Baqiyatallah University of Medical Sciences International Journal of Medical Reviews 2345-525X 9 3 2022 09 01 Tenofovir-based HIV Pre-Exposure Prophylaxis for Sub-Saharan African Women at High-risk of Acquisition: An Integrative Systematic Qualitative Evidence Synthesis of Factors Affecting Adherence 306 316 158743 10.30491/ijmr.2021.297884.1215 EN Grant Murewanhema Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe 0000-0001-7531-730X Journal Article 2021 08 01 Introduction: Women from Sub-Saharan Africa remain at substantial risk of HIV acquisition and require urgent interventions to mitigate this issue. Oral pre-exposure prophylaxis offers a viable option. Unfortunately, it was ineffective during clinical trials in this population due to poor adherence. This systematic review has been conducted in order to understand the factors uniquely affecting adherence in this population. Methods: Five databases (Embase, Medline, CENTRAL, Web of Science and ClinicalTrials.gov) were searched for relevant observational and qualitative studies reporting the factors affecting adherence. Titles and abstracts of returned articles were assessed for eligibility, leading to retrieval of full texts. Quality and risk of bias assessments were done before data extraction. Thematic qualitative evidence synthesis was done for factors affecting adherence. Results: Sub studies and ancillary studies of the three main clinical trials were retrieved, employing quantitative and qualitative methods to assess factors affecting adherence to tenofovir-based pre-exposure prophylaxis. Identified themes were grouped into five categories based on a modification of Ickovics and Meisler’s conceptual framework. These are individual, partner, social/community, product/drug and research related factors. Within each category, barriers and facilitators of adherence were placed. Significant barriers to uptake pre-exposure prophylaxis were identified. Conclusion: The success of future clinical trials on HIV prevention methods among Sub-Saharan African women, and the successful rollout of preventive public health interventions will depend on adequately addressing barriers to adherence. Therefore, clinical and public health researchers must aim to understand these factors, to optimise uptake and benefit from the interventions.

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