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Gitome S, Musara P, Chitukuta M, Mhlanga F, Mateveke B, Chirenda T, Mgodi N, Mutero P, Matubu A, Chareka G, Chasakara C, Murombedzi C, Makurumure T, Smith-Hughes C, Bukusi E, Cohen CR, Shiboski S, Darbes L, Rutherford GW, Chirenje ZM, Brown JM. " First was to sit down and bring our minds together". A qualitative study on safer conception decision-making among HIV sero-different couples in Zimbabwe. Sex Reprod Health Matters 2024; 32:2366587. [PMID: 39007699 PMCID: PMC11251431 DOI: 10.1080/26410397.2024.2366587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Decision-making on childbearing and safer conception use in HIV sero-different couples involves an intricate balance of individual desires and perceived HIV acquisition risk. This paper addresses an important knowledge gap regarding HIV sero-different couples' considerations and the relationship and power dynamics involved when deciding to use a safer conception method. Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples, who exited the SAFER study - a pilot study assessing the feasibility, acceptability and cost-effectiveness of a safer conception programme for HIV sero-different couples in Zimbabwe. All couples in SAFER were provided with a choice of safer conception methods and were followed for up to 12 months of pregnancy attempts and 3 months following pregnancy. While couples generally perceived their safer conception discussions to be easy and consensus-driven, the decision-making process also involved complex gender dynamics and trade-offs in relationship power, which resulted in differing interpretations of what constituted a joint or shared couple decision. Participants regarded effective couple communication as an essential component of and precursor to good safer conception conversations and requested additional training in couple communication. Couples relied on information from healthcare providers to kickstart their safer conception discussions. Safer conception programmes should address relationship power imbalances, promote effective couple communication and offer healthcare provider support to enable HIV sero-different couples to make informed choices about conception in a manner that upholds their safety and reproductive autonomy.
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Affiliation(s)
- Serah Gitome
- Clinical Research Scientist, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Petina Musara
- Social Scientist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Miria Chitukuta
- Social Scientist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Felix Mhlanga
- Senior Lecturer, Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe; Principal Investigator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Bismark Mateveke
- Obstetrician & Gynecologist, Honorary lecturer, Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe
| | - Thandiwe Chirenda
- Registered Nurse/Midwife, Clinical Research Coordinator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Nyaradzo Mgodi
- Clinical Research Site Leader, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Prisca Mutero
- Social Scientist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Allen Matubu
- Laboratory Director, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Gift Chareka
- Coordinator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Charles Chasakara
- Community Engagement Coordinator, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Caroline Murombedzi
- Research Pharmacist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe
| | - Tinei Makurumure
- Laboratory Director, Mercy-Care Fertility Centre, Harare, Zimbabwe
| | - Carolyn Smith-Hughes
- Associate Director of Evidence Translation, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Elizabeth Bukusi
- Senior Principal Clinical Research Scientist, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R. Cohen
- Professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen Shiboski
- Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lynae Darbes
- Professor, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, USA
| | - George W. Rutherford
- Professor, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Z. Michael Chirenje
- Professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA; Professor, Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Joelle M. Brown
- Associate Professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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Wu L, Kaftan D, Wittenauer R, Arrouzet C, Patel N, Saravis AL, Pfau B, Mudimu E, Bershteyn A, Sharma M. Health impact, budget impact, and price threshold for cost-effectiveness of lenacapavir for HIV pre-exposure prophylaxis in eastern and southern Africa: a modelling analysis. Lancet HIV 2024:S2352-3018(24)00239-X. [PMID: 39312933 DOI: 10.1016/s2352-3018(24)00239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/01/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Injectable lenacapavir administered every 6 months is a promising product for HIV pre-exposure prophylaxis (PrEP). We aimed to estimate the health and budget impacts and threshold price at which lenacapavir could be cost-effective in eastern and southern Africa. METHODS We adapted an agent-based network model, EMOD-HIV, to simulate lenacapavir scale-up in Zimbabwe, South Africa, and western Kenya from 2026 to 2035. Uptake assumptions were informed by a literature review of PrEP product preferences. In the main analysis, we varied lenacapavir coverage by subgroup: female sex workers (40% coverage); male clients of female sex workers (40%); adolescent girls and young women aged 15-24 years with more than one sexual partner (32%); women aged 25 years and older with more than one sexual partner (36%); and males with more than one sexual partner (32%). We also assessed a higher coverage scenario (64-76% across subgroups) and scenarios of expanding lenacapavir use, varying from concentrated among those at highest HIV risk to broader coverage including those at medium HIV risk. We estimated the maximum per-dose lenacapavir price that achieved cost-effectiveness ( FINDINGS In the main analysis, lenacapavir was projected to achieve from 1·6% (95% uncertainty interval [UI] 1·5-1·8) to 4·0% (3·4-5·1) population coverage across settings and to avert from 12·3% (5·4-19·5) to 18·0% (11·0-22·9) of infections over 10 years. The maximum price per dose was highest in South Africa ($106·28 [95% UI 95·72-115·87]), followed by Zimbabwe ($21·15 [17·70-24·89]), and lowest in western Kenya ($16·58 [15·44-17·70]). The 5-year budget impact was US$507·25 million (95% UI 436·14-585·42) in South Africa, $16·80 million (13·95-22·64) in Zimbabwe, and $4·09 million (3·86-4·30) in western Kenya. In the higher coverage scenario, lenacapavir distribution was projected to reach from 3·2% (95% UI 2·9-3·6) to 8·1% (6·8-10·5) population coverage and to avert from 21·2% (95% UI 14·7-18·5) to 33·3% (28·5-36·9) of HIV infections across settings over 10 years. Price thresholds were lower than in the main analysis: $88·34 (95% UI 83·02-94·19) in South Africa, $17·71 (15·61-20·05) in Zimbabwe, and $14·78 (14·33-15·30) in western Kenya. The 5-year budget impact was higher than the main analysis: $835·29 million (95% UI 736·98-962·98) in South Africa, $29·50 million (24·62-39·52) in Zimbabwe, and $7·45 million (7·11-7·85) in western Kenya. Expanding lenacapavir coverage resulted in higher HIV infections averted but lower price thresholds than scenarios of concentrated use among those with highest HIV risk. INTERPRETATION Our findings suggest that lenacapavir could avert substantial HIV incidence and that price thresholds and budget impacts vary by setting and coverage. These results could inform policy deliberations regarding lenacapavir pricing and resource planning. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Linxuan Wu
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - David Kaftan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rachel Wittenauer
- CHOICE Institute, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Cory Arrouzet
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Nishali Patel
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Arden L Saravis
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Brian Pfau
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Edinah Mudimu
- Department of Decision Sciences, University of South Africa, Pretoria, South Africa
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, USA.
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McGowan M, Wairimu N, Reedy AM, Mogere P, Culquichicon C, Njeru I, Malen RC, Jahn A, Bärnighausen T, Roche SD, Ngure K, Ortblad KF. Formalized peer referral to HIV pre-exposure prophylaxis supported with self-testing: a mixed-methods pilot study among young Kenyan women. Front Public Health 2024; 12:1428609. [PMID: 39324163 PMCID: PMC11422135 DOI: 10.3389/fpubh.2024.1428609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/06/2024] [Indexed: 09/27/2024] Open
Abstract
Background The uptake of daily oral HIV pre-exposure prophylaxis (PrEP)-a highly effective intervention-remains low among African adolescent girls and young women (AGYW) who could benefit. AGYW who initiate PrEP often do so through informal peer referral, which may be enhanced with formalized peer referral and peer-delivered HIV self-testing (HIVST). To understand the feasibility of this PrEP referral model among AGYW, we conducted a pilot study in Kenya. Method From March to May 2022, we recruited AGYW (≥16-24 years) using PrEP (i.e., "peer providers") from public healthcare clinics in Kiambu County and trained them on HIV prevention, HIVST use, and peer-supported linkage to clinic-based HIV services. Following training, peer providers received eight HIVST kits and were encouraged to refer four peers (i.e., "peer clients") to PrEP. We completed surveys with peer providers and clients one month following intervention delivery to assess PrEP initiation among peer clients. Later, we conducted focus group discussions (FGDs) with peer providers and clients to identify factors that facilitated or challenged intervention outcomes. Results We trained 16 peer providers (median age: 23 years, IQR 21-24) who reported delivering the intervention to 56 peer clients; 30 peer clients (median age: 21 years, IQR 19-22) contacted the study team and were enrolled. Most of the enrolled peer clients reported behaviors associated with HIV risk (e.g., condomless sex; 80%, 24/30) and were PrEP-naïve (87%, 26/30). At one-month, PrEP initiation among eligible PrEP-naïve peer clients was high, as reported by providers (78%, 43/55) and clients (85%, 22/26); recent HIVST use was also high among peer clients (provider report: 95%, 53/56; client report: 97%, 29/30). In the FGDs, participants reported that intervention outcomes were facilitated by close preexisting relationships, HIVST assistance, and being escorted to clinic-based HIV services by peer providers; intervention barriers included conflicting priorities and limited HIVST experience. Conclusion A formalized model of peer referral with HIVST delivery supported PrEP initiation among Kenyan AGYW. These findings demonstrate the potential for peer-delivered interventions to engage AGYW in HIV prevention services; however, more research is needed on the effectiveness and sustainability of this approach at scale.
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Affiliation(s)
- Maureen McGowan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Njeri Wairimu
- Partners in Health and Research Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Adriana M Reedy
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Peter Mogere
- Partners in Health and Research Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Carlos Culquichicon
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Irene Njeru
- Partners in Health and Research Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, United States
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Stephanie D Roche
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Katrina F Ortblad
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
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Kampamba M, Nelumbu NN, Hikaambo CN, Mudenda S, Hangoma JM, Kunda M, Mufwambi W, Hamachila A, Mukosha M. Awareness and willingness to use pre-exposure prophylaxis among the University of Zambia students: A cross-sectional study. Health Sci Rep 2024; 7:e70060. [PMID: 39257911 PMCID: PMC11386235 DOI: 10.1002/hsr2.70060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 08/06/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
Background and Aims Despite a quick rollout of PrEP as a preventive method against Human Immunodeficiency Virus (HIV) infections in Zambia, adolescent and young adult populations have remained very vulnerable to HIV infection. This study assessed the awareness and willingness to use PrEP among University of Zambia (UNZA) students. Methods Three hundred forty-six students participated in this cross-sectional study at UNZA between March and June 2021. A previously validated questionnaire assessed willingness to use PrEP. We tested the hypothesized pathways between sexual risk behavior and willingness to use PrEP using the structural equation model. Multivariate logistic regression analysis was employed to determine factors associated with willingness to use PrEP. Variables with a p-value < 0.05 were considered statistically significant. Results Of the 346 students, 271 (78.3%) were aware of PrEP, and 59 (17.1%) of the participants were willing to use PrEP. Only 17 (4.9%) of the participants had used PrEP before. In the multivariable logistic regression model, students who were aware of PrEP compared to those who were not (AOR = 3.03, 95% CI: 1.10, 8.40, p) were more likely to be willing to use PrEP. Sexual risk behavior indirectly and positively affected willingness to use PrEP through awareness of PrEP. Conclusion Even though most students were aware of PrEP, the willingness to use this preventative measure is still low among UNZA students, resulting in low uptake. Therefore, concerted efforts are required to influence the willingness and uptake of PrEP, especially in high-risk age groups such as university students.
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Affiliation(s)
- Martin Kampamba
- Department of Pharmacy School of Health Sciences, University of Zambia Lusaka Zambia
| | - Natalia N Nelumbu
- Department of Pharmacy School of Health Sciences, University of Zambia Lusaka Zambia
| | - Christabel N Hikaambo
- Department of Pharmacy School of Health Sciences, University of Zambia Lusaka Zambia
| | - Steward Mudenda
- Department of Pharmacy School of Health Sciences, University of Zambia Lusaka Zambia
| | - Jimmy M Hangoma
- Department of Pharmacy School of Health Sciences, Levy Mwanawasa Medical University Lusaka Zambia
| | - Mwape Kunda
- Department of Pharmacy Mary Begg Health Services Ndola Zambia
| | - Webrod Mufwambi
- Department of Pharmacy School of Health Sciences, University of Zambia Lusaka Zambia
| | - Audrey Hamachila
- Department of Pharmacy School of Health Sciences, University of Zambia Lusaka Zambia
| | - Moses Mukosha
- HIV and Women's Health Research Group University Teaching Hospital Lusaka Zambia
- Department of Epidemiology and Biostatistics School of Public Health, University of the Witwatersrand Johannesburg South Africa
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Kohler P, Larsen A, Abuna F, Owiti G, Sila J, Owens T, Kemunto V, Lagat H, Vera M, Richardson BA, Wilson K, Pintye J, John-Stewart G, Kinuthia J. Patient actor training improves preexposure prophylaxis delivery for adolescent girls and young women in Kenya: a cluster randomized trial. AIDS 2024; 38:1505-1512. [PMID: 38857513 PMCID: PMC11288181 DOI: 10.1097/qad.0000000000003943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya. DESIGN Cluster randomized trial and mystery shopper evaluation. METHODS Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or "mystery shoppers" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP. RESULTS Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P < 0.001). CONCLUSIONS SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.
