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Bogart LM, Musoke W, Mukama CS, Allupo S, Klein DJ, Sejjemba A, Mwima S, Kadama H, Mulebeke R, Pandey R, Wagner Z, Mukasa B, Wanyenze RK. Enhanced Oral Pre-exposure Prophylaxis (PrEP) Implementation for Ugandan Fisherfolk: Pilot Intervention Outcomes. AIDS Behav 2024:10.1007/s10461-024-04432-w. [PMID: 39028385 DOI: 10.1007/s10461-024-04432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
Mobile populations such as fisherfolk show high HIV incidence and prevalence. We pilot-tested implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake and adherence in the context of healthcare outreach events in two mainland fisherfolk communities on Lake Victoria, Uganda from September 2021 to February 2022. The implementation strategies included PrEP adherence supporters (selected from PrEP users' social networks), community workshops (to address misconceptions and stigma, and empower PrEP advocacy), and check-in calls (including refill reminders). PrEP medical records data were collected from 6-months pre-intervention to 6-months post-intervention. Qualitative interviews with 20 PrEP users (10 who continued, 10 who discontinued), 9 adherence supporters, and 7 key partners (providers, community leaders) explored acceptability. Percentages of PrEP initiators (of those eligible) were significantly higher during the intervention (96.5%) than 6-months before the intervention (84.5%), p < 0.0001; percentages of PrEP users who persisted (i.e., possessed a refill) 6-months post-initiation (47.9% vs. 6.7%) and had at least 80% PrEP coverage (based on their medication possession ratio) from the initiation date to 6-months later (35.9% vs. 0%) were higher during versus pre-intervention, p < 0.0001. A comparison fisherfolk community with better healthcare access had lower uptake (78.3%; p < 0.0001) and persistence at 6-months (34.0%; p < 0.001), but higher coverage during the intervention period (70.4%; p < 0.0001). Qualitative data suggested the strategies promoted PrEP use through reduced stigma and misconceptions. The intervention bundle cost was $223.95, $172.98, and $94.66 for each additional person for PrEP initiation, persistence, and coverage, respectively. Enhanced community-based PrEP implementation that fosters a supportive community environment can improve PrEP use in mobile populations without easy access to healthcare. (NCT05084716).
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
| | | | | | | | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | | | - Simon Mwima
- School of Social Work, University of Illinois at Urbana Champagne, Urbana, IL, USA
| | | | | | - Rakesh Pandey
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Zachary Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
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Camlin CS, Arunga T, Johnson‐Peretz J, Akatukwasa C, Atwine F, Onyango A, Owino L, Kamya MR, Petersen ML, Chamie G, Kakande E, Kabami J, Balzer LB, Havlir DV, Ayieko J. Client experiences with "Dynamic Choice Prevention," a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa. J Int AIDS Soc 2024; 27:e26336. [PMID: 39020454 PMCID: PMC11254577 DOI: 10.1002/jia2.26336] [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: 09/08/2023] [Accepted: 07/02/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models. METHODS In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes. RESULTS Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure. CONCLUSIONS Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.
