Table 5.

Facilitators and barriers of PrEP uptake and adherence at the program level.

	Theme	Timing	Illustrative quote
Facilitators	High-quality provider training, provider confidentiality, and logistics around effective/high quality/reliable medication management, storage, and distribution	Before	Health workers from the clinic are more trained compared to community health workers. If I have not understood well on how to use that medicine [PrEP], he can explain to me more how to use, keep it in order to know more about it. (IDI, female, 22 years old, sex worker, fishing village)
	Convenience for highly mobile groups	Both	The health worker brings the medicine here to us. We gather at the church and get PrEP. He comes on a motorcycle and parks at the church. He then gets one of us to go and look for all PrEP users to come for their refills. (IDI, male, 30 years old, discordant couple, fishing village, remaining on PrEP and adherent)
	Providers give telephone reminders	After	They used to write dates for us and included the day when we shall go back and get PrEP. When the date is due, they take the initiative to call you on phone and remind you. When you reach at the center, you go and get the medicine... There is no more challenge I find because we go and get the medicine. (IDI, female, 26 years old, sex worker, mainland, remaining on PrEP but non-adherent)
	Peers can pick up refills for others	After	We help each other because even when the refill dates are due, she might have forgotten but then you remind her, or I might have forgotten, and she reminds me that lets go and get our medicine. That is how we support each other. (IDI, female, 39 years old, sex worker, mainland, remaining on PrEP and adherent)
	Three-month refill schedule (instead of one-month)	After	The period of one month is really very hard and most people fail to adhere to it. However, clients of three months are okay because they prepare for it in advance, so that after three months they can go back for the refill. (IDI, male, 27 years old, service provider)
Barriers	Fear of unskilled community health workers distributing inauthentic or expired prescriptions or price gouging by community distributers (lack of fixed, transparent pricing)	Before	If PrEP cost three hundred shillings, a community health worker will tell you that it costs four hundred shillings. (IDI, male, 26 years old, fisherman)
	Long wait times or clinic operation hours incompatible with PrEP client availability, and lack of clear guidelines for PrEP eligibility or adherence counselling	Before	[During PrEP training] it was mentioned that sex workers would not prefer to wait for long hours or lining up at the health center. Instead, a sex worker needs instant attention the moment she arrives at the health center. [But so far] we have not organized for a private room specifically for PrEP and no specific health provider deployed to work on PrEP. (IDI, female, 34 years old, service provider)
	Distance from PrEP clinics	Both	The other challenge would be distance. There are people that we started on PrEP in Kyabasimba, we don’t have facilitation to go back to Kyabasimba. If we had transport back to Kyabasimba, I would know that I have to go there every month or after two months and give them medicine. There are some places along the lake shores that aren’t easily accessible because you can’t go there with motorcycles, you have to walk there. (IDI, male, 25 years old, service provider)
	Staffing or supply shortages	Both	Today if I leave here and I go to Kyazanga [a nearby town], where will I get it [PrEP] from? I have come here to get it. It is out of stock on that side of ours, so even though I need transport to come back this side to pick it up, then I say, "Aha let me go to the clinic [here] to get PrEP." (FGD, males, 20–34 years old, community members, fishing village)