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Affiliation(s)
- Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
- Department of Global Health, University of Washington, Seattle USA
| | - Anna Larsen
- Department of Global Health, University of Washington, Seattle USA
- Department of Epidemiology, University of Washington, Seattle USA
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - George Owiti
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Tamara Owens
- Clinical Skills and Simulation Center, Howard University, Washington DC USA
| | - Valerie Kemunto
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Harrison Lagat
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Melissa Vera
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle USA
- Department of Biostatistics University of Washington, Seattle USA
| | - Kate Wilson
- Department of Global Health, University of Washington, Seattle USA
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, Seattle USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle USA
- Department of Pediatrics, University of Washington, Seattle USA
- Department of Allergy and Infectious Diseases, University of Washington, Seattle USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
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Rucinski K, Knight J, Willis K, Wang L, Rao A, Roach MA, Phaswana-Mafuya R, Bao L, Thiam S, Arimi P, Mishra S, Baral S. Challenges and Opportunities in Big Data Science to Address Health Inequities and Focus the HIV Response. Curr HIV/AIDS Rep 2024; 21:208-219. [PMID: 38916675 PMCID: PMC11283392 DOI: 10.1007/s11904-024-00702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE OF REVIEW Big Data Science can be used to pragmatically guide the allocation of resources within the context of national HIV programs and inform priorities for intervention. In this review, we discuss the importance of grounding Big Data Science in the principles of equity and social justice to optimize the efficiency and effectiveness of the global HIV response. RECENT FINDINGS Social, ethical, and legal considerations of Big Data Science have been identified in the context of HIV research. However, efforts to mitigate these challenges have been limited. Consequences include disciplinary silos within the field of HIV, a lack of meaningful engagement and ownership with and by communities, and potential misinterpretation or misappropriation of analyses that could further exacerbate health inequities. Big Data Science can support the HIV response by helping to identify gaps in previously undiscovered or understudied pathways to HIV acquisition and onward transmission, including the consequences for health outcomes and associated comorbidities. However, in the absence of a guiding framework for equity, alongside meaningful collaboration with communities through balanced partnerships, a reliance on big data could continue to reinforce inequities within and across marginalized populations.
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Affiliation(s)
- Katherine Rucinski
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Jesse Knight
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kalai Willis
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Linwei Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary Anne Roach
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Refilwe Phaswana-Mafuya
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research (PACER) Extramural Unit, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Le Bao
- Department of Statistics, Pennsylvania State University, University Park, PA, USA
| | - Safiatou Thiam
- Conseil National de Lutte Contre Le Sida, Dakar, Senegal
| | - Peter Arimi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation & Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Manguro GO, Kioko UM, Githinji G, Owira P, Langat L, Okoro D, Temmerman M, Luchters S. Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya. BMC Health Serv Res 2024; 24:822. [PMID: 39014381 PMCID: PMC11253356 DOI: 10.1186/s12913-024-11293-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Comprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya. METHODS We implemented a top-bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization's expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020). RESULTS In 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60. CONCLUSION Programs should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.
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Affiliation(s)
- Griffins O Manguro
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Gerald Githinji
- Monitoring and Evaluation, International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Patricia Owira
- Monitoring and Evaluation, International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | | | | | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Monitoring and Evaluation, International Centre for Reproductive Health Kenya, Mombasa, Kenya
- Aga Khan University Centre for Excellence in Women and Child Health, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
- Centre for Sexual Health and, HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
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Sikazwe I, Musheke M, Chiyenu K, Ngosa B, Pry JM, Mulubwa C, Zimba M, Sakala M, Sakala M, Somwe P, Nyirenda G, Savory T, Bolton-Moore C, Herce ME. Programme science in action: lessons from an observational study of HIV prevention programming for key populations in Lusaka, Zambia. J Int AIDS Soc 2024; 27 Suppl 2:e26237. [PMID: 38982890 PMCID: PMC11233926 DOI: 10.1002/jia2.26237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/12/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Optimizing uptake of pre-exposure prophylaxis (PrEP) for individuals at risk of HIV acquisition has been challenging despite clear scientific evidence and normative guidelines, particularly for key populations (KPs) such as men who have sex with men (MSM), female sex workers (FSWs), transgender (TG) people and persons who inject drugs (PWID). Applying an iterative Programme Science cycle, building on the effective programme coverage framework, we describe the approach used by the Centre for Infectious Disease Research in Zambia (CIDRZ) to scale up PrEP delivery and address inequities in PrEP access for KP in Lusaka, Zambia. METHODS In 2019, CIDRZ partnered with 10 local KP civil society organizations (CSOs) and the Ministry of Health (MOH) to offer HIV services within KP-designated community safe spaces. KP CSO partners led KP mobilization, managed safe spaces and delivered peer support; MOH organized clinicians and clinical commodities; and CIDRZ provided technical oversight. In December 2021, we introduced a community-based intervention focused on PrEP delivery in venues where KP socialize. We collected routine programme data from September 2019 to June 2023 using programme-specific tools and the national electronic health record. We estimated the before-after effects of our intervention on PrEP uptake, continuation and equity for KP using descriptive statistics and interrupted time series regression, and used mixed-effects regression to estimate marginal probabilities of PrEP continuity. RESULTS Most (25,658) of the 38,307 (67.0%) Key Population Investment Fund beneficiaries were reached with HIV prevention services at community-based venues. In total, 23,527 (61.4%) received HIV testing services, with 15,508 (65.9%) testing HIV negative and found PrEP eligible, and 15,241 (98.3%) initiating PrEP. Across all programme quarters and KP types, PrEP uptake was >90%. After introducing venue-based PrEP delivery, PrEP uptake (98.7% after vs. 96.5% before, p < 0.001) and the number of initiations (p = 0.014) increased significantly. The proportion of KP with ≥1 PrEP continuation visit within 6 months of initiation was unchanged post-intervention (46.7%, 95% confidence interval [CI]: 45.7%, 47.6%) versus pre-intervention (47.2%, 95% CI: 45.4%, 49.1%). CONCLUSIONS Applying Programme Science principles, we demonstrate how decentralizing HIV prevention services to KP venues and safe spaces in partnership with KP CSOs enabled successful community-based PrEP delivery beyond the reach of traditional facility-based services.
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Affiliation(s)
- Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Maurice Musheke
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Kanema Chiyenu
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Benard Ngosa
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Public Health Sciences, School of Medicine, University of California, Davis, California, USA
| | - Chama Mulubwa
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | | | | | - Paul Somwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Goodwin Nyirenda
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Theodora Savory
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
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9
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Kebede S, Brazier E, Freeman AM, Muwonge TR, Choi JY, de Waal R, Poda A, Cesar C, Munyaneza A, Kasozi C, Pasayan MKU, Althoff KN, Shongo A, Low N, Ekouevi D, Veloso VG, Ross J. Preexposure prophylaxis availability among health facilities participating in the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. AIDS 2024; 38:751-756. [PMID: 38133656 PMCID: PMC10939841 DOI: 10.1097/qad.0000000000003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND While recognized as a key HIV prevention strategy, preexposure prophylaxis (PrEP) availability and accessibility are not well documented globally. We aimed to describe PrEP drug registration status and the availability of PrEP services across HIV care sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium. METHODS We used country-level PrEP drug registration status from the AIDS Vaccine Advocacy Coalition and data from IeDEA surveys conducted in 2014, 2017 and 2020 among participating HIV clinics in seven global regions. We used descriptive statistics to assess PrEP availability across IeDEA sites serving adult patients in 2020 and examined trends in PrEP availability among sites that responded to all three surveys. RESULTS Of 199 sites that completed the 2020 survey, PrEP was available in 161 (81%). PrEP availability was highest at sites in North America (29/30; 97%) and East Africa (70/74; 95%) and lowest at sites in Central (10/20; 50%) and West Africa (1/6; 17%). PrEP availability was higher among sites in countries where PrEP was officially registered (146/161; 91%) than where it was not (14/32; 44%). Availability was higher at health centers (109/120; 90%) and district hospitals (14/16; 88%) compared to regional/teaching hospitals (36/63). Among the 94 sites that responded to all three surveys, PrEP availability increased from 47% in 2014 to 60% in 2017 and 76% in 2020. CONCLUSION PrEP availability has substantially increased since 2014 and is now available at most IeDEA sites. However, PrEP service provision varies markedly across global regions.
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Affiliation(s)
- Samuel Kebede
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Renee de Waal
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Armel Poda
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alisho Shongo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nicola Low
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | | | - Valdiléa G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janerio, Brazil
| | - Jonathan Ross
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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10
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Wyatt MA, Pisarski EE, Nalumansi A, Kasiita V, Kamusiime B, Nalukwago GK, Thomas D, Muwonge TR, Mujugira A, Heffron R, Ware NC. How PrEP delivery was integrated into public ART clinics in central Uganda: A qualitative analysis of implementation processes. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002916. [PMID: 38452111 PMCID: PMC10919847 DOI: 10.1371/journal.pgph.0002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
Tailored delivery strategies are important for optimizing the benefit and overall reach of PrEP in sub-Saharan Africa. An integrated approach of delivering time-limited PrEP in combination with ART to serodifferent couples encourages PrEP use in the HIV-negative partner as a bridge to sustained ART use. Although PrEP has been delivered in ART clinics for many years, the processes involved in integrating PrEP into ART services are not well understood. The Partners PrEP Program was a stepped-wedge cluster randomized trial of integrated PrEP and ART delivery for HIV serodifferent couples in 12 public health facilities in central Uganda (Clinicaltrials.gov NCT03586128). Using qualitative data, we identified and characterized key implementation processes that explain how PrEP delivery was integrated into existing ART services in the Partners PrEP Program. In-depth interviews were conducted with a purposefully-selected sub-sample of 83 members of 42 participating serodifferent couples, and with 36 health care providers implementing integrated delivery. High quality training, technical supervision, and teamwork were identified as key processes supporting providers to implement PrEP delivery. Interest in the PrEP program was promoted through the numerous ways health care providers made integrated ART and PrEP meaningful for serodifferent couples, including tailored counseling messages, efforts to build confidence in integrated delivery, and strategies to create demand for PrEP. Couples in the qualitative sample responded positively to providers' efforts to promote the integrated strategy. HIV-negative partners initiated PrEP to preserve their relationships, which inspired their partners living with HIV to recommit to ART adherence. Lack of disclosure among couples and poor retention on PrEP were identified as barriers to implementation of the PrEP program. A greater emphasis on understanding the meaning of PrEP for users and its contribution to implementation promises to strengthen future research on PrEP scale up in sub-Saharan Africa.
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Affiliation(s)
- Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard Global, Cambridge, Massachusetts, United States of America
| | - Emily E. Pisarski
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Dorothy Thomas
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Norma C. Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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11
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Cox SN, Wu L, Wittenauer R, Clark S, Roberts DA, Nwogu IB, Vitruk O, Kuo AP, Johnson C, Jamil MS, Sands A, Schaefer R, Kisia C, Baggaley R, Stekler JD, Akullian A, Sharma M. Impact of HIV self-testing for oral pre-exposure prophylaxis scale-up on drug resistance and HIV outcomes in western Kenya: a modelling study. Lancet HIV 2024; 11:e167-e175. [PMID: 38301668 PMCID: PMC10896737 DOI: 10.1016/s2352-3018(23)00268-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Community-based oral pre-exposure prophylaxis (PrEP) provision has the potential to expand PrEP coverage. HIV self-testing can facilitate PrEP community-based delivery but might have lower sensitivity than facility-based HIV testing, potentially leading to inappropriate PrEP use among people with HIV and subsequent development of drug resistance. We aimed to evaluate the impact of HIV self-testing use for PrEP scale-up. METHODS We parameterised an agent-based network model, EMOD-HIV, to simulate generic tenofovir disoproxil fumarate and emtricitabine PrEP scale-up in western Kenya using four testing scenarios: provider-administered nucleic acid testing, provider-administered rapid diagnostic tests detecting antibodies, blood-based HIV self-testing, or oral fluid HIV self-testing. Scenarios were compared with a no PrEP counterfactual. Individuals aged 18-49 years with one or more heterosexual partners who screened HIV-negative were eligible for PrEP. We assessed the cost and health impact of rapid PrEP scale-up with high coverage over 20 years, and the budget impact over 5 years, using various HIV testing modalities. FINDINGS PrEP coverage of 29% was projected to avert approximately 54% of HIV infections and 17% of HIV-related deaths among adults aged 18-49 years over 20 years; health impacts were similar across HIV testing modalities used to deliver PrEP. The percentage of HIV infections with PrEP-associated nucleoside reverse transcriptase inhibitor (NRTI) drug resistance was 0·6% (95% uncertainty intervals 0·4-0·9) in the blood HIV self-testing scenario and 0·8% (0·6-1·0) in the oral HIV self-testing scenario, compared with 0·3% (0·2-0·3) in the antibody rapid diagnostic testing scenario and 0·2% (0·1-0·2) in the nucleic acid testing scenario. Accounting for background NRTI resistance, we found similarly low proportions of drug resistance across scenarios. The budget impact of implementing PrEP using HIV self-testing and provider-administered rapid diagnostic tests were similar, while nucleic acid testing was approximately 50% more costly. INTERPRETATION Scaling up PrEP using HIV self-testing has similar health impacts, costs, and low risk of drug resistance as provider-administered rapid diagnostic tests. Policy makers should consider leveraging HIV self-testing to expand PrEP access among those at HIV risk. FUNDING The Bill and Melinda Gates Foundation.
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Affiliation(s)
- Sarah N Cox
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Linxuan Wu
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Samantha Clark
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ifechukwu Benedict Nwogu
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Olga Vitruk
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alexandra P Kuo
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Anita Sands
- Regulation and Prequalification Department, World Health Organization, Geneva, Switzerland
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Christine Kisia
- World Health Organization - Kenya Country Office, Nairobi, Kenya
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Joanne D Stekler
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Adam Akullian
- Department of Global Health, University of Washington, Seattle, WA, USA; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, USA.
