Table 3.

Current and potential PrEP users’ perceived barriers and facilitators to accessing PrEP in Birmingham, AL

Dimension of Access to Carea (Definition)	Perceived barrier or facilitator	Major sub-themes
Approachability (knowledge of the availability of services, which may vary by social or geographical groups)	Perceived barrier(s)	Lack of awareness of PrEP and limited advertisement of PrEP within non-white communities and among non-MSM populations
	Perceived facilitator(s)	PrEP-related information sharing via internet, social media and close interpersonal connections
Acceptability (the cultural and social factors that affect perceived appropriateness to seek out a service)	Perceived barrier(s)	Cultural and social norms that silence discussion concerning sexuality Fear and experiences of sexuality-related stigma
	Perceived facilitator(s)	Increased dialogue and visibility concerning PrEP in some social groups
Availability and accommodation (the ability to access services both physically, and in a timely manner)	Perceived barrier(s)	Long travel distances to access PrEP Time conflicts with available PrEP clinic appointments Repeated clinic visits needed to begin and receive cost assistance for PrEP
	Perceived facilitator(s)	Assistance from social support networks, employers, and others
Affordability (the ability to pay for services)	Perceived barrier(s)	High prescription and co-pay costs Lack of awareness of financial assistance programs Lack of resources for health insurance and cost-related challenges
	Perceived facilitator(s)	Financial and logistical support from assistance programs and clinic staff Assistance from peer navigators
Appropriateness (the fit between client needs and the services offered, including the type and quality of services provided)	Perceived barrier(s)	Lack of awareness of PrEP by primary care and family practitioners Preference for other modes of PrEP delivery (i.e., injectables) Low perceived HIV risk relative to the resources required for PrEP use Concern about side effects
	Perceived facilitator(s)	Interpersonal quality of interactions with PrEP providers Self-motivation and treatment self-efficacy

^aAs defined by Levesque et al. (2013)