Pre-exposure prophylaxis (PrEP) in primary health care: A qualitative study of users’ therapeutic itineraries in the Brazilian Amazon

Abstract Background Pre-exposure prophylaxis (PrEP) for HIV is available free of charge through the Brazilian Unified Health System, yet little is known about users’ experiences in primary health care in the Brazilian Amazon. This study describes and analyzes the therapeutic itineraries (TI) of PrEP users attending a Family Health Unit (FHU) in Manaus, Amazonas. Methods This is a qualitative, exploratory, and descriptive study based on in-depth interviews conducted between July and September 2023. Twenty HIV-negative adults (cisgender men and women, and one transgender man) using PrEP at FHU were included. Data were analyzed using MAXQDA. TI were interpreted using Arthur Kleinman’s Health Care System model as an analytical framework. Results Participants learned about PrEP through media, social networks, partners, friends, and previous experiences with post-exposure prophylaxis (PEP). Information acquired through interpersonal relationships was frequently legitimized through professional care, where testing, counselling, and access to PrEP transformed awareness into prevention practices. Continuity of care was influenced by distance, transportation costs, work schedules, stigma, and concerns about confidentiality. Primary care services were often perceived as more accessible and less stigmatizing than specialized HIV services. Interruptions and resumptions of PrEP use reflected ongoing reassessments of risk and prevention needs, while trust and supportive care relationships facilitated continuity. Conclusion TI revealed that PrEP use is a dynamic process shaped by interactions among social networks, institutional practices, stigma, and everyday prevention strategies. Strengthening decentralized, flexible, and privacy-protective primary health care services may reduce barriers and support equitable HIV prevention in the Brazilian Amazon.