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12
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Kamitani E, Mizuno Y, Koenig LJ. Strategies to Eliminate Inequity in PrEP Services in the US South and Rural Communities. J Assoc Nurses AIDS Care 2024; 35:153-160. [PMID: 37963267 PMCID: PMC11090982 DOI: 10.1097/jnc.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Inequity in preexposure prophylaxis (PrEP) care in the US South and rural communities is likely attributed to Social Determinants of Health and structural issues beyond individuals' control. We describe three approaches to modify PrEP care practice models to make access easier-"normalizing," "digitalizing," and "simplifying." "Normalizing" approaches are defined as practice models where medical providers who have access to PrEP candidates prescribe PrEP routinely (e.g., primary care providers, community pharmacists); these approaches are found to be highly applicable in real-world settings. Telehealth and other dHealth tools are examples of "digitalizing" PrEP, and their use has been increasing rapidly since the COVID-19 pandemic. "Simplifying" PrEP care (e.g., with HIV self-testing, on-demand PrEP) is highlighted in the most recent World Health Organization PrEP guideline. Identifying, implementing, and scaling up these new strategies can allow PrEP candidates to access it, potentially addressing inequities and promoting HIV risk reduction in the US South and rural communities.
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Affiliation(s)
- Emiko Kamitani
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
| | - Yuko Mizuno
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
| | - Linda J. Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
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13
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Zhang R, Qiao S, Aggarwal A, Yuan G, Muttau N, Sharma A, Lwatula C, Ngosa L, Kabwe M, Manasyan A, Menon A, Ostermann J, Weissman S, Li X, Harper GW. Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia. Arch Psychiatr Nurs 2024; 48:51-58. [PMID: 38453282 DOI: 10.1016/j.apnu.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/08/2023] [Accepted: 01/03/2024] [Indexed: 03/09/2024]
Abstract
Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18-35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ2 = 12.91, p ≤ .001), PTSD symptoms (χ2 = 7.13, p < .01), tobacco use (χ2 = 10.47, p < .01), cannabis use (χ2 = 5.90, p < .05), and a higher number of sexual partners (t = 1.99, p < .05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV-related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatric-mental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non-judgmental environment for SMM to improve their well-being.
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Affiliation(s)
- Ran Zhang
- University of South Carolina, Columbia, South Carolina, USA
| | - Shan Qiao
- University of South Carolina, Columbia, South Carolina, USA.
| | | | - Guangzhe Yuan
- University of South Carolina, Columbia, South Carolina, USA
| | - Nobutu Muttau
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Levy Ngosa
- Dignitate Zambia Limited, Lusaka, Zambia
| | | | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jan Ostermann
- University of South Carolina, Columbia, South Carolina, USA
| | | | - Xiaoming Li
- University of South Carolina, Columbia, South Carolina, USA
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14
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Wan Z, Shi M, Gong Y, Lucci M, Li J, Zhou J, Yang XL, Lelli M, He X, Mao J. Multitasking Pharmacophores Support Cabotegravir-Based Long-Acting HIV Pre-Exposure Prophylaxis (PrEP). Molecules 2024; 29:376. [PMID: 38257288 PMCID: PMC10819392 DOI: 10.3390/molecules29020376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Cabotegravir is an integrase strand transfer inhibitor (INSTI) for HIV treatment and prevention. Cabotegravir-based long-acting pre-exposure prophylaxis (PrEP) presents an emerging paradigm for infectious disease control. In this scheme, a combination of a high efficacy and low solubility of anti-infection drugs permits the establishment of a pharmaceutical firewall in HIV-vulnerable groups over a long period. Although the structure-activity-relationship (SAR) of cabotegravir as an INSTI is known, the structural determinants of its low solubility have not been identified. In this work, we have integrated multiple experimental and computational methods, namely X-ray diffraction, solid-state NMR (SSNMR) spectroscopy, solution NMR spectroscopy, automated fragmentation (AF)-QM/MM and density functional theory (DFT) calculations, to address this question. The molecular organization of cabotegravir in crystal lattice has been determined. The combination of very-fast magic-angle-sample-spinning (VF MAS) SSNMR and solution NMR, as supported by AF-QM/MM and DFT calculations, permits the identification of structural factors that contribute to the low aqueous solubility of cabotegravir. Our study reveals the multitasking nature of pharmacophores in cabotegravir, which controls the drug solubility and, meanwhile, the biological activity. By unraveling these function-defining molecular features, our work could inspire further development of long-acting HIV PrEP drugs.
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Affiliation(s)
- Zheng Wan
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, Shanghai Frontiers Science Center of Molecule Intelligent Syntheses, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, China
| | - Man Shi
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, Shanghai Frontiers Science Center of Molecule Intelligent Syntheses, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, China
| | - Yanqing Gong
- State Key Laboratory of New Drug and Pharmaceutical Process, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, 285 Gebaini Road, Shanghai 201203, China;
| | - Massimo Lucci
- C.I.R.M.M.P.—Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine, Via L. Sacconi 6, 50019 Sesto Fiorentino, Firenze, Italy;
| | - Jinjin Li
- Key Laboratory for Thin Film and Microfabrication of Ministry of Education, Department of Micro/Nano-electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jiahai Zhou
- CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China;
| | - Xiao-Liang Yang
- State Key Laboratory of Coordination Chemistry and Jiangsu Key Laboratory of Advanced Organic Materials, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210023, China
| | - Moreno Lelli
- C.I.R.M.M.P.—Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine, Via L. Sacconi 6, 50019 Sesto Fiorentino, Firenze, Italy;
- Department of Chemistry “Ugo Schiff”, Magnetic Resonance Center (CERM), University of Florence, Via della Lastruccia 3, 50019 Sesto Fiorentino, Florence, Italy
| | - Xiao He
- Shanghai Engineering Research Center of Molecular Therapeutics and New Drug Development, Shanghai Frontiers Science Center of Molecule Intelligent Syntheses, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, China
- New York University–East China Normal University Center for Computational Chemistry, New York University Shanghai, Shanghai 200062, China
| | - Jiafei Mao
- Beijing National Laboratory for Molecular Sciences (BNLMS), Institute of Chemistry, Chinese Academy of Sciences, Zhongguancun North First Street 2, Beijing 100190, China
- Center for Physicochemical Analysis and Measurement, Institute of Chemistry, Chinese Academy of Sciences, Zhongguancun North First Street 2, Beijing 100190, China
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15
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Hall M, Golubchik T, Bonsall D, Abeler-Dörner L, Limbada M, Kosloff B, Schaap A, de Cesare M, MacIntyre-Cockett G, Otecko N, Probert W, Ratmann O, Bulas Cruz A, Piwowar-Manning E, Burns DN, Cohen MS, Donnell DJ, Eshleman SH, Simwinga M, Fidler S, Hayes R, Ayles H, Fraser C. Demographics of sources of HIV-1 transmission in Zambia: a molecular epidemiology analysis in the HPTN 071 PopART study. THE LANCET. MICROBE 2024; 5:e62-e71. [PMID: 38081203 PMCID: PMC10789608 DOI: 10.1016/s2666-5247(23)00220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND In the last decade, universally available antiretroviral therapy (ART) has led to greatly improved health and survival of people living with HIV in sub-Saharan Africa, but new infections continue to appear. The design of effective prevention strategies requires the demographic characterisation of individuals acting as sources of infection, which is the aim of this study. METHODS Between 2014 and 2018, the HPTN 071 PopART study was conducted to quantify the public health benefits of ART. Viral samples from 7124 study participants in Zambia were deep-sequenced as part of HPTN 071-02 PopART Phylogenetics, an ancillary study. We used these sequences to identify likely transmission pairs. After demographic weighting of the recipients in these pairs to match the overall HIV-positive population, we analysed the demographic characteristics of the sources to better understand transmission in the general population. FINDINGS We identified a total of 300 likely transmission pairs. 178 (59·4%) were male to female, with 130 (95% CI 110-150; 43·3%) from males aged 25-40 years. Overall, men transmitted 2·09-fold (2·06-2·29) more infections per capita than women, a ratio peaking at 5·87 (2·78-15·8) in the 35-39 years source age group. 40 (26-57; 13·2%) transmissions linked individuals from different communities in the trial. Of 288 sources with recorded information on drug resistance mutations, 52 (38-69; 18·1%) carried viruses resistant to first-line ART. INTERPRETATION HIV-1 transmission in the HPTN 071 study communities comes from a wide range of age and sex groups, and there is no outsized contribution to new infections from importation or drug resistance mutations. Men aged 25-39 years, underserved by current treatment and prevention services, should be prioritised for HIV testing and ART. FUNDING National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health.
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Affiliation(s)
- Matthew Hall
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Sydney Infectious Diseases Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David Bonsall
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Barry Kosloff
- Zambart, University of Zambia, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ab Schaap
- Zambart, University of Zambia, Lusaka, Zambia
| | - Mariateresa de Cesare
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Newton Otecko
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - William Probert
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, UK
| | - Ana Bulas Cruz
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - David N Burns
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Myron S Cohen
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sarah Fidler
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, University of Zambia, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Christophe Fraser
- Pandemic Sciences Institute and Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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16
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Mudzingwa EK, de Vos L, Fynn L, Atujuna M, Katz IT, Hosek S, Celum C, Daniels J, Bekker LG, Medina-Marino A. Youth-friendly services was the magic: Experiences of adolescent girls and young women in the community PrEP study, South Africa. Glob Public Health 2024; 19:2349918. [PMID: 38752416 PMCID: PMC11101151 DOI: 10.1080/17441692.2024.2349918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
Adherence to daily oral pre-exposure prophylaxis (PrEP) for HIV prevention has been challenging for adolescent girls and young women (AGYW). As part of The Community PrEP Study (CPS), AGYW were randomised to HIV-prevention empowerment counselling (intervention) or basic medication pick-up (control). In this qualitative sub-study, we interviewed AGYW participants (n = 39) to explore PrEP use and study experiences by study arm, and study staff (n = 7) to explore study implementation, site environment, and participant engagement. Data were thematically analysed using a constant comparison approach. Comparative matrices assessed similarities and differences in study experiences and PrEP support preferences. Friendly, non-judgmental, non-stigmatizing study staff were described as central to participant's positive experiences. Participants highly valued CPS staff's holistic health support (e.g. physical and psycho-social). Intervention participants described empowerment counselling as helpful in supporting PrEP disclosure. However, control participants also described disclosing PrEP use to trusted individuals. Participants and staff recommended public-sector PrEP services provide holistic, confidential, and integrated sexual and reproductive health services, and community sensitisation. An adolescent and youth-friendly environment was the primary factor motivating AGYW's study engagement. While HIV-prevention empowerment counselling was well received, welcoming, respectful and non-judgmental staff may be the 'secret sauce' for implementing effective PrEP services to AGYW.
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Affiliation(s)
- Emily Krogstad Mudzingwa
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Lauren Fynn
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Millicent Atujuna
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Ingrid T. Katz
- Harvard Medical School, Boston, MA, USA
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sybil Hosek
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Joseph Daniels
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Andrew Medina-Marino
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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17
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Olakunde BO, Folala-Anoemuah Y, Ujam C, Ndukwe CD, Olaifa Y, Yahaya HB, Bello H, Ogundipe A. Awareness and uptake of oral pre-exposure prophylaxis among adolescent and young key populations in Nigeria: a secondary data analysis of the 2020 Integrated Biological & Behavioural Surveillance Survey. AIDS Care 2024; 36:146-152. [PMID: 37683258 DOI: 10.1080/09540121.2023.2254547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
Oral pre-exposure prophylaxis (PrEP) is a critical intervention for HIV prevention among key populations (KP) in Nigeria. However, little is known about its coverage among adolescent and young key populations (AYKP). Using the 2020 Integrated Biological & Behavioural Surveillance Survey conducted among KP, including female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people (TG), we assessed the awareness and uptake of PrEP among AYKP (15-24 years) in Nigeria. We performed weighted descriptive statistics and logistic regression analyses. Of the 6882 AYKP included in this study, 36.1% were aware of PrEP, ranging from 47.9% in MSM to 19.8% in FSW. Compared with FSW, MSM (aOR = 3.7, 95%CI = 3.22-4.35) and TG (aOR = 2.6, 95%CI = 2.18-2.98) had significant higher odds of PrEP awareness. Among those aware of PrEP, 24.5% had ever taken PrEP. The uptake of PrEP varied by KP group: TG (28.1%), MSM (25.3%), PWID (18.0%), and FSW (14.4%). MSM (aOR = 2.6, 95%CI = 1.72-4.07) and TG (aOR = 2.7, 95%CI = 1.71-4.14) had significant higher odds of PrEP uptake relative to FSW. The awareness and uptake of PrEP among AYKP in Nigeria is low. This calls for more awareness creation about PrEP addressing the barriers that limit its uptake.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Yinka Folala-Anoemuah
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Chukwugozie Ujam
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Chinwedu D Ndukwe
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- African Institute of Health Policy and Health Systems, Abakaliki, Nigeria
| | - Yewande Olaifa
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Hidayat B Yahaya
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Hasiya Bello
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Alex Ogundipe
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
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18
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Reddy K, Palanee-Phillips T, Heffron R. Awareness of Heightened Sexual and Behavioral Vulnerability as a Trigger for PrEP Resumption Among Adolescent Girls and Young Women in East and Southern Africa. Curr HIV/AIDS Rep 2023; 20:333-344. [PMID: 38051383 PMCID: PMC10719120 DOI: 10.1007/s11904-023-00680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE OF REVIEW East and Southern Africa are the epicenter of the HIV epidemic. High HIV incidence rates among adolescent girls and young women (AGYW) remain stable over the last decade despite access to daily oral PrEP. Some settings have experienced high PrEP uptake among AGYW; however, discontinuation has been high. This review sought to understand drivers of PrEP discontinuation in this population in order to identify potential mechanisms to facilitate PrEP restart and optimize PrEP use. RECENT FINDINGS Drivers of PrEP discontinuation included low perceived HIV acquisition risk, PrEP-associated side effects, pill burden, family/sexual partner disapproval, lack of/intermittent sexual activity, PrEP use stigma, fear of intimate partner violence, misinformation about long-term PrEP use, and limited/inconsistent access to PrEP. The most frequently reported driver of PrEP discontinuation was low perceived HIV acquisition risk. This indicates that innovative interventions to help AGYW recognize their HIV risk and make informed decisions about PrEP use are urgently needed.
