Table 6.

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

	Theme	Timing	Illustrative quote
Facilitators	Ability to demonstrate HIV-negative serostatus to others	Before	Every time someone scorns you over ARVs, you die a little inside. So most people hide [ART use] for that reason, while for PrEP, it is not scary because you swallow it while you are healthy. You can even come from the health center and show off your receipt to people. (IDI, female, 33 years old, sex worker)
	Observation of PrEP efficacy from peer experiences	Before	He [fisherman] is already prepared since he took his medicine [PrEP] and it functions properly, thus he is not worried of anything because he is protected. (IDI, female, 22 years old, sex worker)
	Community trust in providers and ancillary PrEP implementation staff	Both	First, the service providers working on PrEP are good people. They explain to you and finally make your own decision.You first go for HIV testing. If you are diagnosed as HIV negative, then you are eligible to receive PrEP medicine. (IDI, female, 26 years old, discordant couple, mainland, remaining on PrEP but non-adherent)
	Peers make reminders (e.g. to consume daily pill, to pick up refills)	Both	PrEP medicine is the first item I put in my wallet before I leave home. Sometimes I leave my workplace very late and yet I am supposed to take my medicine. My PrEP companion can also remind me about taking my medicine through phone call. This is how I can take my medicine on time. (IDI, female, 26 years old, sex worker, mainland, remaining on PrEP and adherent)
	Awareness of living in HIV high-risk community	After	By mere fact that most people in this community are HIV positive, it makes it easier for PrEP users take their medicine every day. An example is announcing vaccination among people to prevent against getting infected with Cholera disease. I cannot fail to get vaccinated if some people in my community are already suffering from cholera disease. I cannot hesitate to go for this vaccination. After all, I will fear getting the same disease. (IDI, male, 31 years old, fisherman, fishing village, remaining on PrEP but non-adherent)
	Trust that PrEP is protective against HIV	After	I realized that I had many chances of getting infected, yet there was medicine that could reduce at the risk. Hence, I decided to participate in the PrEP program. The way we live here, you know there are many women here. There are many places of having fun and you can have sex with different women. For me, I said that I cannot allow a woman to destroy my life because no woman can stay here with only one man. The reason why I stuck on this medicine, I could see many of my colleagues I grew up with taking HIV medicine. I said that we have the same behavior; if I am not yet infected, why do I not try and protect myself. (IDI, male, 28 years old, fisherman, remaining on PrEP and adherent)
	Support/counselling from experienced users to use/refill PrEP or to manage side effects	After	They advise you that you can do everything you want but you should not forget taking your medicine. So, my colleagues advise me to take my medicine especially when I am travelling to work somewhere far from here. (IDI, female, 28 years old, sex worker, mainland, remaining on PrEP and adherent)
	Drug sharing (borrowing)	After	If I am stuck, I can borrow some tablets from a colleague and I take. That is how my colleagues support me. There is a time we move far, when some of them forgot the drugs or it got finished on the way, but you use the medicine of a colleague who still has some tablets. (IDI, female, 28 years old, sex worker, fishing village, remaining on PrEP and adherent)
Barriers	Fear of stigma because PrEP is mistaken for ART	Both	The difference between PrEP and ARVs is very small. They are both taken on daily basis, the providers are the same, the facilities where we pick them from are the same. It is very easy for one to say, "That person is lying that he is on PrEP. He is on ARVs." There is no way you can explain the difference. (IDI, male, 44 years old, fisherman)
	Fear of stigma because PrEP users could be viewed as having multiple sexual partners, being promiscuous, or being a sex worker	Both	He can say that you are a sex worker. He might ask you the reason why you take that medicine if you are not infected. So, your partner might think that you are a sex worker. (FGD, females, 15–19 years old, community members, mainland)
	Fear that PrEP usage may increase STI prevalence	After	The problem with PrEP is that the moment you take it you are protected, but the problem you can get afterward is getting sexually transmitted diseases. (IDI, female, 39 years old, sex worker, mainland, remaining on PrEP and adherent)
	Negative remarks or discouragement from peers	After	Someone could take it and stop it because of people’s words. They lost interest because of statements such as: Why do you take it when you are not sick? What will you take in case you get infected? So, some people threw it away, whereas others stopped it completely. (IDI, male, 28 years old, fisherman, remaining on PrEP and adherent)