A qualitative study on pre-exposure prophylaxis uptake and retention among men who have sex with men and transgender women in Myanmar

Oral pre-exposure prophylaxis (PrEP) is efficacious in reducing human immunodeficiency virus transmission among people at substantial risk. In Myanmar's PrEP demonstration project among men who have sex with men (MSM) and transgender women (TGW), 39% (n=216) of eligible MSM/TGW initiated daily oral PrEP and 43% (n=93) of them remained on PrEP at 1 y. Here we aimed to understand the barriers and facilitators of PrEP uptake and retention among Myanmar's MSM/TGW and healthcare providers. We conducted three focus group discussions among 29 MSM/TGW (PrEP users and non-users) and in-depth interviews among 18 MSM/TGW and 8 healthcare providers (non-PrEP and PrEP prescribers) from Yangon. Interviews were audio recorded and transcribed in Burmese. Transcripts were analysed using thematic analysis. Among 47 participating MSM/TGW, the median age was 27 y, half identified as TGW (51% [n=24]) and 49% (n=23) were MSM and 53% (n=25) were taking PrEP during the study. Among healthcare providers, the median age was 31 y, seven were male, one was female and half were PrEP providers. In our study, perceived stigma linked with homosexuality, the daily pill burden and community misconceptions of PrEP as antiretroviral therapy were barriers. Providing telemedicine services and incentives and having a supportive network and peers facilitated PrEP uptake and retention.