Communication Needs for Improved Uptake of Prep and HIVST Services Among Key Populations in Nigeria: A Mixed-Method Study
Authors: Durosinmi-Etti Olawale , Nwala Emmanuel Kelechi , Oki Funke , Ikpeazu Akudo , Godwin Emmanuel , Umoh Paul , Shaibu Arome , Ogundipe Alex , Kalaiwo Abiye 
Published: April 2021

Abstract
BackgroundWorld Health Organization (WHO) reports that people who indulge in risky behaviours such as penile-anal sex, unprotected intercourse, multiple sex partners, and use of alcohol and illicit drugs are at risk of HIV/AIDS and have been classified as key populations (KPs). Since the introduction of PrEP and HIVST for the key population groups in Nigeria, government entities and implementing partners have used a range of channels in messaging these essential services across to the target groups – ranging from in-person, social media, television, and radio adverts. Yet, only little successes have been recorded, thereby necessitating the need to document the enabling facilitators, barriers to, and needs of the KP groups in communicating PrEP and HIVST services in Nigeria. MethodsA mixed-method cross-sectional design was used for the study with a total of 1169 key populations in Nigeria. Surveys and qualitative exploratory methods were employed to collect data from MSM, FSWs, and key influencers of the KP groups (health providers, peer educators, HIV program officers). Quantitative data was collected data through an open data kit (ODK), while qualitative data was collected using a topic guide in August 2020. Quantitative data analysis was conducted using SPSS version 20 for descriptive statistics while qualitative data analysis was conducted through deductive and thematic analysis based on the codebook.Results The KPs were mainly urban dwellers, and a majority of the participants were aged between 18 to 28yrs. However, the MSM group were of a younger population compared to the FSWs. Different level of education was reported, although a majority completed secondary education (56.1% FSWs and 43.5% MSM). The MSM group showed more tendency to acquire higher education compared to the FSWs. For example, about 51.3% of the MSM group were undergraduates compared to 9.5% of the FSWs. The majority of the KPs were self-employed (56.4% FSWs and 40% MSM), however, the proportion of KPs who were unemployed was also glaring (25.8% FSWs and 16.5% MSM). Only about 51% of the KPs were aware of PrEP, with typological variations (39.9% FSWs and 62.3% MSM). Among the MSM group, awareness about PrEP services was higher in Lagos (82.5%), compared to 53.1% and 54.5% in A/Ibom and C/River states respectively. Among the enablers to acquiring PrEP information was the ability of the KPs to network within their communities and on personal relationships. Evidence shows that no single approach influenced the acquisition and use of PrEP information by KPs. Only about 50% of the KPs were aware of HIVST services (40% FSWs and 60% MSM), although this proportion varied across the geographic locations. The factors that enabled the acquisition and use of the prevention commodities were cross-cutting and included previous or current role as peer educator, integration of the messages, peer networking, multi-lingual and multi-channel presentation, use of job aids and reminders. KPs expressed the need for information on how to take PrEP, eligibility, clarification on differences between PrEP and PEP, clarification on any side effects, pricing, for PrEP, price, efficacy, sales point, dosage, available brands. A scale-up of the research across all geopolitical zones and a survey to quantify the prevalence would help in understanding the dynamics and prioritization of interventions for scaling up PrEP and HIVST services in Nigeria. ConclusionsThe policy actors should consider the preferences of the KPs and key influencers in reducing barriers to communication and increasing the uptake of PrEP and HIVST services, and ensure it is reflected in a tailored communication strategy. Since multi-linguistics and multi-channels of presentation were enablers to acquiring PrEP and HIVST messages, the communications strategy for HIV prevention should incorporate these recommendations and adapt to context-specific approaches for effective messaging.