledge alone does not affect uptake. Low uptake of
PrEP can be influenced by individual and interpersonal
factors including fear of side effects and stigma as outlined in the modified SEM model we used in our study.
Another study done in South Africa revealed that
ensuring awareness of PrEP across multiple communication channels and promoting an interest in this form
of HIV prevention increases uptake [9]. Other work has
shown that disseminating health information through
social networking sites can be highly effective since it
generates public discussions among users and other community members that assist people in understanding and
interpreting public health information [34]. Thus, there is
need to broaden the platforms where health information
Chimukuche et al. BMC Health Services Research
(2022) 22:1336
is promoted with social media platforms, for example,
being attractive channels to spread health information
among young people [19]. Indeed, other work has shown
that using social media facilitates rapid dissemination
of health information over a wider community, at a low
cost [21]. Although there are disadvantages, including
the spreading of misinformation and a lack of acknowledgement of sources. However, given how widespread
engagement with social media is among young people
health care providers recognise the importance of social
media websites and their potential in providing valuable health messages [21]. Finding ways to harness social
media to counter misinformation is critical [35].
To assist in processing the available information provided, good patient–provider communication is an
important factor contributing towards improving health
and PrEP literacy [28]. Effective health communication
between health providers and users encourages positive
behaviour change and affects HIV prevention and treatment outcomes [36]. Health workers can be influential in
the dissemination of PrEP information within communities and where PrEP is available at health facilities [37]; as
our findings show, that influence can be supportive, but
also detrimental to uptake where those distributing PrEP
pass judgement, or are perceived to pass judgement, on
those seeking PrEP. Health care workers may need intensified PrEP education, and instruction on self-management strategies to promote among PrEP users This can
assist health workers to support users adequately and
ensure high-uptake of PrEP within the general population [37].
Schools can also provide a starting place to conduct
the PrEP educational/awareness programs targeting the
adolescents and young people between ages of 15-24
who are at a high risk of HIV acquisition in South Africa
[38]. School based education campaigns and community based sexual health programs can be used to spread
PrEP education [34, 38]. Given the importance of clinics
in providing PrEP and information about PrEP, strategies
are needed to bridge the gap for young people between
school-based knowledge on HIV prevention and accessing PrEP in health facilities. For the wider population
facilitating easier access to PrEP as part of routine sexual
and reproductive health care can support an increased
understanding of its intended purpose and importance [22].
Limitations of study
While a strength of this study was our ability to draw on
data from a HIV vaccine trial preparedness cohort study,
our limitation was that the interview topic guides were
not originally tailored to focus on PrEP literacy and
awareness. Therefore, we drew our findings form data
provided on the broader prospective HIV vaccine trial
Page 6 of 8
preparedness cohort study. Another limitation is our inability to generalise to other populations since this was a
clinical study setting where participants all received the
same information on PrEP. The trial setting could have
influenced our findings, notably social desirability of participants responses.
Recommendations
Based on our findings, we recommend that health care
workers should be trained in different ways in which
information on PrEP can be shared in the community.
Information leaflets detailing PrEP can be made available to the public in several forms such as paper copies,
shared on digital platforms, as well as provided through
local radio programmes to reach the less-literate. In
addition, PrEP users, may be encouraged to tell others
about their experience and contribute to addressing HIVrelated stigma in their communities.
Conclusion
Using the SEM, we have highlighted different layers of
influence that affect PrEP literacy, knowledge and acceptance. The perceived barriers to uptake greatly affect
PrEP understanding and acceptability. It is important to
increase the sources of reliable information to enhance
PrEP knowledge. This can be done whilst addressing the
barriers, particularly rumours and stigma, which affect
uptake in communities. Gaining a better understanding
of different influences is integral to understanding how to
maximize the value of PrEP as an effective HIV prevention intervention in the general population, outside of the
context of clinical trials.
Abbreviations
IDI: In-depth interviews; IEC: Information, Education and Communication;
MSM: Men who have sex with men; PLWHIV: People living with HIV; PrEP: Oral
pre-exposure prophylaxis; SEM: Socio-Ecological Model; TAF/FTC: Tenofovir
alafenamide (TAF) plus emtricitabine; TDF/FTC: Tenofovir desoproxil fumarate/
emtricitabine.
Supplementary Information
The online version contains supplementary material available at https://doi.
org/10.1186/s12913-022-08730-8.
Additional file 1.
Acknowledgements
We thank all the participants and staff at all the sites participating in the
PrEPVacc Study.
