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Views of policymakers, healthcare workers and NGOs on HIV pre-exposure prophylaxis (PrEP): a multinational qualitative study
  1. Ana Wheelock1,
  2. Andreas B Eisingerich2,
  3. Gabriela B Gomez3,
  4. Emily Gray4,
  5. Mark R Dybul5,6,
  6. Peter Piot7
  1. 1Centre for Patient Safety and Service Quality, Imperial College London, London, UK
  2. 2Imperial College Business School, London, UK
  3. 3Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
  4. 4Ipsos MORI Social Research Institute, London, UK
  5. 5Georgetown O'Neill Institute for National and Global Health Law, Washington, DC, USA
  6. 6George W. Bush Institute, Dallas, Texas, USA
  7. 7London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence toAna Wheelock; a.wheelock{at}


Objectives To examine policymakers and providers' views on pre-exposure prophylaxis (PrEP) and their willingness to support its introduction, to inform policy and practice in this emerging field.

Design Semistructured qualitative interview study.

Setting Peru, Ukraine, India, Kenya, Uganda, Botswana and South Africa.

Participants 35 policymakers, 35 healthcare workers and 21 non-governmental organisation representatives involved in HIV prevention.

Results Six themes emerged from the data: (1) perceived HIV prevention landscape: prevention initiatives needed to be improved and expanded; (2) PrEP awareness: 50 of 91 participants had heard of PrEP; (3) benefits of PrEP: one component of the combination prevention arsenal that could help prioritise HIV prevention, empower key populations and result in economic gains; (4) challenges of PrEP: regimen complexity, cost and cost-effectiveness, risk compensation, efficacy and effectiveness, stigmatisation and criminalisation, information and training and healthcare system capacity; (5) programmatic considerations: user eligibility, communication strategy, cost, distribution, medication and HIV testing compliance and (6) early versus late implementation: participants were divided as to whether they would support an early introduction of PrEP in their country or would prefer to wait until it has been successfully implemented in other countries, with around half of those we spoke to supporting each option. Very few said they would not support PrEP at all.

Conclusions Despite the multiple challenges identified, there was general willingness to support the introduction of PrEP. Yet, strengthening existing HIV prevention efforts was also deemed necessary. Our results suggest that an effective PrEP programme would be delivered in healthcare facilities and involve non-governmental organisations and the community and consider the needs of mobile populations. Comprehensive information packages and training for users and providers would be critical. The cost of PrEP would be affordable and possibly segmented. Extensive counselling and innovative monitoring measures ought to be considered.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Wheelock A, Eisingerich AB, Gomez GB, et al. Views of policymakers, healthcare workers and NGOs on HIV pre-exposure prophylaxis (PrEP): a multinational qualitative study. BMJ Open 2012;2:e001234. doi:10.1136/bmjopen-2012-001234

  • Contributors AW, ABE, GBG, EG, MRD and PP agree with the manuscript's results and conclusions. ABE and AW designed the measures/the study with the support of EG and PP. AW, GBG and ABE reviewed the available data and literature and performed the analyses. All authors contributed to the interpretation of results and write-up. MRD was principal investigator for the grant. PP and ABE were investigators for the grant at Imperial College London.

  • Funding The sponsor of the study, the Bill & Melinda Gates Foundation, had no role in study design, data collection, data analysis or write-up of the paper.

  • Competing interests The authors have declared that no competing interests exist.

  • Ethics approval This study was approved by the Ethics Committee of Imperial College London, the Universidad Peruana Cayetano Heredia in Peru, the Sociological Association of Ukraine (SAU), the Independent Ethics Committee Consultants (IEC) in India, the Institutional Review Board of the Kenya Medical Research Institute (KEMRI), the Director General Health Services of the Ministry of Health in Uganda, the Health Research and Development Division of the Ministry of Health in Botswana and the Human Research Ethics Committee (Medical) of the University of Witwatersrand in South Africa.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.