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

From: Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation

Finding Examples Considerations and/or Implications for policy and practice
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