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Affiliation(s)
- Krishnaveni Reddy
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Thesla Palanee-Phillips
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- University of Washington, Seattle, WA, USA
| | - Renee Heffron
- University of Alabama at Birmingham, Birmingham, AL, USA
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19
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Singer SE, Wechsberg WM, Kline T, Browne FA, Howard BN, Carney T, Myers B, Bonner CP, Chin-Quee D. Binge drinking and condom negotiation behaviours among adolescent girls and young women living in Cape Town, South Africa: sexual control and perceived personal power. BMC Public Health 2023; 23:2282. [PMID: 37980472 PMCID: PMC10657119 DOI: 10.1186/s12889-023-17188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Condom use among young people in South Africa has declined in recent years and adolescent girls and young women continue to bear the highest incidence of HIV in the country. Young women who have dropped out of school may be more at risk because of traditional gender norms that create substantial power imbalances and a lack of power to negotiate condom use with their male partners, especially when using alcohol and other drugs. METHODS This study presents an analysis of baseline data provided by 500 adolescent girls and young women (AGYW) from Cape Town communities between November 2016 and November 2018 who were reached for a cluster-randomised trial conducted to assess the efficacy of an evidence-based, young woman-focused intervention seeking to reduce HIV risk and substance use behaviours. The analysis focuses on associations between binge drinking, condom use, and sexual negotiation, including impaired sex (any substance use at last sex). RESULTS AGYW who reported frequent condom negotiation with their partners were 8.92 times (95% CI: [4.36, 18.24]) as likely to use a condom when alcohol or other drugs were not used at last sex and 5.50 times (95% CI: [2.06, 14.72]) as likely when alcohol or other drugs were used at last sex (p < 0.05). AGYW who reported frequent binge drinking in the past month (n = 177) had significantly reduced odds of condom use at last sex, irrespective of whether the sex was impaired (OR 0.60, 95% CI: [0.49, 0.73]) or not impaired (OR 0.69, 95% CI: [0.60, 0.81]). DISCUSSION The findings highlight the need for interventions that reach AGYW in South Africa by specifically aiming to educate AGYW about the effect of binge drinking on negotiating power in their relationships, thus providing them with the knowledge and skills to increase agency regarding condom use. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02974998 (recruitment completed). 29/11/2016.
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Affiliation(s)
- Suzanne E Singer
- RTI International, Research Triangle Park, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, Chapel Hill, NC, USA.
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27708, USA.
- Department of Psychology, North Carolina State University, Raleigh, NC, USA.
| | - Tracy Kline
- RTI International, Research Triangle Park, Chapel Hill, NC, USA
| | - Felicia A Browne
- RTI International, Research Triangle Park, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Courtney Peasant Bonner
- RTI International, Research Triangle Park, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dawn Chin-Quee
- RTI International, Research Triangle Park, Chapel Hill, NC, USA
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20
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Shibesh BF, Admas AB, Lake AW, Getu SB, Worede DT. Uptake of retroviral pre-exposure prophylaxis and its associated factors among female sex workers, Northwest Ethiopia. AIDS Res Ther 2023; 20:77. [PMID: 37926821 PMCID: PMC10626692 DOI: 10.1186/s12981-023-00573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis is the use of antiretroviral medications by HIV-negative individuals to prevent infection before exposure. Ethiopia has made progress in reducing new HIV infections, but the burden remains high with ongoing challenges in prevention uptake. This study examined the utilization and factors associated with pre-exposure prophylaxis among female sex workers. METHODS A community-based cross-sectional study design was conducted in Bahir Dar city administration among female sexual workers in 2022. The results were collected using a pre-tested and structured questionnaire. Epi data for data entry and social package for social science for analysis were used. RESULT Overall, 15.9% (CI: 12.0-21.1) of female sexual workers received pre-exposure prophylaxis. Parents' living condition (only father alive [AOR = 0.23, 95% CI, 0.02-0.64], only mother alive [AOR = 0.31, 95% CI, 0.02-0.74]), marital status being single (AOR = 0.27, 95% CI, 0.06-0.94), having history of STI (AOR = 2.82, 95% CI, 1.60-4.77) were associated with pre-exposure prophylaxis uptake. CONCLUSION This study showed low pre-exposure prophylaxis uptake. The study identified a history of sexually transmitted infections, marital status, and parent living conditions as significant factors. To increase pre-exposure prophylaxis uptake and reduce HIV incidence, an awareness campaign, tailored support, targeted interventions, and addressing concerns of high-risk groups are needed.
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Affiliation(s)
- Belayneh Fentahun Shibesh
- MPH in Epidemiology, HIV/AIDS Prevention, Treatment, and Care, Amhara Regional State Health Bureau, Bahir Dar, Ethiopia.
| | - Aragaw Bitew Admas
- MPH in Reproductive Health, HIV/AIDS prevention Treatment and Care, Amhara Regional State Health Bureau, Bahir Dar, Ethiopia
| | - Amarech Wondie Lake
- HIV/AIDS prevention Treatment and Care, MPH, Amhara Regional State Health Bureau, Bahir Dar, Ethiopia
| | - Samuel Befekadu Getu
- MPH in Public Health in Disaster, Infection disease control, Södertärn University, Huddinge, Sweden
| | - Daniel Tarekegn Worede
- MPH in Epidemiology, Department of Public Health, College of Medicine and Health Science, Debre Markos University, Bahir Dar, Ethiopia
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21
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Dam A, Schueller J, Peine KJ, Mason J, Dorward E, Vij A. Turning the promise of multipurpose prevention technologies into a market reality: a commentary. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1181043. [PMID: 38023534 PMCID: PMC10652864 DOI: 10.3389/frph.2023.1181043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
The promise of multipurpose prevention technologies (MPTs) for the prevention of HIV and unintended pregnancy are on the horizon. While many are still in clinical development, others are closer to becoming a realistic, accessible option for users, like the dual prevention pill (DPP). Researchers, governments, donors, and implementers will have to collaboratively address systemic challenges to successfully introduce and scale-up MPTs. To ensure the rollout of MPTs is successful, the global community should address user and country-specific needs, coordinate with advocates and policymakers, and set a realistic plan for product introduction and scale-up that considers the needs of both family planning (FP) and HIV programs, while laying the groundwork for future new product introduction. To achieve these aims, global and regional stakeholder coordination should emphasize country-led, person-centered decision-making while addressing: (1) procurement and supply chain barriers; (2) the potential burden on health systems; and (3) the impact on current programs.
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Affiliation(s)
- Anita Dam
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, United States
- Global Health Training, Advisory, and Support Contract (GHTASC), Credence Management Solutions LLC, Washington, DC, United States
| | - Jane Schueller
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC, United States
| | - Kevin J. Peine
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC, United States
| | - Jennifer Mason
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC, United States
- Global Health Training, Advisory, and Support Contract (GHTASC), Public Health Institute, Washington, DC, United States
| | - Emily Dorward
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, United States
| | - Ashley Vij
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, United States
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22
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Hurley EA, Mayatsa J, Matovu JKB, Schuetz N, Wanyenze R, Wagner G, Goggin K. Piloting Gain and Loss-Framed PrEP and Childbearing Messaging to Promote HIV Testing in Uganda: Perspectives from Couples and Providers. JOURNAL OF HEALTH COMMUNICATION 2023; 28:669-679. [PMID: 37642350 DOI: 10.1080/10810730.2023.2251919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Fears of relationship dissolution and the inability to bear healthy children remain barriers to HIV testing in sub-Saharan Africa. Pre-exposure prophylaxis (PrEP) carries both clinical and symbolic benefits that counter these fears. We conducted a pilot messaging intervention through Uganda's assisted partner notification (APN) program, where providers assist HIV-positive index clients in notifying sexual partners and encourage testing. We randomized providers at three clinics to implement phone scripts over two months with (1) gain-framed or (2) loss-framed information about PrEP and childbearing; or (3) usual care. In 23 in-depth interviews with providers, index clients, and partners, five major themes emerged on intervention acceptability and feasibility: (1) value of PrEP and childbearing messaging in APN; (2) value of this messaging coming earlier in APN; (3) overall preference for gain-framed messages; (4) need to tailor timing of messaging; and (5) need for messaging outside of APN. Register data (109 index clients, 145 partners) indicated most index clients (95%) wanted their potential conception partners informed about PrEP. Preliminary trends suggest the intervention sites outperformed usual care in testing rates among potential conception partners. Messaging that highlights PrEP and safe childbearing may be a promising new communication strategy to promote HIV testing.
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Affiliation(s)
- Emily A Hurley
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jimmy Mayatsa
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph K B Matovu
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Nik Schuetz
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Rhoda Wanyenze
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, USA
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23
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Sisimayi T, Nhamo D, Chatora K, Chapwanya G, Mawoyo T, Ncube G, Bruns C, Harris EL, Shelley KD. Early implementation learnings on acceptability and feasibility of "V": a multi-level PrEP intervention designed with and for adolescent girls and young women in Zimbabwe. Health Res Policy Syst 2023; 21:101. [PMID: 37784195 PMCID: PMC10546763 DOI: 10.1186/s12961-023-01040-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/11/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) remain disproportionately affected by HIV in Zimbabwe. Several HIV prevention options are available, including oral tenofovir-based pre-exposure prophylaxis (PrEP), however AGYW face unique barriers to PrEP uptake and continuation and novel approaches are therefore needed to empower AGYW to use PrEP. The objective of this study was to characterize early learnings from implementing a multi-level intervention consisting of fashionable branding (including a "V Starter Kit"), service integration, and peer education and support throughout a young woman's journey using oral PrEP across four phases of implementation, from creating demand, preparing for PrEP, initiation of PrEP, and adherence to PrEP. METHODS A mixed methods implementation research study was undertaken, including site observations and interviews to explore the acceptability of "V" and its relevance to target users, as well as the feasibility of integrating "V" with existing service delivery models. Interviews (n = 46) were conducted with healthcare workers, Brand Ambassadors, and young women purposively sampled from four implementation sites. Interview data was analyzed thematically using the framework method for qualitative data management and analysis. Project budgets and invoices were used to compile unit cost and procurement data for all "V" materials. RESULTS "V" was acceptable to providers and young women due to attractive branding coupled with factual and thought-provoking messaging, establishing "a girl code" for discussing PrEP, and addressing a gap in communications materials. "V" was also feasible to integrate into routine service provision and outreach, alongside other services targeting AGYW. Cost for the "V" branded materials ranked most essential-FAQ insert, pill case, makeup bag, reminder sticker-were $7.61 per AGYW initiated on PrEP. CONCLUSION "V" is a novel approach that is an acceptable and feasible multi-level intervention to improve PrEP access, uptake, and continuation among AGYW, which works through empowering AGYW to take control of their HIV prevention needs. In considering "V" for scale up in Zimbabwe, higher volume procurement and a customized lighter package of "V" materials, while still retaining V's core approach, should be explored.
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Affiliation(s)
| | - Definate Nhamo
- Pangaea Zimbabwe AIDS Trust (PZAT), 27 Rowland Square, Milton Park, Harare, Zimbabwe
| | - Kumbirai Chatora
- Population Services International (PSI), 45 Piers Road, Sam Levy's Village Block C, Harare, Zimbabwe
| | - Gwendoline Chapwanya
- Pangaea Zimbabwe AIDS Trust (PZAT), 27 Rowland Square, Milton Park, Harare, Zimbabwe
| | - Tinovonga Mawoyo
- Population Services International (PSI), 45 Piers Road, Sam Levy's Village Block C, Harare, Zimbabwe
| | - Getrude Ncube
- Ministry of Health and Child Care (MoHCC), 4th Floor Kaguvi Building, Harare, Zimbabwe
| | - Cal Bruns
- Matchboxology, 70, 7th Avenue, Parktown North, Johannesburg, 2193, South Africa
| | - Emily L Harris
- United States Agency for International Development (USAID), Office of HIV/AIDS, Washington, DC, USA
| | - Katharine D Shelley
- PATH, Primary Health Care, 2201 Westlake Ave Suite 200, Seattle, WA, 98121, USA
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24
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Brown CA, Siegler AJ, Zahn RJ, Valencia RK, Sanchez T, Kramer MR, Phaswana-Mafuya NR, Stephenson R, Bekker LG, Baral SD, Sullivan PS. Assessing the association of stigma and HIV service and prevention uptake among men who have sex with men and transgender women in South Africa. AIDS Care 2023; 35:1497-1507. [PMID: 36755403 PMCID: PMC10406969 DOI: 10.1080/09540121.2023.2175770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
HIV prevention for gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) is critical to reducing health disparities and population HIV prevalence. To understand if different types of stigma impact engagement with HIV prevention services, we assessed associations between stigmas and use of HIV prevention services offered through an HIV prevention intervention. This analysis included 201 GBMSM and TGW enrolled in a prospective cohort offering a package of HIV prevention interventions. Participants completed a baseline survey that included four domains of sexual identity/behavior stigma, HIV-related stigma, and healthcare stigma. Impact of stigma on PrEP uptake and the number of drop-in visits was assessed. No domain of stigma was associated with PrEP uptake. In bivariate analysis, increased enacted sexual identity stigma increased number of drop-in visits. In a logistic regression analysis constrained to sexual identity stigma, enacted stigma was associated with increased drop-in visits (aIRR = 1.30, [95% CI: 1.02, 1.65]). Participants reporting higher enacted stigma were modestly more likely to attend additional services and have contact with the study clinics and staff. GBMSM and TGW with higher levels of enacted stigma may seek out sensitized care after negative experiences in their communities or other healthcare settings.