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Affiliation(s)
- Carol S. Camlin
- University of California, San Francisco (UCSF), Obstetrics, Gynecology & Reproductive SciencesSan FranciscoCaliforniaUSA
| | - Titus Arunga
- Kenya Medical Research Institute (KEMRI)KisumuKenya
| | - Jason Johnson‐Peretz
- University of California, San Francisco (UCSF), Obstetrics, Gynecology & Reproductive SciencesSan FranciscoCaliforniaUSA
| | | | | | | | | | - Moses R. Kamya
- Infectious Diseases Research CollaborationKampalaUganda
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Maya L. Petersen
- University of California, Berkeley, Biostatistics, Epidemiology, and Computational Precision HealthBerkeleyCaliforniaUSA
| | - Gabriel Chamie
- University of California, San Francisco (UCSF), MedicineSan FranciscoCaliforniaUSA
| | | | - Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
| | - Laura B. Balzer
- University of California, Berkeley, Biostatistics, Epidemiology, and Computational Precision HealthBerkeleyCaliforniaUSA
| | - Diane V. Havlir
- University of California, San Francisco (UCSF), MedicineSan FranciscoCaliforniaUSA
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI)KisumuKenya
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Goswami S, Borate S, Marupuru S, Marupuru S. A Scoping Review of the Current Landscape of Pre-Exposure Prophylaxis and Postexposure Prophylaxis in India. AIDS Patient Care STDS 2024; 38:287-304. [PMID: 38800957 DOI: 10.1089/apc.2024.0078] [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] [Indexed: 05/29/2024] Open
Abstract
This scoping review aimed to review and summarize the evidence related to the attitudes toward human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP)/postexposure prophylaxis (PEP) among people at risk of HIV, health care workers (HCWs), and the general population in India. A literature search of PubMed, Embase, Scopus, and PsycINFO was conducted from January 1, 2002, to February 1, 2024. The search field contained a combination of keywords and MeSH terms such as: HIV, PrEP, PEP knowledge, awareness, willingness, and practice. Studies published in English language, conducted in India, and having reported at least one prespecified outcome related to PrEP or PEP were included. Of 599 studies identified, 48 were included (PrEP, n = 17 studies; PEP, n = 31 studies). Among the people at risk of HIV, awareness about PrEP was very low (17% or less). However, willingness to use PrEP and interest in knowing more or obtaining PrEP were reported to be high (84-95%). Among the health care professionals, the knowledge and awareness of PEP and its dosing schedule varied from 20% to 96%. The uptake to prevent this occupational hazard was reported to be poor (12-36%). This scoping review highlighted critical research gaps related to PrEP and PEP in India, related to PrEP adherence, outcomes related to nonoccupational PEP, HCW readiness to provide PrEP, etc. Overall, this study indicated the need to design policies and implement interventions aimed toward improving the knowledge, awareness, and uptake of PrEP/PEP in India. An increased focus on improving PrEP/PEP access in India through government schemes at a lower cost is imperative.
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Affiliation(s)
- Swarnali Goswami
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Mississippi, USA
| | - Samruddhi Borate
- Department of Pharmacy, Birla Institute of Technology and Science (BITS) Pilani, Hyderabad, India
| | - Sumanth Marupuru
- Sri Venkateswara Medical College, Alipiri Road Srinivasa Nagar, Tirupati, Andhra Pradesh, India
| | - Srujitha Marupuru
- Department of Pharmacy Practice, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, Arizona, USA
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Laurence J. "The Path That Ends AIDS": National and International Politics in Conflict with Treatment and Prevention Science. AIDS Patient Care STDS 2023; 37:505-506. [PMID: 37815806 DOI: 10.1089/apc.2023.29020.com] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Affiliation(s)
- Jeffrey Laurence
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
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Zhang L, Song Y, Zheng X, Liu Y, Chen H. The experience of healthcare workers to HIV pre-exposure prophylaxis (PrEP) implementation in low- and middle-income countries: a systematic review and qualitative meta-synthesis. Front Public Health 2023; 11:1224461. [PMID: 37693715 PMCID: PMC10484594 DOI: 10.3389/fpubh.2023.1224461] [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: 05/17/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background The effectiveness of pre-exposure prophylaxis has been extensively documented. However, there are substantial gaps between the actual implementation of pre-exposure prophylaxis and the ideal goal, especially in low-and middle-income countries. Healthcare workers play critical roles in the pre-exposure prophylaxis implementation, and they have more multi-level experiences about the barriers of pre-exposure prophylaxis implementation and how to facilitate it. However, the evidence aiming to synthesize their experiences is limited. Objective This study aims to aggregate the healthcare workers' experiences of providing pre-exposure prophylaxis in low-and middle-income countries, and