Table 4.

Illustrative quotations from High TFV-DP participants describing factors enabling their PrEP use

Supportive partners and family members

“Even my boyfriend I told that I’m taking PrEP, he’s my supporter. He even said when I go to the gym ‘take your pill box put them in your bag you will drink it at the gym’, and when the alarm rings at 8 pm and we are at the gym. […] Even my grandmother said “no, if you see that it’s [PrEP] good for you, take it my child.” (High, peri-urban, age 23) ”Yes at home they [family] know about it because when I started using PrEP they [study staff] came to my home and I was with them. […] At home I have a sister who is [living with] HIV, so my mother said, ‘no I can see it [PrEP] is a right thing and it can also help you’ and I also had that in my mind. […] It's not something that I hide … it’s something that will help me.” (High, rural, age 25) “I told my sister, and she was supportive. She wanted it for my other sister’s daughter but they had already stopped taking new people. She also wanted it for herself […] I wanted them to know and also advise me if I did something that is out of line.” (High, peri-urban, age 22) “They [family] asked a lot of questions to the person who was introducing PrEP to me [study staff member during home visit]. The counsellor told my mother that PrEP is safe to use and a lot of people are using it, it was not the first time she heard about PrEP. […] it was not difficult to convince her." (High, rural, age 25)

Belief that PrEP works

“My friend says I should not take PrEP, it’s wrong for me, your boyfriend will leave you, those pills will give AIDS. […] I told her that she will regret when she has AIDS that why didn’t she take PrEP, and as for me I will die without contracting AIDS.” (High, peri-urban, age 23) "I used to [feel at risk] before PrEP but now I feel free because PrEP is my hope, I take it every day, I never miss it. […] I will always use it because my partner has HIV and I would like to continue with it." (High, peri-urban, age 22) “When PrEP was introduced there were people who said bad things about it. [….] ‘These pills are going to cause disease’ or ‘they are not accurate’ or ‘they have side effects’. […] They said so many things but on my mind I thought they are not the ones who introduced me to PrEP […] They don’t know anything about it. They are hearing it by those who have not learned about it. So I thought it is better to listen to these people [study staff] than to listen to people who do not know about it. […] I will see it by myself … and if they [PrEP pills] have side effects I will tell PrEP study staff and they will tell me what to do.” (High, rural, age 25) “[PrEP] was protecting me from getting HIV virus so that is one thing that drove me." (High, peri-urban, age 18)

Planning for PrEP taking

“[When first started PrEP] I usually forgot about it [PrEP], and I thought to myself that it will help me to set an alarm and I should not hide it. I put it on top of the dresser in the morning […] then I see it.” (High, rural, age 25) "I keep [PrEP] in the wardrobe because that is the only place I open it everyday. […] When I used to forget I set an alarm. These days on your smart phone you can write what is that alarm for, I used to write “take PrEP” alarm. […] We have that brown container [pill box] so even if I am not at home I still take my pills with, there is not anything that prevents me from taking PrEP.” (High, peri-urban, age 18) “I keep it on that green container I got from here, next to the children’s lunch boxes in the morning at home. So that I can always see it and not forget it. […] I have an alarm that rings at 8 pm, so when that alarm rings I know it’s time to take PrEP, and when my phone is off I have a ring that I wear and that ring I put it on my pinkie finger. When I put it on my pinkie finger it reminds me to always ask what time it is." (High, peri-urban, age 23)

*Participant quotations are labeled with adherence level based on DBS, study site, and age at baseline