Restricted accessResearch articleFirst published online 2026-1
Perspectives of HIV Prevention Policymakers,Health Care Workers and Community Workers Concerning PrEP Implementation in Cambodia: The ANRS Quali-PrEP Study
This study aimed to explore the perspectives of actors in human immunodeficiency virus (HIV) prevention concerning pre-exposure prophylaxis (PrEP) in Cambodia. Interviews with national-level policymakers and focus groups with service providers (health care workers and community-based organization [CBO] workers) providing care to key populations (KPs) were conducted in 2022. Actors viewed pre-exposure prophylaxis as an effective tool for reducing HIV transmission among KPs and were committed to its implementation. However, they were concerned about KPs’ lack of protection against sexually transmitted infections other than HIV and about unintended pregnancies, as well as potential challenges to PrEP adherence and associated side effects. Key barriers to implementation included funding shortages, difficulties in reaching mobile KPs, and the need for further training for service providers. This study revealed the strong commitment to PrEP of actors in HIV prevention in Cambodia, and the need for community-centered approaches to ensure that sexual and reproductive health services best meet KPs’ needs.
World Health Organization. Consolidated Guidelines on HIV, Viral Hepatitis and STI Prevention, Diagnosis, Treatment and Care for Key Populations. World Health Organization; 2022.
WheelockAEisingerichABGomezGBGrayEDybulMRPiotP.Views of policymakers, healthcare workers and NGOs on HIV pre-exposure prophylaxis (PrEP): a multinational qualitative study. BMJ Open. 2012;2(4):e001234.
8.
BuchbinderSPLiuA.Pre-exposure prophylaxis and the promise of combination prevention approaches. AIDS Behav. 2011;15(S1):72-79. doi:10.1007/s10461-011-9894-1
9.
OliveriCEangRSégéralO, et al. High PrEP acceptability and need for tailored implementation in Cambodian key populations: results from a qualitative assessment. AIDS Care. 2024;36(suppl 1):109-116. doi:10.1080/09540121.2024.2308029
10.
FiorentinoM. Qualitative assessment about PrEP acceptability in key-populations and conditions required for community-based PrEP implementation in Cambodia (clinicaltrials.gov ID: NCT05091489). Published 2023. Accessed January 1, 2024. https://clinicaltrials.gov/study/NCT05091489
11.
KitzingerJ.The methodology of Focus Groups: the importance of interaction between research participants. Sociol Health Illn. 1994;16(1):103-121. doi:10.1111/1467-9566.ep11347023
12.
BraunVClarkeV.Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa
13.
PleuhsBQuinnKGWalshJLPetrollAEJohnSA.Health care provider barriers to HIV pre-exposure prophylaxis in the United States: a systematic review. AIDS Patient Care STDs. 2020;34(3):111-123. doi:10.1089/apc.2019.0189
14.
HullSJTessemaHThukuJScottRK.Providers PrEP: identifying primary health care providers’ biases as barriers to provision of equitable PrEP services. J Acquir Immune Defic Syndr. 2021;88(2):165-172.
15.
KumarSHaderxhanajLTSpicknallIH.Reviewing PrEP’s effect on STI incidence among men who have sex with men—balancing increased STI screening and potential behavioral sexual risk compensation. AIDS Behav. 2021;25(6):1810-1818. doi:10.1007/s10461-020-03110-x
OukVHengLSVirakM, et al. High prevalence of ceftriaxone-resistant and XDR Neisseria gonorrhoeae in several cities of Cambodia, 2022–23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP). JAC Antimicrob Resist. 2024;6(2):dlae053.
18.
MolinaJMCharreauIChidiacC, et al. Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. Lancet Infect Dis. 2018;18(3):308-317.
19.
LuetkemeyerAFDonnellDDombrowskiJC, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med. 2023;388(14):1296-1306. doi:10.1056/NEJMoa2211934
20.
DuffPEvansJLSteinESPageKMaherL; Young Women’s Health Study Collaborative. High pregnancy incidence and low contraceptive use among a prospective cohort of female entertainment and sex workers in Phnom Penh, Cambodia. BMC Pregnancy Childbirth. 2018;18(1):128. doi:10.1186/s12884-018-1768-3
21.
MoharebAMLarmarangeJKimAY, et al. Risks and benefits of oral HIV pre-exposure prophylaxis for people with chronic hepatitis B. Lancet HIV. 2022;9(8):e585-e594.
22.
Razavi-ShearerDGamkrelidzeIPanC, et al. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023;8(10):879-907.
23.
BecquetVNouamanMPlazyM, et al. A community-based healthcare package combining testing and prevention tools, including pre-exposure prophylaxis (PrEP), immediate HIV treatment, management of hepatitis B virus, and sexual and reproductive health (SRH), targeting female sex workers (FSWs) in Côte d’Ivoire: the ANRS 12381 PRINCESSE project. BMC Public Health. 2021;21(1):2214. doi:10.1186/s12889-021-12235-0
24.
CattaniVBJalilEMEkstermanL, et al. Impact of feminizing hormone therapy on tenofovir and emtricitabine plasma pharmacokinetics: a nested drug–drug interaction study in a cohort of Brazilian transgender women using HIV pre-exposure prophylaxis. J Antimicrob Chemother. 2022;77(10):2729-2736.
25.
ValentePKRusleyJCOperarioDBielloKB.Readiness to provide oral and injectable PrEP for sexual and gender minority youth among healthcare providers and clinics in the US Northeast. J Adolesc Health. 2023;72(5):722-729.
26.
LorenzettiLDinhNVan Der StratenA, et al. Systematic review of the values and preferences regarding the use of injectable pre-exposure prophylaxis to prevent HIV acquisition. J Int AIDS Soc. 2023;26(S2):e26107. doi:10.1002/jia2.26107
27.
KityoCCortesCPPhanuphakNGrinsztejnBVenterF.Barriers to uptake of long-acting antiretroviral products for treatment and prevention of HIV in low-and middle-income countries (LMICs). Clin Infect Dis. 2022;75(suppl 4):S549-S556.
28.
BekkerLGDasMAbdool KarimQ, et al. Twice-yearly lenacapavir or daily F/TAF for HIV Prevention in Cisgender Women. N Engl J Med. 2024;391(13):1179-1192. doi:10.1056/NEJMoa2407001
