Table 3 Summary of community member perspectives on the uptake and implementation of PrEP at the population level

Community members are unaware and/or unknowledgeable about PrEP

Of those who reported no previous understanding of PrEP:

Need for materials or procedures within PrEP programs that can overcome historical mistrust of the medical system.

· Expressed mistrust of medical system

· Consumer information that is simplified and clearly written so that local community members accurately understand PrEP findings.

· Do not believe PrEP actually exists and/or do not believe it will work

· Enhanced efforts to disseminate findings to local communities. This is likely to include use of venues and media accessed by those communities.

· Did not know that any studies of an HIV prevention pill were underway

Of those who reported previous knowledge of PrEP:

· Often confused PrEP with PEP

· Had incorrect information regarding clinical trials

· Do not see its purpose

Community members expressed mixed interest in receiving PrEP

Of those who expressed interest in using PrEP:

· Believe it would help connect individuals to the healthcare system

· It is critical for information campaigns about PrEP to focus on:

· Expressed that anything to help reduce HIV transmission is a good thing

· (1) its efficacy at preventing HIV infection;

· Noted that PrEP already fit into their medical routine

· (2) its safety;

Of those who reported conditional willingness to use PrEP:

· (3) the logistical ease of the regimen and associated medical monitoring; and

· Reported various concerns about safety and side effects

· (4) programming, funding sources or opportunities that would make PrEP affordable for low-income populations.

· Believe cost is a major barrier (both for themselves and others)

· Need more statistics and data to make a final decision

Of those who expressed minimal to no interest in receiving PrEP:

· Do not believe PrEP is effective enough and/or believed condoms were a better alternative

· Feel that monitoring of side effects is burdensome

· Stated that a once-a-day regimen is not realistic

Community members noted concerns regarding the rollout of PrEP

Of those who noted concerns about PrEP as a package:

Critical to implement PrEP as part of comprehensive programs that combine daily pill regimens with other strategies, such as testing and counseling and behavioral intervention approaches.

· Believe much disinhibition and risk compensation will occur in their communities

· Need to develop protocols that define clearly the roles that clinical providers and community-based providers will play in the provision of combination prevention strategies that include PrEP and more traditional prevention approaches (e.g., testing, behavior change).

· Fear that ARVs would be prioritized over education, condom use, testing and counseling

· Inclusion of diverse viewpoints in decision making around funding priorities for HIV prevention dollars.

· Feel that messaging will not reach the communities it needs to

Of those who noted concerns about PrEP accessibility:

· Expressed multiple fears of equity and access

· Questioned the roles and responsibilities of providers, health insurance and pharmaceutical companies in reducing health disparities