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Affiliation(s)
- Carolyn A Brown
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
- ViiV Healthcare, Durham, NC, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Ryan J Zahn
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Rachel K Valencia
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Nancy Refilwe Phaswana-Mafuya
- SAMRC/JJ Pan African Centre for Epidemics Research (PACER) Extramural Unit; Department of Environmental Health, University of Johannesburg, Johannesburg, South Africa
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, USA
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Haaland I, Metta E, Moen K. The use of PrEP among men who have sex with men and transgender women as Biomedical Prevention Work: A conceptual framework. Soc Sci Med 2023; 333:116147. [PMID: 37556992 DOI: 10.1016/j.socscimed.2023.116147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/06/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
Based on ethnographic fieldwork among men who have sex with men and transgender women in Tanzania, this article explores the various types of work that may go into enrolment into PrEP programming and using pre-exposure prophylaxis (PrEP). PrEP protects against HIV acquisition and is widely touted as an essential tool in 'ending AIDS by 2030'. While taking PrEP has often been portrayed as 'just taking a pill a day' in public health campaigns, a striking observation during fieldwork was that enrolling in PrEP programming and adhering to PrEP involved a wide range of tasks. Inspired by this fieldwork experience and the literature on sociology of work, more specifically illness work and patient work, we started to think of these tasks as work. This paper identifies the range of tasks that PrEP users in Dar es Salaam had to perform as part of their enrolment and usage of PrEP. We provide a description of these tasks, organised into three categories of work that we refer to as (a) readying work, (b) user work, and (c) social navigation work that jointly make up what we propose to call biomedical prevention work. We further suggest that this analytical framework can be applicable to other biomedical prevention methods in other contexts.
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Affiliation(s)
- Inga Haaland
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Emmy Metta
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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26
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Inzaule SC, Siedner MJ, Little SJ, Avila-Rios S, Ayitewala A, Bosch RJ, Calvez V, Ceccherini-Silberstein F, Charpentier C, Descamps D, Eshleman SH, Fokam J, Frenkel LM, Gupta RK, Ioannidis JP, Kaleebu P, Kantor R, Kassaye SG, Kosakovsky Pond SL, Kouamou V, Kouyos RD, Kuritzkes DR, Lessells R, Marcelin AG, Mbuagbaw L, Minalga B, Ndembi N, Neher RA, Paredes R, Pillay D, Raizes EG, Rhee SY, Richman DD, Ruxrungtham K, Sabeti PC, Schapiro JM, Sirivichayakul S, Steegen K, Sugiura W, van Zyl GU, Vandamme AM, Wensing AM, Wertheim JO, Gunthard HF, Jordan MR, Shafer RW. Recommendations on data sharing in HIV drug resistance research. PLoS Med 2023; 20:e1004293. [PMID: 37738247 PMCID: PMC10558071 DOI: 10.1371/journal.pmed.1004293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/06/2023] [Indexed: 09/24/2023] Open
Abstract
• Human immunodeficiency virus (HIV) drug resistance has implications for antiretroviral treatment strategies and for containing the HIV pandemic because the development of HIV drug resistance leads to the requirement for antiretroviral drugs that may be less effective, less well-tolerated, and more expensive than those used in first-line regimens. • HIV drug resistance studies are designed to determine which HIV mutations are selected by antiretroviral drugs and, in turn, how these mutations affect antiretroviral drug susceptibility and response to future antiretroviral treatment regimens. • Such studies collectively form a vital knowledge base essential for monitoring global HIV drug resistance trends, interpreting HIV genotypic tests, and updating HIV treatment guidelines. • Although HIV drug resistance data are collected in many studies, such data are often not publicly shared, prompting the need to recommend best practices to encourage and standardize HIV drug resistance data sharing. • In contrast to other viruses, sharing HIV sequences from phylogenetic studies of transmission dynamics requires additional precautions as HIV transmission is criminalized in many countries and regions. • Our recommendations are designed to ensure that the data that contribute to HIV drug resistance knowledge will be available without undue hardship to those publishing HIV drug resistance studies and without risk to people living with HIV.
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Affiliation(s)
- Seth C. Inzaule
- Amsterdam Institute for Global Health and Development, and Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark J. Siedner
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Santiago Avila-Rios
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Alisen Ayitewala
- National Health Laboratories and Diagnostic Services, Ministries of Health, Kampala, Uganda
| | - Ronald J. Bosch
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France
| | | | - Charlotte Charpentier
- Service de Virologie, Université Paris Cité, INSERM, IAME, UMR 1137, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Diane Descamps
- Service de Virologie, Université Paris Cité, INSERM, IAME, UMR 1137, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Joseph Fokam
- Virology Laboratory, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon, and Faculty of Health Sciences, University of Buea, Yaoundé, Cameroon
| | - Lisa M. Frenkel
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| | - Ravindra K. Gupta
- Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, United Kingdom
| | - John P.A. Ioannidis
- Department of Medicine, Department of Epidemiology and Population Health, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Entebbe, Uganda
| | - Rami Kantor
- Department of Medicine, Brown University, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Seble G. Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington DC, United States of America
| | - Sergei L. Kosakovsky Pond
- Institute for Genomics and Evolutionary Medicine, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Vinie Kouamou
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Roger D. Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Daniel R. Kuritzkes
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Richard Lessells
- Affiliation is KwaZulu-Natal Research Innovation & Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
| | - Anne-Genevieve Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière—Charles Foix, Laboratoire de Virologie, Paris, France
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Brian Minalga
- Office of HIV/AIDS Network Coordination, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Nicaise Ndembi
- Institute of Human Virology Nigeria, Herbert Macaulay Way, Abuja, Nigeria
| | | | - Roger Paredes
- Department of Infectious Diseases & irsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Elliot G. Raizes
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Soo-Yon Rhee
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Douglas D. Richman
- Center for AIDS Research, Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Kiat Ruxrungtham
- School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pardis C. Sabeti
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | | | | | - Kim Steegen
- Department of Molecular Medicine and Haematology, National Health Laboratory Service, Johannesburg, South Africa
| | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gert U. van Zyl
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Service, Cape Town, South Africa
| | - Anne-Mieke Vandamme
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
- Center for Global Health And Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Annemarie M.J. Wensing
- University Medical Center Utrecht, the Netherlands and Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel O. Wertheim
- Department of Medicine, University of California San Diego, San Diego, La Jolla, California, United States of America
| | - Huldrych F. Gunthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Michael R. Jordan
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Robert W. Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, California, United States of America
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Barnabee G, Billah I, Ndeikemona L, Silas L, Ensminger A, MacLachlan E, Korn AK, Mawire S, Fischer-Walker C, Ashipala L, Forster N, O’Malley G, Velloza J. PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia. PLoS One 2023; 18:e0289353. [PMID: 37647257 PMCID: PMC10468070 DOI: 10.1371/journal.pone.0289353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) face barriers in accessing clinic-based HIV pre-exposure prophylaxis (PrEP) services and community-based models are a proposed alternative. Evidence from such models, however, is limited. We evaluated PrEP service coverage, uptake, and early persistence among AGYW receiving services through community and hybrid models in Namibia. METHODS We analyzed routine data for AGYW aged 15-24 who initiated PrEP within HIV prevention programming. PrEP was delivered via three models: community-concierge (fully community-based services with individually-tailored refill locations), community-fixed (community-based initiation and refills delivered by community providers on a set schedule at fixed sites), and hybrid community-clinic (community-based initiation and referral to clinics for refills delivered by clinic providers). We examined proportions of AGYW engaged in services along a programmatic PrEP cascade, overall and by model, and assessed factors associated with PrEP uptake and early persistence (refill within 15-44 days after initiation) using multivariable generalized estimating equations. RESULTS Over 10-months, 7593 AGYW participated in HIV prevention programming. Of these, 7516 (99.0%) received PrEP education, 6105 (81.2%) received HIV testing services, 6035 (98.9%) tested HIV-negative, and 2225 (36.9%) initiated PrEP. Of the 2047 AGYW expected for PrEP refill during the study period, 254 (12.4%) persisted with PrEP one-month after initiation. Structural and behavioral HIV risk factors including early school dropout, food insecurity, inconsistent condom use, and transactional sex were associated with PrEP uptake. AGYW who delayed starting PrEP were 2.89 times more likely to persist (95% confidence interval (CI): 1.52-5.46) and those receiving services via the community-concierge model were 8.7 times (95% CI: 5.44-13.9) more likely to persist (compared to the hybrid model). CONCLUSION Community-based models of PrEP service delivery to AGYW can achieve high PrEP education and HIV testing coverage and moderate PrEP uptake. AGYW-centered approaches to delivering PrEP refills can promote higher persistence.
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Affiliation(s)
- Gena Barnabee
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Idel Billah
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | | | - Lukas Silas
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Alison Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Ellen MacLachlan
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Abigail K. Korn
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | | | | | - Laimi Ashipala
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States of America
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
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28
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Hartmann M, Triplett N, Roberts ST, Lanham M, Reddy K, Tenza S, Mayisela N, Mbewe D, Maboa O, Mampuru L, Tolley EE, Palanee-Phillips T, Montgomery ET. Changes in relationships, HIV risk, and feelings towards PrEP: findings from a qualitative explanatory study among participants in the CHARISMA intervention trial. BMC Womens Health 2023; 23:440. [PMID: 37608373 PMCID: PMC10464438 DOI: 10.1186/s12905-023-02603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) and other relationship-based challenges have been demonstrated to reduce women's ability to use pre-exposure prophylaxis (PrEP) effectively for HIV prevention. The Community Health Clinical Model for Agency in Relationships and Safer Microbicide Adherence (CHARISMA) intervention was designed to mitigate these challenges and increase South African women's agency to use PrEP. The CHARISMA randomized controlled trial did not identify statistically significant differences in PrEP adherence or relationship dynamics between the intervention and control arms. As such, the aim of this explanatory qualitative sub-study was to understand women's experiences with the CHARISMA trial and explore reasons for the null results. METHODS Twelve CHARISMA trial participants were purposively selected to participate in serial in-depth interviews, which took place at the trial end and 3 months later. Participants represented individuals who had received each of the three counselling modules, 1) healthy communication counselling, 2) PrEP disclosure counselling, or 3) IPV counselling, as well as those in the control arm who received IPV standard-of-care counselling. RESULTS A thematic case analysis revealed numerous positive relationship outcomes among intervention participants, including identifying and ending unhealthy relationships, gaining a sense of personal empowerment, and enacting more positive behaviors and HIV risk reduction strategies in subsequent relationships. These positive shifts were occasionally described as contributing to decisions to discontinue PrEP use, which may partly explain the limited impact of the intervention on PrEP adherence. CONCLUSIONS Future investigations of counselling interventions addressing relationship-based barriers to PrEP use should account for changing risk dynamics and need for PrEP.
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Affiliation(s)
- Miriam Hartmann
- Women's Global Health Imperative, RTI International, Berkeley, California, USA.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Noah Triplett
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | | | - Krishnaveni Reddy
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siyanda Tenza
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonkululeko Mayisela
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dorica Mbewe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ontathile Maboa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lydia Mampuru
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Thesla Palanee-Phillips
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
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Goymann H, Mavuso M, McMahon SA, Hettema A, Hughey AB, Matse S, Dlamini P, Kahn K, Bärnighausen T, Jahn A, Bärnighausen K. 'We Should Not Be Quiet but We Should Talk': Qualitative Accounts of Community-Based Communication of HIV Pre-Exposure Prophylaxis. QUALITATIVE HEALTH RESEARCH 2023; 33:842-856. [PMID: 37403738 PMCID: PMC10426252 DOI: 10.1177/10497323231181207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Community leaders play an important role in the acceptance of public health services, but little is known about their willingness to facilitate HIV pre-exposure prophylaxis (PrEP) roll-out in Eswatini. We conducted in-depth interviews (n = 25) with purposefully selected male and female community leaders in Eswatini. We analysed our data inductively using a thematic analysis approach. Community leaders feel they are important communicators of culturally appropriate PrEP messaging. Our participants described a complex social space within their communities influenced by religion, tradition, values, and HIV stigma. Community leaders use their position to provide leverage for unique, effective, and easily accessible messages and platforms to reach the community in a manner that ensures trust, relatability, familiarity, and shared faith. Community leaders feel that they are trusted and see trust manifesting in the conversations they are able to engage in, and have a reach that extends beyond formal health services. Existing PrEP programming should embed community leader participation in PrEP programming and engage the trust, knowledge, and potential of community leaders to support PrEP uptake and acceptance.