We thank all the members of the PrEPVacc Study Group:
South Africa: Glenda Gray, Nishanta Singh, Zakir Gaffoor, Neetha Morar,
Thandiwe Sithole, Kubashni Woeber, Samantha Siva, Eldinah Hwengwere,
Rujeko Samanthia Chidawanyika, Nteboheleng Mahapa, Phindile Khanyile
Mozambique: Ilesh Jani, Edna Viegas, Isabel Remane, Odete Bule, Edna
Nhacule, Patricia Ramgi, Raquel Chissumba, Eduardo Namalango, Yolanda
Manganhe , Carmelia Massingue, Igor Capitine, Jorge Ribeiro
Chimukuche et al. BMC Health Services Research
(2022) 22:1336
Tanzania: Lucas Maganga, Wiston William, Emmanuel Kapesa , Elizabeth Danstan, Doreen Pamba, Marco Missanga Amani Kway, Abisai Kisinda, Lilian Njovu,
Lwitiho Sudi, Revocatus Kunambi
Said Aboud, Patricia Munseri, Eligius Lyamuya, Frank Msafiri, Agricola Joachim,
Edith Tarimo, Diana Faini Tumaini Nagu, Deus Buma, Muhammad Bakari,
Uganda: Pontiano Kaleebu, Freddie Mukasa Kibengo, Ayoub Kakande, Jennifer
Serwanga, Rachel Kawuma, Christian Hansen Holmes, Sheila Kansiime, Eugene
Ruzagira, Janet Seeley, Sylvia Kusemererwa, Sylvia Masawi, Vincent Basajja,
Tobias Vudriko, Peter Hughes, Shamim Nabukenya, Gertrude Mutonyi, Rita
Nakiboneka, Susan Mugaba,
Europe: Jonathan Weber, Cherry Kingsley, Tom Miller, Sheena McCormack,
Angela Crook, David Dunn, Henry Bern, Aminata Sy, Liz Brodnicki, Sarah
Joseph, Claire Wenden, Kundai Chinyenze, Jacqueline Musau, Mabela Matsoso,
Mary Amondi, Paramesh Chetty, Anne Gumbe, Giuseppe Pantaleo, Song Ding,
Charlotta Nilsson, Arne Kroidl, Julie Fox, Gustavo Doncel, Allison Matthews, Jim
Rooney, Carter Lee, Merlin Robb.
Authors’ contributions
Contributed to the design of the study and essential documents: JS, ER, RK.
Performed the study and led data collection: RSC, NM, SM. Analyzed the data:
RSC, NM, SM, RK. Contribute to the interpretation of the data: RSC, NM, SM, RK,
JS, NS, SS, ER. Writing-original draft: RSC. Writing-review & editing: RSC, RK, JS,
NS, SS, ER. Project Administration: ER, JS, RK, Supervision: RK, JS, SS. The authors
read and approved the final manuscript.
Funding
PrEPVacc is funded by The Second European & Developing Countries Clinical
Trials Partnership (EDCTP2); (Grant reference: RIA2016 - 1644) in collaboration
with support from industry partners and sponsored by Imperial College London, UK. This research was funded in whole, or in part by Wellcome [Wellcome
Strategic Core Award 201433/Z/16/A]. For the purposes of open access, the
author has applied a CC BY public copyright licence to any Author Accepted
Manuscript version arising from this submission.
Availability of data and materials
The datasets generated and/or analysed during the current study are not
publicly available due to confidentiality assured to our participants by protecting their anonymity but data is available from the corresponding author on
reasonable request.
Declarations
Ethics approval and consent to participate
Approval to conduct the HIV vaccine trial preparedness study was obtained
from the South African Medical Research Council Ethics Committee (Reference
number: EC004-5/2018). All methods were performed in accordance with the
relevant guidelines and regulations. Written informed consent to participate
in all study procedures including the qualitative interviews was obtained at
enrolment into the HIV vaccine trial preparedness study. At the beginning of
each interview the purpose of the study was explained, and the participant
asked if they had any questions. To ensure confidentiality, interviews were
conducted in private rooms and names or personal identifiers were not used
in the transcripts. Access to data was restricted to authorised study staff.
Consent for publication
N/A
Competing interests
N/A
Author details
1
Africa Health Research Institute, KwaZulu-Natal, South Africa. 2 Social Aspects
of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe,
Uganda. 3 Gender and Health Research Unit, South African Medical Research
Council, Durban, South Africa. 4 HIV and Other Infectious Diseases Research
Unit, South African Medical Research Council, Durban, South Africa. 5 HIV
Epidemiology and Interventions Programme, MRC/UVRI and LSHTM Uganda
Research Unit, Entebbe, Uganda. 6 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Page 7 of 8
7
Department of Global Health and Development, London School of Hygiene
and Tropical Medicine, London, UK.
Received: 8 November 2021 Accepted: 26 October 2022
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