find the barriers, facilitators, and recommendations of pre-exposure prophylaxis implementation. Methods The ENTREQ (Enhancing transparency in reporting the synthesis of qualitative research) statement was used to guide the design and reporting of this qualitative meta-synthesis. A comprehensive search was conducted from inception of databases to 16th March 2023 in four databases: PubMed, CINAHL Plus with Full Text, Embase, Web of Science. The quality appraisal was conducted using the Joanna Briggs Institute Critical Appraisal Checklist. JBI's meta-aggregation approach was used to guide the data extraction and synthesis, and the JBI ConQual approach was used to evaluate the evidence level of the synthesized findings. Results Fourteen articles with good methodological quality were included in this review. A total of 122 findings were extracted and 117 findings with credibility ratings of "unequivocal" or "equivocal" were included in this meta-synthesis. The eligible findings were aggregated into 13 new categories and subsequently developed into 3 synthesized findings: the barriers, facilitators, and recommendations of pre-exposure prophylaxis implementation in low-and middle-income countries. The overall ConQual score of all three synthesized findings was rated as "low." Conclusion This review aggregated the experience of health care workers implementing pre-exposure prophylaxis in low-and middle-income countries and we could focus on the following key points to promote the uptake of pre-exposure prophylaxis: improve knowledge about pre-exposure prophylaxis, create a supportive environment, address medication-related barriers, increase the human resources and financial investments, and diversify the providing models. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/. The protocol of this review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023411604).
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Affiliation(s)
- Liao Zhang
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuqing Song
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xutong Zheng
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ying Liu
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Hong Chen
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Chautrakarn S, Rayanakorn A, Intawong K, Chariyalertsak C, Khemngern P, Stonington S, Chariyalertsak S. PrEP stigma among current and non-current PrEP users in Thailand: A comparison between hospital and key population-led health service settings. Front Public Health 2022; 10:1019553. [PMID: 36530709 PMCID: PMC9755171 DOI: 10.3389/fpubh.2022.1019553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) has demonstrated effectiveness in high-risk populations. PrEP service in Thailand became free of charge under the Universal Health Coverage (UHC) in 2021. The National Health Security Office launched a pilot project in 2020 to ensure sustainable service delivery, and the national monitoring and evaluation (M&E) framework was adopted to evaluate early phase implementation. We carried out a cross-sectional survey as part of the M&E process to investigate PrEP stigma among current and non-current PrEP users from both hospital and Key Population Led Health Services (KPLHS) settings in Thailand. Methods Between August and October 2020, an online cross-sectional survey was conducted. A link for a self-administered questionnaire was distributed to all active PrEP centers and PrEP clients were then recruited by PrEP providers. Descriptive and univariate analysis using Chi-square were applied in the analyses. Attitudes toward PrEP were ranked from the most negative to the most positive. The negative attitude can be interpreted as PrEP stigma. Results This study included 513 PrEP clients (355 from hospitals and 158 from KPLHS). In both settings, respondents' attitudes toward PrEP were generally positive, but some potential stigma was observed. 31.8% of hospital PrEP clients and 9.5% of KPLHS clients agreed that PrEP users should keep their pills hidden from others. Almost half (44.5%) of hospital clients and 18.4% of KPLHS clients agreed that PrEP users are often viewed negatively by society. More than 20% of hospital clients and 12% of KPLHS agreed that PrEP users frequently experience difficulties when their partner/lover/family find out that he or she is on PrEP. Respondents from the hospitals had slightly higher PrEP stigma than those from KPLHS. Conclusions According to our findings, at the policy level, the campaign to provide PrEP education to all groups of people should be continued in order to promote a positive view of PrEP and reduce PrEP-related stigma among the general population, which is critical for successful PrEP implementation.
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Affiliation(s)
| | - Ajaree Rayanakorn
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | - Kannikar Intawong
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Porntip Khemngern
- Division of AIDS and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Scott Stonington
- Departments of Internal Medicine and Anthropology, University of Michigan, Ann Arbor, MI, United States
| | - Suwat Chariyalertsak
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand,*Correspondence: Suwat Chariyalertsak
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