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Affiliation(s)
- Hannah Goymann
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | | | | | | | | | | | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Till Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
| | - Albrecht Jahn
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Kate Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Stannah J, Soni N, Lam JKS, Giguère K, Mitchell KM, Kronfli N, Larmarange J, Moh R, Nouaman M, Kouamé GM, Boily MC, Maheu-Giroux M. Trends in HIV testing, the treatment cascade, and HIV incidence among men who have sex with men in Africa: a systematic review and meta-analysis. Lancet HIV 2023; 10:e528-e542. [PMID: 37453439 PMCID: PMC11403132 DOI: 10.1016/s2352-3018(23)00111-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. In Africa, MSM face structural barriers to HIV prevention and treatment that increase their vulnerability to HIV acquisition and transmission, and undermine the HIV response. In this systematic review, we aimed to explore progress towards increases in HIV testing, improving engagement in the HIV treatment cascade, and HIV incidence reductions among MSM in Africa. METHODS We searched Embase, MEDLINE, Global Health, Scopus, and Web of Science for cross-sectional and longitudinal studies reporting HIV testing, knowledge of status, care, antiretroviral therapy (ART) use, viral suppression, and HIV incidence among MSM in Africa published between Jan 1, 1980, and March 3, 2023. We pooled surveys using Bayesian generalised linear mixed-effects models, used meta-regression to assess time trends, and compared HIV incidence estimates among MSM with those of all men. FINDINGS Of 9278 articles identified, we included 152 unique studies published in 2005-23. In 2020, we estimate that 73% (95% credible interval [CrI] 62-87) of MSM had ever tested for HIV. HIV testing in the past 12 months increased over time in central, western, eastern, and southern Africa (odds ratio per year [ORyear] 1·23, 95% CrI 1·01-1·51, n=46) and in 2020 an estimated 82% (70-91) had tested in the past 12 months, but only 51% (30-72) of MSM living with HIV knew their HIV status. Current ART use increased over time in central and western (ORyear 1·41, 1·08-1·93, n=9) and eastern and southern Africa (ORyear 1·37, 1·04-1·84, n=17). We estimated that, in 2020, 73% (47-88) of all MSM living with HIV in Africa were currently on ART. Nevertheless, we did not find strong evidence to suggest that viral suppression increased, with only 69% (38-89) of MSM living with HIV estimated to be virally suppressed in 2020. We found insufficient evidence of a decrease in HIV incidence over time (incidence ratio per year 0·96, 95% CrI 0·63-1·50, n=39), and HIV incidence remained high in 2020 (6·9 per 100 person-years, 95% CrI 3·1-27·6) and substantially higher (27-199 times higher) than among all men. INTERPRETATION HIV incidence remains high, and might not be decreasing among MSM in Africa over time, despite some increases in HIV testing and ART use. Achieving the UNAIDS 95-95-95 targets for diagnosis, treatment, and viral suppression equitably for all requires renewed focus on this key population. Combination interventions for MSM are urgently required to reduce disparities in HIV incidence and tackle the social, structural, and behavioural factors that make MSM vulnerable to HIV acquisition. FUNDING US National Institutes of Health, UK Medical Research Council, Canadian Institutes of Health Research, and Fonds de Recherche du Québec-Santé. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- James Stannah
- School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Nirali Soni
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Jin Keng Stephen Lam
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Katia Giguère
- Institut national de santé publique du Québec, Québec, QC, Canada
| | - Kate M Mitchell
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University Health Centre, Montréal, QC, Canada
| | - Joseph Larmarange
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
| | - Raoul Moh
- Pedagogical Unit of Dermatology and Infectiology, RTU Medical Science, Abidjan, Côte d'Ivoire; Programme PAC-CI, CHU de Treichville, Site ANRS, Abidjan, Côte d'Ivoire
| | - Marcellin Nouaman
- Programme PAC-CI, CHU de Treichville, Site ANRS, Abidjan, Côte d'Ivoire
| | | | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.
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Gyamerah AO, Kinzer E, Aidoo-Frimpong G, Sorensen G, Mensah MD, Taylor KD, Vanderpuye NA, Lippman SA. PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and MSM, trans women, and gender diverse individuals living with HIV. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001956. [PMID: 37285336 DOI: 10.1371/journal.pgph.0001956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/29/2023] [Indexed: 06/09/2023]
Abstract
Pre-exposure prophylaxis (PrEP) could help reduce HIV incidence among cis men, trans women, and gender diverse individuals assigned male at birth who have sex with men (MSM, trans women, and GDSM) in Ghana, a group that bears a high HIV burden. Our study examined PrEP knowledge and acceptability, and barriers and facilitators to its uptake and implementation through qualitative interviews with 32 MSM, trans women, and GDSM clients living with HIV, 14 service providers (SPs), and four key informants (KIs) in Accra, Ghana. We interviewed participants about their PrEP knowledge, whether MSM would take PrEP, and what factors would make it easy/difficult to uptake or implement PrEP. Interview transcripts were analyzed using thematic analysis. There was high acceptability of PrEP use and implementation among MSM, trans women, GDSM, and SPs/KIs in Ghana. MSM, trans women, and GDSM interest in, access to, and use of PrEP were shaped by intersectional HIV and anti-gay stigma; PrEP affordability, acceptability, and ease of use (e.g., consumption and side effects); sexual preferences (e.g., condomless sex vs. condom use), and HIV risk perception. Concerns raised about barriers and facilitators of PrEP use and implementation ranged from medical concerns (e.g., STIs; drug resistance); social behavioral concerns (e.g., stigma, risk compensation, adherence issues); and structural barriers (e.g., cost/affordability, govern commitment, monitoring systems, policy guidance). Targeted education on PrEP and proper use of it is needed to generate demand and dispel worries of side effects among MSM, trans women, and GDSM. Free, confidential, and easy access to PrEP must be supported by health systems strengthening, clear prescription guidelines, and anti-stigma training for providers.
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Affiliation(s)
- Akua O Gyamerah
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Ezra Kinzer
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, The State University of New York at Buffalo, Buffalo, New York, United States of America
| | | | | | - Kelly D Taylor
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Sheri A Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Ortblad KF, Bardon AR, Mogere P, Kiptinness C, Gakuo S, Mbaire S, Thomas KK, Mugo NR, Baeten JM, Ngure K. Effect of 6-Month HIV Preexposure Prophylaxis Dispensing With Interim Self-testing on Preexposure Prophylaxis Continuation at 12 Months: A Randomized Noninferiority Trial. JAMA Netw Open 2023; 6:e2318590. [PMID: 37318803 PMCID: PMC10273023 DOI: 10.1001/jamanetworkopen.2023.18590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/27/2023] [Indexed: 06/16/2023] Open
Abstract
Importance Daily oral HIV preexposure prophylaxis (PrEP) delivery requires quarterly clinic visits for HIV testing and drug refilling that are costly to health systems and clients. Objective To evaluate whether 6-month PrEP dispensing supported with interim HIV self-testing (HIVST) results in noninferior PrEP continuation outcomes at 12 months compared with standard quarterly clinic visits. Design, Setting, and Participants This randomized noninferiority trial was conducted from May 2018 to May 2021 with 12 months of follow-up among PrEP clients aged 18 years or older who were returning for their first refill at a research clinic in Kiambu County, Kenya. Intervention Participants were randomized 2:1 to (1) 6-month PrEP dispensing with semiannual clinic visits and interim HIVST at 3 months or (2) standard-of-care (SOC) PrEP delivery with 3-month dispensing, quarterly clinic visits, and clinic-based HIV testing. Main Outcomes and Measures Prespecified 12-month outcomes included recent HIV testing (any in past 6 months), PrEP refilling, and PrEP adherence (detectable tenofovir-diphosphate concentrations in dried blood spots). Binomial regression models were used to estimate risk differences (RDs), and a 1-sided 95% CI lower bound (LB) of -10% or greater was interpreted as noninferior. Results A total of 495 participants were enrolled, with 329 enrolled in the intervention group and 166 enrolled in the SOC group; 330 (66.7%) were women, 295 (59.6%) were in serodifferent relationships, and the median (IQR) age was 33 (27-40) years. At 12 months, 241 individuals in the intervention group (73.3%) and 120 in the SOC group (72.3%) returned to clinic. In the intervention group, recent HIV testing was noninferior (230 individuals [69.9%]) compared with the SOC group (116 [69.9%]; RD, -0.33%, 95% CI LB, -7.44%). PrEP refilling in the intervention group (196 [59.6%]) was inconclusive compared with the SOC group (104 [62.7%]; RD, -3.25%; 95% CI LB, -10.84%), and PrEP adherence was noninferior in the intervention group (151 [45.9%]) compared with the SOC group (70 [42.2%]; RD, 4.96%; 95% CI LB, -2.46%). No HIV seroconversions were observed over the follow-up period. Conclusions and Relevance In this analysis of secondary trial end points at 1 year, semiannual PrEP dispensing with interim HIVST resulted in noninferior recent HIV testing and PrEP adherence compared with SOC quarterly PrEP dispensing. This novel model has the potential to optimize PrEP delivery. Trial Registration ClinicalTrials.gov Identifier: NCT03593629.
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Affiliation(s)
- Katrina F. Ortblad
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Ashley R. Bardon
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Peter Mogere
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Stephen Gakuo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sarah Mbaire
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Nelly R. Mugo
- Department of Global Health, University of Washington, Seattle
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- now with Gilead Sciences, Foster City, California
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Basdav J, Reddy P, Haffejee F. Motivators for oral PrEP uptake and adherence in the eThekwini municipality, KwaZulu-Natal. AIDS Care 2023:1-16. [PMID: 37144287 DOI: 10.1080/09540121.2023.2208322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a single daily pill that prevents a seropositive HIV status. Since 2016, South Africa has staggered PrEP roll-out, with uptake levels not reaching optimal goals. The aim of this study was to determine motivation behind PrEP initiation and adherence among South African users. A phenomenological qualitative study (n = 15) was used. Participants were purposively recruited from two primary healthcare clinics in eThekwini, KwaZulu-Natal. Thematic analysis was used to analyse the data. Three themes were identified: motivation for PrEP uptake, PrEP adherence and PrEP awareness. Initiation was influenced by healthcare professionals. Responsibility for one's well-being, serodiscordant relationships and sexual partner's behavioural patterns contributed toward initiation. Most were fully compliant, using reminders to negate medication forgetfulness. The internet and healthcare professionals served as information sources, however, few were aware of PrEP prior to this. Innovative ways are required to increase awareness levels and increase uptake.
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Affiliation(s)
- Jyotika Basdav
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Poovendhree Reddy
- Department of Community Health Studies, Durban University of Technology, Durban, South Africa
| | - Firoza Haffejee
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
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de Sousa AFL, Lima SVMA, Ribeiro CJN, de Sousa AR, Barreto NMPV, Camargo ELS, Araújo AAC, dos Santos AD, Bezerra-Santos M, Fortunato MDR, Possani MA, dos Santos AJ, de Lima JLT, Gir E, Fronteira I, Mendes IAC. Adherence to Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in Portuguese-Speaking Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4881. [PMID: 36981792 PMCID: PMC10049571 DOI: 10.3390/ijerph20064881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Strengthening strategies to improve adherence to the use of pre-exposure prophylaxis (PrEP) in key populations constitutes a global health priority to be achieved across countries, especially in countries that share a high flow of people such as Brazil and Portugal. This study aimed to analyze the factors associated with adherence to PrEP among MSM from two Portuguese-speaking countries, highlighting the opportunities and preventive strategies for the global health scenario. This was a cross-sectional analytical online survey conducted from January 2020 to May 2021 with MSM in Brazil and Portugal. For analysis of the data, the Poisson regression model was used to estimate the prevalence ratio (PR) for developing a model to evaluate the associated factors in both countries in a comparative and isolated way. Adherence to PrEP use corresponded to 19.5% (n = 1682) of the overall sample: 18.3% (n = 970) for Brazil and 21.5% (n = 712) for Portugal. Having more than two sex partners in the last 30 days (aPR: 30.87) and routinely undergoing HIV tests (aPR: 26.21) increased the use of this medication. Being an immigrant (PR: 1.36) and knowing the partner's serological status (PR: 1.28) increased adherence to PrEP in Portugal, whereas, in Brazil, it was being an immigrant (PR: 0.83) and not knowing the serological status (PR: 2.24) that promoted the use of this medication. Our findings reinforce the need to invest in programs and strategies to improve access and adherence to PrEP, especially in key populations.
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Affiliation(s)
- Alvaro Francisco Lopes de Sousa
- Hospital Sírio-Libânes, Instituto de Ensino e Pesquisa, São Paulo 01308-050, São Paulo, Brazil
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Shirley Veronica Melo Almeida Lima
- Collective Health Research Center, Universidade Federal de Sergipe, Lagarto 49400-000, Sergipe, Brazil
- Graduate Program in Nursing, Universidade Federal de Sergipe, São Cristóvão 49100-000, Sergipe, Brazil
| | | | - Anderson Reis de Sousa
- Graduate Program in Nursing and Health of the Nursing School, Universidade Federal da Bahia, Salvador 40170-110, Bahia, Brazil
| | | | | | | | - Allan Dantas dos Santos
- Collective Health Research Center, Universidade Federal de Sergipe, Lagarto 49400-000, Sergipe, Brazil
| | - Márcio Bezerra-Santos
- Medical and Nursing Science Center, Universidade Federal de Alagoas, Arapiraca 57309-005, Alagoas, Brazil
| | | | - Matheus Arantes Possani
- Medical School, Universidade Federal do Triângulo Mineiro, Uberaba 38025-180, Minas Gerais, Brazil
| | - Adriano José dos Santos
- Collective Health Research Center, Universidade Federal de Sergipe, Lagarto 49400-000, Sergipe, Brazil
| | | | - Elucir Gir
- Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto 14040-902, São Paulo, Brazil
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Isabel Amélia Costa Mendes
- Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto 14040-902, São Paulo, Brazil
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Diakite M, Shaw-Saliba K, Lau CY. Malignancy and viral infections in Sub-Saharan Africa: A review. FRONTIERS IN VIROLOGY (LAUSANNE, SWITZERLAND) 2023; 3:1103737. [PMID: 37476029 PMCID: PMC10358275 DOI: 10.3389/fviro.2023.1103737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
The burden of malignancy related to viral infection is increasing in Sub-Saharan Africa (SSA). In 2018, approximately 2 million new cancer cases worldwide were attributable to infection. Prevention or treatment of these infections could reduce cancer cases by 23% in less developed regions and about 7% in developed regions. Contemporaneous increases in longevity and changes in lifestyle have contributed to the cancer burden in SSA. African hospitals are reporting more cases of cancer related to infection (e.g., cervical cancer in women and stomach and liver cancer in men). SSA populations also have elevated underlying prevalence of viral infections compared to other regions. Of 10 infectious agents identified as carcinogenic by the International Agency for Research on Cancer, six are viruses: hepatitis B and C viruses (HBV and HCV, respectively), Epstein-Barr virus (EBV), high-risk types of human papillomavirus (HPV), Human T-cell lymphotropic virus type 1 (HTLV-1), and Kaposi's sarcoma herpesvirus (KSHV, also known as human herpesvirus type 8, HHV-8). Human immunodeficiency virus type 1 (HIV) also facilitates oncogenesis. EBV is associated with lymphomas and nasopharyngeal carcinoma; HBV and HCV are associated with hepatocellular carcinoma; KSHV causes Kaposi's sarcoma; HTLV-1 causes T-cell leukemia and lymphoma; HPV causes carcinoma of the oropharynx and anogenital squamous cell cancer. HIV-1, for which SSA has the greatest global burden, has been linked to increasing risk of malignancy through immunologic dysregulation and clonal hematopoiesis. Public health approaches to prevent infection, such as vaccination, safer injection techniques, screening of blood products, antimicrobial treatments and safer sexual practices could reduce the burden of cancer in Africa. In SSA, inequalities in access to cancer screening and treatment are exacerbated by the perception of cancer as taboo. National level cancer registries, new screening strategies for detection of viral infection and public health messaging should be prioritized in SSA's battle against malignancy. In this review, we discuss the impact of carcinogenic viruses in SSA with a focus on regional epidemiology.
