Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study
Authors: Chimukuche Rujeko Samanthia , Kawuma Rachel , Mahapa Nteboheleng , Mkhwanazi Smanga , Singh Nishanta , Siva Samantha , Ruzagira Eugene , Seeley Janet ,   On behalf of the PrEPVacc Study Group, Gray Glenda , Singh Nishanta , Gaffoor Zakir , Morar Neetha , Sithole Thandiwe , Woeber Kubashni , Siva Samantha , Hwengwere Eldinah , Chidawanyika Rujeko Samanthia , Mahapa Nteboheleng , Khanyile Phindile , Jani Ilesh , Viegas Edna , Remane Isabel , Bule Odete , Nhacule Edna , Ramgi Patricia , Chissumba Raquel , Namalango Eduardo , Manganhe Yolanda , Massingue Carmelia , Capitine Igor , Ribeiro Jorge , Maganga Lucas , William Wiston , Kapesa Emmanuel , Danstan Elizabeth , Pamba Doreen , Kway Marco Missanga Amani , Kisinda Abisai , Njovu Lilian , Sudi Lwitiho , Kunambi Revocatus , Aboud Said , Munseri Patricia , Lyamuya Eligius , Msafiri Frank , Joachim Agricola , Tarimo Edith , Nagu Diana Faini Tumaini , Buma Deus , Bakari Muhammad , Kaleebu Pontiano , Kibengo Freddie Mukasa , Kakande Ayoub , Serwanga Jennifer , Kawuma Rachel , Holmes Christian Hansen , Kansiime Sheila , Ruzagira Eugene , Seeley Janet , Kusemererwa Sylvia , Masawi Sylvia , Basajja Vincent , Vudriko Tobias , Hughes Peter , Nabukenya Shamim , Mutonyi Gertrude , Nakiboneka Rita , Mugaba Susan , Weber Jonathan , Kingsley Cherry , Miller Tom , McCormack Sheena , Crook Angela , Dunn David , Bern Henry , Sy Aminata , Brodnicki Liz , Joseph Sarah , Wenden Claire , Chinyenze Kundai , Musau Jacqueline , Matsoso Mabela , Amondi Mary , Chetty Paramesh , Gumbe Anne , Pantaleo Giuseppe , Ding Song , Nilsson Charlotta , Kroidl Arne , Fox Julie , Doncel Gustavo , Matthews Allison , Rooney Jim , Lee Carter , Robb Merlin 
Published: November 2022

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