ArticleAIDS and behavior2026
Barriers and Facilitators to Pre-exposure Prophylaxis Adherence Among Thai Men Who have Sex with Men in Bangkok: COM-B Model Analysis.
Article in AIDS and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The Thai government addresses human immunodeficiency virus (HIV) incidence by providing free Pre-Exposure Prophylaxis (PrEP) to reduce infection rates and expand access among at-risk populations. This qualitative study used the Capability, Opportunity, Motivation, and Behavior (COM-B) model to explore barriers and facilitators to PrEP adherence among Thai men who have sex with men (MSM) in Bangkok. In-depth, semi-structured interviews were conducted with 12 Thai MSM. Data were thematically analyzed and then mapped to the COM-B framework. Seven key barriers were identified: difficulty keeping medication on hand; limited awareness; cost concerns; stigma related to HIV and sexual behavior; fear of long-term side effects; substance use; and low perceived HIV risk. Twelve facilitators emerged, including: reminder tools, follow-up calls, and ease of access; self-efficacy; peer and community support; inclusive and flexible services; media and public campaigns; trust in PrEP and healthcare providers; aversion to condoms; routine integration of PrEP; distrust of partners; perceived threat and susceptibility; and self-care motivations. All participants had access to government-provided free PrEP, which supported adherence. The findings, organized through the COM-B framework, identified key determinants of PrEP adherence among Thai MSM. This application of COM-B demonstrates its utility as an analytical lens for structuring behavioral determinants in adherence research. Future research should develop targeted interventions addressing these specific COM-B components to enhance PrEP adherence in this population and extend to more diverse groups, thereby strengthening Thailand's HIV prevention strategies.
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