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Affiliation(s)
- Mahamadou Diakite
- University Clinical Research Center, University of Sciences, Techniques, and Technologies, Bamako, Mali
| | - Kathryn Shaw-Saliba
- Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Chuen-Yen Lau
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
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Brown JM, Gitome S, Mataveke B, Chirenda T, Matubu A, Chareka G, Chasakara C, Mgodi N, Murombedzi C, Musara P, Makurumure T, Hughes CS, Bukusi E, Cohen CR, Shiboski S, Darbes L, Kahn JG, Rutherford GW, Chirenje ZM, Mhlanga F. Preventing HIV and achieving pregnancy among HIV sero-different couples: Pilot study of a safer conception intervention in Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000796. [PMID: 36963004 PMCID: PMC10022125 DOI: 10.1371/journal.pgph.0000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Safer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive safer conception program (Clintrials.gov identifier: NCT03049176) for HIV sero-different couples planning pregnancy in Zimbabwe to measure feasibility, method uptake, acceptability, pregnancy outcome, and HIV transmission. This study was not designed to compare rates of HIV transmission by safer conception method choice but rather to understand choices couples make when seeking to minimize risk of HIV transmission and maximize likelihood of pregnancy. Couples in this prospective, non-randomized study were given a choice of one or more currently available safer conception methods: antiretroviral therapy (ART) with monthly viral load (VL) monitoring for the HIV-positive partner (ART/VL), pre-exposure prophylaxis (PrEP) for the HIV-negative partner, vaginal insemination (VI) for couples with an HIV-positive woman, and semen washing (SW) for couples with an HIV-positive man. Couples were followed monthly for up to 12 months of pregnancy attempts, quarterly during pregnancy, and 12 weeks post-partum. At each visit, data on method use, urine for pregnancy testing, and blood for HIV antibody testing, or viral load if HIV-positive, were obtained. Infants born to HIV-positive women were tested for HIV at 6 and 12 weeks. Between March 2017 and June 2019, 46 individuals from 23 HIV sero-different partnerships were enrolled and followed. At enrollment, all couples chose ART/VL, and all couples chose at least one additional method; 74% chose PrEP, 36% chose SW, and 25% chose VI. During pre-pregnancy follow-up visits, three couples discontinued SW, and one couple discontinued VI; all four of these couples opted for ART/VL plus PrEP. Satisfaction with safer conception methods was high among those who chose ART/VL and PrEP. Twelve couples achieved pregnancy. There were no cases of HIV transmission to partners, and no infants tested positive for HIV. This safer conception program is feasible and acceptable, allowing sero-different couples to safely achieve pregnancy. Sero-different couples in Zimbabwe seek a combination of HIV prevention methods, particularly ART/VL plus PrEP. Trial Registration: Clintrials.gov, NCT03049176.
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Affiliation(s)
- Joelle M. Brown
- Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Serah Gitome
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Thandiwe Chirenda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Allen Matubu
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Gift Chareka
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Charles Chasakara
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Petina Musara
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Carolyn Smith Hughes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Stephen Shiboski
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Lynae Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - James G. Kahn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Z. Michael Chirenje
- Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
- University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Felix Mhlanga
- University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
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de Medeiros RM, Valverde-Villegas JM, Ellwanger JH. Editorial: Host-virus interaction at the omics and ecology levels. Front Immunol 2023; 14:1209532. [PMID: 37207198 PMCID: PMC10189102 DOI: 10.3389/fimmu.2023.1209532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Rúbia Marília de Medeiros
- Independent Researcher, Porto Alegre, Rio Grande do Sul, Brazil
- *Correspondence: Rúbia Marília de Medeiros,
| | | | - Joel Henrique Ellwanger
- Laboratory of Immunobiology and Immunogenetics, Department of Genetics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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Nkomo S, Makoni W, Shapley-Quinn MK, Luecke E, Mbatsane E, Manenzhe K, Ahmed K, Johnson LM, Mahaka I, van der Straten A. Prospective acceptability of a multipurpose technology (MPT) implant in preclinical development to prevent HIV and unplanned pregnancy: Qualitative insights from women end users and health care providers in South Africa and Zimbabwe. PLoS One 2023; 18:e0285711. [PMID: 37195918 DOI: 10.1371/journal.pone.0285711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Given the high rates of both HIV and unintended pregnancies in sub-Saharan Africa, the SCHIELD program aims to develop a multipurpose technology implant for HIV and pregnancy prevention. An end-user evaluation was undertaken with young women and health care providers to assess preferences for modifiable implant attributes to improve future adoption and rollout. METHODS Focus group discussions were conducted with potential women end users, and health care providers experienced in implant insertion or removal participated in in-depth interviews. All participants were recruited from Harare, Zimbabwe, or Soshanguve, South Africa. The purposively stratified sampled women were either implant experienced or implant naïve and were categorized into three groups: nulliparous, postpartum, or engaged in transactional sex. Topics covered included duration (six months to three years), biodegradability, removability, and independent rod retrievability (per indication). Data were analyzed using Dedoose software and summarized into emerging themes. RESULTS Participants identified three key areas that could facilitate rollout, uptake, and adherence of an implant for HIV and pregnancy prevention. First, discreetness was the most salient topic and was associated with implant characteristics such as anatomical location, flexibility, and biodegradability. Second, the ability to independently retrieve the HIV or pregnancy prevention component was preferred, as life circumstances may change and was favored by all participants, except for young women in Soshanguve. Third, there is a need for proper counseling, sensitization, provider training, and health campaigns to facilitate rollout of a 2-in-1 implant. CONCLUSIONS A 2-in-1 implant was seen as highly desirable by most young women and health care providers. Participants discussed potential concerns and barriers to uptake of a biodegradable implant with dual HIV prevention and contraceptive properties, identifying key implant attributes that product developers can modify while still in preclinical stages.
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Affiliation(s)
| | | | - Mary Kate Shapley-Quinn
- Women's Global Health Imperative, RTI International, San Jose, California, United States of America
| | - Ellen Luecke
- Women's Global Health Imperative, RTI International, San Jose, California, United States of America
| | | | | | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Leah M Johnson
- RTI International, Research Triangle Park, North Carolina, United States of America
| | | | - Ariane van der Straten
- ASTRA Consulting, Kensington, California, United States of America
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, United States of America
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Duby Z, Bunce B, Fowler C, Jonas K, Bergh K, Govindasamy D, Wagner C, Mathews C. "These Girls Have a Chance to be the Future Generation of HIV Negative": Experiences of Implementing a PrEP Programme for Adolescent Girls and Young Women in South Africa. AIDS Behav 2023; 27:134-149. [PMID: 35793053 PMCID: PMC9258476 DOI: 10.1007/s10461-022-03750-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 01/24/2023]
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. Adolescent girls and young women (AGYW) have been prioritised for PrEP delivery in South Africa. A combination HIV prevention intervention providing integrated biomedical, behavioural and structural interventions for AGYW aged 15-24 in twelve districts in South Africa characterised by high HIV prevalence, was implemented 2019-2022. We conducted qualitative interviews to explore PrEP implementation experiences with 38 individuals involved in the implementation of the combination HIV prevention programme, including programme managers and project coordinators, health care providers / nurses, social workers, counsellors, peer group trainers and outreach workers. Narratives included various challenges associated with PrEP uptake, adherence and acceptability experienced by implementers. Barriers to PrEP acceptability included AGYW fears of side effects and preference for injectable versus daily oral PrEP; resistance towards PrEP from AGYW, communities and parents due to a lack of accurate information; PrEP stigma linked to associations with antiretrovirals and assumptions of promiscuity; and issues pertaining to parental consent. Additionally, implementers faced logistical challenges related to procurement, stockouts, and supply of PrEP. Findings highlighted the critical role of parental and community acceptability of PrEP for successful implementation. Overall, PrEP was perceived by implementers as a valuable HIV prevention tool. In order to ensure the accessibility of PrEP for AGYW in South Africa, efforts to reduce stigma and foster social support for PrEP use, campaigns to raise awareness, ensure positive framing of PrEP, and build community acceptability of PrEP, are needed.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa.
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Brittany Bunce
- Institute for Global Sustainable Development (IGSD), University of Sheffield, Sheffield, United Kingdom
| | - Chantal Fowler
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Kate Bergh
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
| | - Colleen Wagner
- NACOSA (Networking HIV/AIDS Community of South Africa), Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerberg, Cape Town, South Africa
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Awareness, Willingness and Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers Living in Dar-es-Salaam, Tanzania. AIDS Behav 2023; 27:335-343. [PMID: 35838859 PMCID: PMC9852168 DOI: 10.1007/s10461-022-03769-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
Tanzania is in the final stages to roll out pre-exposure prophylaxis (PrEP) to Female Sex Workers (FSWs) so as to reduce new infections. PrEP demonstration projects support programming through gaining first experiences.We analyzed data from a cohort of 700 HIV negative FSWs in Dar-es-Salaam to determine proportions of FSWs who were aware, willing and used PrEP. We compared proportions at cohort enrolment and after 12 months. Logistic regression was used to determine factors associated with PrEP use. PrEP awareness increased from 67% to 97% after 12 months. Willingness was high at both time points (98% versus 96%). Only 8% (57/700) had used PrEP. Being married/cohabiting or separated/divorced/widowed and having sex with a HIV infected partner were independently associated with PrEP use. The PrEP program should focus on scaling up access as willingness to use PrEP is high.
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Abstract
Preexposure prophylaxis (PrEP) is increasingly implemented in national HIV prevention programmes through routine care. Monitoring will be vital to understand whether programmes succeed in engaging people into using PrEP appropriately, and in reducing the HIV epidemic. Yet, it is currently unclear which indicators are most suited to monitor PrEP programmes' performance. We therefore aimed to identify and map indicators that are currently used or suggested for monitoring PrEP programmes. We conducted a scoping review based on the framework by Arksey and O'Malley. We combined a systematic search in the peer-reviewed literature with hand-searching grey literature documents describing indicators and strategies that are used or suggested for PrEP monitoring. Only literature published after 2012 was included. No geographical restrictions were set. We charted data on indicator definitions, data sources used, reported experiences with monitoring and any relevant contextual factors. Ultimately, 35 peer-reviewed and 14 grey literature records were included. We identified indicators related to preuptake stages of PrEP, uptake and coverage, and programme impact. The indicators most commonly suggested for national-level monitoring were the number of new and current PrEP users, the number of HIV seroconversions among PrEP users and some variably defined indicators related to continuation and discontinuation of PrEP. Despite its perceived high relevance, studies reported several challenges to routinely monitor the population in need of PrEP and track prevention-effective PrEP use. In conclusion, a variety of indicators is currently used or suggested for monitoring PrEP programmes. Implementing proxy measures that track different aspects of PrEP use over time, and making synergies with research more explicit, could be used as strategies to obtain more granular insights into trends revealed by routine monitoring.
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Barnabee G, O’Bryan G, Ndeikemona L, Billah I, Silas L, Morgan KL, Shulock K, Mawire S, MacLachlan E, Nghipangelwa J, Muremi E, Ensminger A, Forster N, O’Malley G. Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:1048702. [PMID: 36545490 PMCID: PMC9760915 DOI: 10.3389/frph.2022.1048702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Despite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services through community and hybrid models in Namibia to facility-based services. We subsequently identify potential mechanisms to explain how and why community and hybrid models achieved (or not) improved persistence to inform further service delivery innovation. Methods Data were collected from PrEP service delivery to AGYW over two-years in Namibia's Khomas Region. We used Kaplan-Meier analysis to estimate survival curves for PrEP persistence beyond three-months after initiation and report the cumulative probability of persistence at one- and three-months. Persistence was defined as any PrEP use within three months after initiation followed by a PrEP refill or previously prescribed supply of at least 30 days at the three-month visit. Interviews were conducted with 28 AGYW and 19 providers and analyzed using a deductive-inductive thematic approach. Results From October 2017 through September 2019, 372 (18.7%) AGYW received services through a facility model, 302 (15.1%) through a community model, and 1,320 (66.2%) through a hybrid model. PrEP persistence at one- and three-months was 41.2% and 34.9% in the community model and 6.2% and 4.8% in the hybrid model compared to 36.8% and 26.7% in the facility model. Within the community and hybrid models, we identified three potential mechanisms related to PrEP persistence. Individualized service delivery offered convenience and simplicity which enabled AGYW to overcome barriers to obtaining refills but did not work as well for highly mobile AGYW. Consistent interactions and shared experiences fostered social connectedness with providers and with peers, building social networks and support systems for PrEP use. PrEP and HIV-related stigma, however, was widely experienced outside of these networks. Community-to-facility referral for PrEP refill triggered apprehension towards unfamiliar PrEP services and providers in AGYW, which discouraged persistence. Conclusion Service delivery approaches that offer convenience and simplicity and foster social connectedness may reduce access barriers and increase social support enabling AGYW to self-manage their PrEP use and achieve improved PrEP persistence.
