Table 2.

Facilitators of and barriers to study-provided PrEP use

Theme	Defined as discourse on…	Example quotes
Facilitators of PrEP use
Efficacy beliefs	Beliefs that PrEP works to prevent HIV	‘What motivated me is the fact that they protect me from getting HIV, because sometimes I forget to use a condom with my boyfriend that is why I continued using the pills. I had that hope that the pills will protect me…” D IDI “The treatment made me safe so I continued taking the pills.” E IDI “I heard here at the site that these pills work and that they were being tested overseas too and that the results proved that these pills do work so that made me take the pills.” E FG
Perceived HIV-prevention needs/risks	Risk of being exposed to HIV/desire to protect HIV-negative status; discussion of prevention in context of rape/forced sex	“As I said before, it made me want to protect myself. Before I was involved in the study, I didn’t care as much as I do now.” T IDI “… I also knew that this pill will help me in any case like if I was to be raped I would not be infected with HIV” D IDI
Use of concrete adherence strategies	Strategies used for adherence	“I didn’t set my phone or anything like that. I knew that if Generations [a popular television series] is about to begin, I would take my pill.” D FG “I would keep the tablets in my pocket so that I always remember to drink the tablets” E IDI
Social support for use	Support from partner/friend/family for taking PrEP	“My friends would also help me because they knew at a certain time I was supposed to take the pill. So it was those kinds of things that helped me.” T FG “The boyfriend that I was staying with was very supportive and he always encourages me to drink the tablets.” E IDI
Barriers to PrEP use
Attributes of PrEP pills (taste, smell)	Negative perceptions of pill attributes	“Yes, at the beginning I was asking myself, how am I going to be able to swallow this big pill and as time goes on, I was able to swallow them.” D IDI “What I found difficult was the way it smelled, it made me nauseous. So when the time came for me to take it, I had to think hard about it. I wasn’t too happy taking it.” D FG
Side-effects attributed to PrEP	Negative physical experiences attributed to using PrEP in self or others	“At first it was hard because they were not good for my immune system but they have told me here that at first I might have some side effects such as always feel[ing] hungry, dizziness and they made me to have a small rush but as time goes on, I got used to it.” D IDI
ARV-related stigma	Fears that PrEP use will be misattributed to HIV-treatment; participant will be assumed to be HIV-positive	“Plus negative response from friends … they compare Truvada® to ARVs because they know someone who was taking the same medication and ended up being HIV positive.” D IDI “We are very shy of walking around with pills in our bags, because we are scared of what people would say, because let us say you take out your pills and take them at the party, some people won’t even ask- they will just say it’s an ARV.” E FG
Needs for privacy/non-disclosure	Non-disclosure of study participation to significant others, due to anticipated stigma, misunderstanding or lack of support	“The problem was that I didn’t tell my boyfriend that I was taking the Truvada®. So when I went to his place, I wouldn’t take it along” T FG “So you are now sitting with friends and you see that the time is about to arrive. So what will they say if I were to take these pills in front of them? My friends are going to judge me. So I end up not taking them then.” E FG
Non-daily regimens
Sex-dependent doses	Difficulty in determining whether or not sex would occur (for pre-sex dosing) and a mismatch between PrEP dosing and the post-sex milieu	“What would get me to forget is that—I live with my boyfriend, right, okay. So maybe we’re lying on the bed together and then sex just happens… Now my pills sit in a divider and sometimes they are looking at me, but I am busy at the moment… So I will have sex and then will wait for the appropriate time for me to take the after sex pills.” E FG “The regimen that we were in was very difficult. Let’s say that you are in town and your partner phones you and says: “Baby, please come this way when you’re finished in town.” Now you might not have a chance to stop off at home because it could be late.” E FG “And sometimes, after sex, you want to sleep. Maybe you’re tired. You don’t think about taking pills. Maybe you guys are sitting together and talking since you don’t see each other so often. So then you will forget the pills.” E IDI “After sex…. After I have just finished having sex, it’s nice to sit back and relax a bit.” T FG

D daily regimen, T time-driven regimen, E event-driven regimen, IDI in depth interview participant, FG focus group participant