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Affiliation(s)
- Gena Barnabee
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Gillian O’Bryan
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lylie Ndeikemona
- Directorate of Special Programmes, Ministry of Health and Social Services, Windhoek, Namibia
| | - Idel Billah
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Lukas Silas
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Karie L. Morgan
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI, United States
| | - Katherine Shulock
- Disease Control and Health Statistics (DCHS), Washington State Department of Health, Seattle, WA, United States
| | | | - Ellen MacLachlan
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Josua Nghipangelwa
- Oshikoto Regional Directorate, Ministry of Health and Social Services, Omuthiya, Namibia
| | - Elizabeth Muremi
- Khomas Regional Directorate, Ministry of Health and Social Services, Windhoek, Namibia
| | - Alison Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
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Ekwunife OI, Ejie IL, Okelu V, Mita C, Durosinmi-Eti O, Powell A, Franke MF. Interventions to increase the uptake and continuation of pre-exposure prophylaxis (PrEP) by adolescent girls and young women at high risk of HIV in low-income and middle-income countries: a scoping review. BMJ Glob Health 2022; 7:e009474. [PMID: 36593640 PMCID: PMC9743293 DOI: 10.1136/bmjgh-2022-009474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Effective strategies to increase pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women (AGYW) who engage in sex work or transactional sex are sparsely reported. We aimed to describe the available evidence on strategies for improving the uptake and continuation of PrEP among AGYW who engage in sex work or transactional sex, or otherwise are at high risk of acquiring HIV, and report their implementation outcomes. METHOD PubMed, Embase, CINAHL and Global Health were searched for studies describing strategies to increase uptake and continuation of PrEP for HIV prevention among AGYW at high risk of acquiring HIV in low-income and middle-income countries. Two independent reviewers screened citations for inclusion and performed data abstraction. Proctor's framework was used to report the implementation outcomes of the interventions. RESULT We identified 1046 citations, and reviewed 69 full-text documents, of which we included 11 in the scoping review. A social marketing campaign was used in one study to create demand for PrEP. A decision support tool was used in one study to improve PrEP initiation. SMS reminders (two studies), drug-level feedback (two studies), peer group support (one study) and conditional economic incentives (one study) were used to improve PrEP continuation. Five studies reported adoption outcomes, two of which were high. Four studies reported sustainability outcomes; these were low or moderate. One study found private youth-friendly clinics a better fit for AGYW PrEP delivery compared with public hospitals, and prescription of PrEP by non-study staff in the hospital facility was low. CONCLUSION Multiple promising interventions have been used to deliver PrEP to AGYW at high risk of acquiring HIV; however, more information is needed to understand how these interventions would likely perform at scale outside of a research context.
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Affiliation(s)
- Obinna Ikechukwu Ekwunife
- Takemi Program in International Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Valentine Okelu
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Carol Mita
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Antonia Powell
- Center for HIV and Infectious Diseases, John Snow Inc, Boston, Massachusetts, USA
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Chimukuche RS, Kawuma R, Mahapa N, Mkhwanazi S, Singh N, Siva S, Ruzagira E, Seeley J. Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study. BMC Health Serv Res 2022; 22:1336. [PMID: 36357877 PMCID: PMC9649006 DOI: 10.1186/s12913-022-08730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. METHODS We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. RESULTS We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. CONCLUSION The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04066881.
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Affiliation(s)
| | - Rachel Kawuma
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Smanga Mkhwanazi
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nishanta Singh
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Samantha Siva
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Eugene Ruzagira
- HIV Epidemiology and Interventions Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Roberts DA, Bridenbecker D, Haberer JE, Barnabas RV, Akullian A. The impact of prevention‐effective PrEP use on HIV incidence: a mathematical modelling study. J Int AIDS Soc 2022; 25:e26034. [DOI: 10.1002/jia2.26034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- D. Allen Roberts
- Department of Epidemiology University of Washington Seattle Washington USA
| | - Daniel Bridenbecker
- Institute for Disease Modeling Bill & Melinda Gates Foundation Seattle Washington USA
| | - Jessica E. Haberer
- Center for Global Health Massachusetts General Hospital Boston Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - Ruanne V. Barnabas
- Center for Global Health Massachusetts General Hospital Boston Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - Adam Akullian
- Institute for Disease Modeling Bill & Melinda Gates Foundation Seattle Washington USA
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Health system opportunities and challenges for PrEP implementation in Kenya: A qualitative framework analysis. PLoS One 2022; 17:e0259738. [PMID: 36206224 PMCID: PMC9543691 DOI: 10.1371/journal.pone.0259738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/25/2021] [Indexed: 11/06/2022] Open
Abstract
Background As pre-exposure prophylaxis (PrEP) scales up in sub-Saharan Africa, governments and implementers need to understand how to best manage national programs. Kenya’s national PrEP program offers an opportunity to review elements of program success within the health system and evaluate the utility of a national implementation framework. We explored health system considerations for PrEP implementation to understand how Kenya’s national PrEP implementation priorities align with those of PrEP service providers, peer educators, and program or county managers. Methods We conducted twelve key informant interviews (KII) and nine focus group discussions (FGDs) with PrEP program and county managers (n = 12), peer educators (n = 44), and PrEP service providers (n = 48). We recruited participants across a variety of cadres and experiences with PrEP programs. KIIs and FGDs focused on PrEP service delivery and program implementation. Data were collected by trained study staff, audio recorded, translated into English, and transcribed. We used framework analysis methods to systematically apply Kenya’s 2017 National PrEP Implementation Framework to the data and summarized findings according to the seven Implementation Framework domains. Results All respondents emphasized the important role of communication, coordination, training, and leadership in PrEP implementation. PrEP service providers and program and county managers highlighted the importance of efficient data collection and utilization, and improved resource allocation. Commodity security and research, while key elements of the PrEP Implementation Framework, were less commonly discussed, and research was less prioritized by respondents. Respondents highlighted the importance of coordinated PrEP service delivery across sites and programs to improve overall client experiences. Conclusion In the context of a nationally-scaled PrEP program, PrEP service providers, peer educators, and program and county managers value strong leadership, close coordination of services across sites, and expedient use of data to improve strategies and services. Kenya’s PrEP Implementation Framework aligns closely with the priorities of individuals involved in PrEP service delivery and management, and provides a comprehensive overview of health system considerations for effective implementation of a PrEP program at scale.
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Edwards AJ, Pollard R, Kennedy CE, Mulamba J, Mbabali I, Anok A, Kong X, Nakyanjo N, Ddaaki W, Nishimura H, Wawer M, Rivet Amico K, Hutton HE, Nakigozi G, Larry W Chang. Impact of community health worker intervention on PrEP knowledge and use in Rakai, Uganda: A mixed methods, implementation science evaluation. Int J STD AIDS 2022; 33:995-1004. [PMID: 36006865 PMCID: PMC9910624 DOI: 10.1177/09564624221121208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective models of support for HIV pre-exposure prophylaxis (PrEP) are needed for populations at elevated risk. In a hyperendemic Ugandan fishing community, PrEP counseling was provided through a situated Information, Motivation, and Behavioral Skills (sIMB)-based community health worker (CHW) intervention. We evaluated the intervention using a mixed-methods, implementation science design. METHODS We surveyed all community members aged 15-49 through the Rakai Community Cohort Study. We used multivariable logistic regressions with generalized estimating equations to estimate the intervention's effect on PrEP knowledge and utilization. To understand intervention experiences and mechanisms, we conducted 74 qualitative interviews with 5 informant types (clients, CHWs, program staff, community leaders, health clinic staff) and analyzed data using an iterative, deductive approach. A mobile phone application provided intervention process implementation data. RESULTS Individuals self-reporting receipt of the CHW intervention showed significantly higher PrEP knowledge (N = 1848, PRR: 1.10, 95% CI: 1.06-1.14, p = <.0001), PrEP ever use (N = 1176, PRR: 1.77, 95% CI: 1.33-2.36, p = <.0001), and PrEP current use (N = 1176, PRR: 1.86, 95% CI: 1.22-2.82, p = 0.0039) compared to those who did not. Qualitative findings attributed positive PrEP outcomes to CHW counseling and effective use of motivational interviewing skills by CHWs. Salient themes across the RE-AIM framework included support for the CHW intervention and PrEP across clients, community, and implementers. Mobile application data demonstrated consistent delivery of the PrEP module throughout implementation. CONCLUSIONS CHWs improved PrEP knowledge and use among clients in an HIV hyperendemic fishing community. Mixed-methods, implementation science evaluations can inform adaptation of similar PrEP implementation strategies.
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Affiliation(s)
- Abagail J Edwards
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rose Pollard
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Rakai Health Sciences Program, Rakai, Uganda
| | | | | | - Aggrey Anok
- Rakai Health Sciences Program, Rakai, Uganda
| | - Xiangrong Kong
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Holly Nishimura
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria Wawer
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - K Rivet Amico
- Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Larry W Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bien-Gund CH, Ochwal P, Marcus N, Bair EF, Napierala S, Maman S, Agot K, Thirumurthy H. Adoption of HIV pre-exposure prophylaxis among women at high risk of HIV infection in Kenya. PLoS One 2022; 17:e0273409. [PMID: 36084050 PMCID: PMC9462728 DOI: 10.1371/journal.pone.0273409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
In 2017, Kenya became one of the first African countries to provide pre-exposure prophylaxis (PrEP) in its national HIV prevention plan. We sought to characterize factors associated with PrEP uptake and persistence among a cohort of women at risk of HIV infection during the early stages of PrEP scale-up in Kenya. HIV-negative women ≥18 years with ≥2 sexual partners in the past 4 weeks were recruited as part of an ongoing cluster randomized trial of an HIV self-testing intervention. PrEP use was assessed at baseline and at 6- and 12-month follow-up visits. Between June 2017 and August 2018, 2,086 were enrolled and had complete baseline data. 138 (6.6%) reported PrEP use during the first year of the study. Although PrEP use increased, persistence on PrEP was low, and less than half of individuals reported continuing PrEP at follow-up visits. In multivariate analyses, PrEP use was associated with recent STIs, having an HIV-positive primary partner, having regular transactional sex in the past 12 months, and being a female sex worker. In the early stages of PrEP scale-up in Kenya, uptake increased modestly among women with risk factors for HIV infection, but overall uptake and persistence was low.
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Affiliation(s)
- Cedric H. Bien-Gund
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, PA, United States of America
- * E-mail:
| | - Perez Ochwal
- Impact Research and Development Organisation, Kisumu, Kenya
| | - Noora Marcus
- Division of Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Elizabeth F. Bair
- Division of Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Sue Napierala
- Women’s Global Health Imperative, RTI International, Berkeley, CA, United States of America
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kawango Agot
- Impact Research and Development Organisation, Kisumu, Kenya
| | - Harsha Thirumurthy
- Division of Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
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Abstract
PURPOSE OF REVIEW Ten years since the first regulatory approval of oral HIV preexposure prophylaxis (PrEP), this review summarizes PrEP uptake, the role of ambitious PrEP targets, emerging evidence of impact on the HIV epidemic and innovative approaches to increasing PrEP uptake. RECENT FINDINGS PrEP uptake among people at risk of HIV has been slow, but has accelerated in recent years, particularly in gay and bisexual men in a limited number of high-income settings and recently in heterosexuals at risk of HIV in sub-Saharan Africa. However, UNAIDS 2020 PrEP targets and HIV prevention targets were missed by large margins. Although UNAIDS testing and treatment targets have galvanised public health action, in contras, PrEP targets have been lower profile and insufficiently ambitious. Parts of the USA, Australia and the UK with high PrEP coverage have demonstrated striking reductions in HIV infection at the population level, as PrEP is introduced at scale. Scaling up PrEP uptake will require innovations in PrEP promotion, simplified models of care, improved adherence interventions, improved choice in the form of longer-acting PrEP and interventions to ensure that all those who can benefit from PrEP can access it. SUMMARY PrEP is a revolutionary HIV prevention tool, which if ambitiously scaled up could drive HIV transmission towards elimination. Highly publicized and ambitious PrEP targets could help drive this.
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Untapped Potential for Safer Conception Messaging to Transform PrEP Rollout and Promote Service Engagement Among Serodiscordant Couples. AIDS Behav 2022; 26:2397-2408. [PMID: 35064850 DOI: 10.1007/s10461-022-03584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/01/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa's initial rollout, revealing the need for more effective promotion strategies. In Uganda, we explored potential benefits and challenges of integrating safer conception messaging to promote PrEP among serodiscordant couples. In-depth interviews were conducted with clients and personnel at three clinics and analyzed thematically. Participants (n = 58) valued PrEP as a safer conception method (SCM) but described lack of integration of safer conception and PrEP services as well as inconsistent practices in prescribing PrEP to couples pursuing conception. Participants reported that the wider population remains largely unaware of PrEP and SCM or harbors misconceptions that PrEP is primarily for highly stigmatized groups like sex workers. Participants further described how heterosexual couples can still be reluctant to test for HIV, unaware of tools like PrEP and SCM that would allow them to continue their relationship and/or pursuit of childbearing. Overall, findings suggest that integrating PrEP and SCM in messaging and services targeting serodiscordant couples holds untapped benefits throughout the HIV prevention cascade.
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