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Gbaja-Biamila T, Obiezu-Umeh C, Nwaozuru U, Rosenberg NE, Igbokwe M, Oladele D, Musa AZ, Idigbe I, Conserve D, Day S, Tahlil K, Ong J, Muessig K, Nkengasong S, Xian H, Tucker JD, Ezechi O, Iwelunmor J. Awareness of, willingness to use, and experiences with Pre-exposure prophylaxis among youth in Nigeria. BMC Health Serv Res 2024; 24:1128. [PMID: 39334111 PMCID: PMC11428911 DOI: 10.1186/s12913-024-11459-1] [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: 02/25/2023] [Accepted: 08/19/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Youth (ages 14-24) in Nigeria have disproportionately high rates of new HIV infection. Pre-exposure prophylaxis could substantially reduce new infections among youth but has not been scaled up. This cross-sectional study aimed to assess Pre-exposure prophylaxis awareness, willingness to use, and prior use of Pre-exposure prophylaxis among youth in Nigeria. METHODS This is a secondary analysis of cross-sectional data from a quasi-experimental pilot study (clinical trial NCT04070287). The analysis focused on Pre-exposure prophylaxis awareness, willingness to use, and prior use among 324 youth recruited between September 2019 to March 2020. Descriptive statistics were calculated as frequencies and percentages for categorical variables and means and standard deviations for continuous variables. RESULTS Of the 324 participants, the mean age and standard deviation were 21.17 (± 2.20) years. The majority were 20-24 years old (75.9%) and male (57.7%). Only 30.7% used condoms consistently over three months. Regarding Pre-exposure prophylaxis awareness and willingness, 62.6% had never heard of Pre-exposure prophylaxis, and 158 (50.1%) reported willingness to use Pre-exposure prophylaxis. Only 10 (3.2%) reported having used Pre-exposure prophylaxis. CONCLUSION Nigerian youth have low awareness of and prior use of Pre-exposure prophylaxis. Given the gap between prior use and willingness to use Pre-exposure prophylaxis, our findings suggest missed opportunities to prevent new HIV infections among youth in Nigeria. Efforts to increase awareness and uptake of Pre-exposure prophylaxis among this population should consider youth-led Pre-exposure prophylaxis outreach efforts and effectively communicate the benefits of Pre-exposure prophylaxis to this population. TRIAL REGISTRATION NCT04070287, the Date of registration of the trial is 20-07-2019.
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Affiliation(s)
- Titilola Gbaja-Biamila
- Washington University in St Louis, St Louis, USA.
- Nigerian Institute of Medical Research, Lagos, Nigeria.
| | | | | | - Nora E Rosenberg
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - David Oladele
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Ifeoma Idigbe
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Suzanne Day
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kadija Tahlil
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason Ong
- Monash University, Melbourne, Australia
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Hong Xian
- Saint Louis University, St Louis, USA
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria
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2
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Folayan MO, Aliyu S, Oginni A, Ezechi O, Kolawole G, Ezeama N, Dadem N, Anenih J, Alagi M, Ekanem E, Afiadigwe E, Aguolu R, Oyebode T, Babalola-Jacobs A, Sagay A, Nweneka C, Kamofu H, Idoko J. Effectiveness of three delivery models for promoting access to pre-exposure prophylaxis in HIV-1 serodiscordant couples in Nigeria. PLoS One 2022; 17:e0268011. [PMID: 35511948 PMCID: PMC9070899 DOI: 10.1371/journal.pone.0268011] [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: 04/30/2020] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of three models for pre-exposure prophylaxis (PrEP) service delivery to HIV-1 serodiscordant couples in Nigeria. METHODS 297 heterosexual HIV-1 serodiscordant couples were recruited into three PrEP delivery models and followed up for 18 months. The models were i) Outpatient clinic model providing PreP in routine outpatient care; ii) Antiretroviral therapy (ART) clinic model providing PrEP in ART clinics; and iii) Decentralized care model providing PrEP through primary and secondary care centres linked to a tertiary care centre. The primary effectiveness endpoint was incident HIV-1 infection. The HIV incidence before and after the study was compared and the incidence rate ratio computed for each model. Survival analysis was conducted, Cox regression analysis was used to compare the factors that influenced couple retention in each of the models. Kaplan-Meier survival analysis was used to estimate the median retention time (in months) of the study participants in each of the study models, and log-rank test for equality of survival functions was conducted to test for significant differences among the three models. RESULTS There was no significant difference (p>0.05) in the couple retention rates among the three models. At months 3, 6 and 9, adherence of the HIV-1-infected partners to ART was highest in the decentralized model, whereas at months 9 and 12, the outpatient model had the highest proportion of HIV-1- uninfected partners adhering to PrEP (p<0.001). The HIV incidence per 100 person-years was zero in the general outpatient clinic and ART clinic models and 1.6 (95% CI: 0.04-9.1) in the decentralized clinic model. The difference in the observed and expected incidence rate was 4.3 (95% CI: 0.44-39.57) for the decentralized clinic model. CONCLUSION Although incidence of HIV seroconversion was highest in the decentralized clinic model, this difference may be due to the higher sexual risk behavior among study participants in the decentralized model rather than the type of service delivery. The study findings imply that any of the models can effectively deliver PrEP services.
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Affiliation(s)
| | - Sani Aliyu
- Dept. of Infectious Diseases, Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Grace Kolawole
- Jos University Teaching Hospital, AIDS Prevention Initiative in Nigeria, Jos, Nigeria
| | - Nkiru Ezeama
- Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nnewi, Nigeria
| | - Nancin Dadem
- Jos University Teaching Hospital, AIDS Prevention Initiative in Nigeria, Jos, Nigeria
| | - James Anenih
- National Agency for the Control of AIDS, Abuja, Nigeria
| | | | - Etim Ekanem
- Department of Obstetrics and Gynaecology, University of Calabar, Calabar, Nigeria
| | - Evaristus Afiadigwe
- Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nnewi, Nigeria
| | - Rose Aguolu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | | | | | | | - Chidi Nweneka
- National Agency for the Control of AIDS, Abuja, Nigeria
| | | | - John Idoko
- Jos University Teaching Hospital, Jos, Nigeria
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Velloza J, Khoza N, Scorgie F, Chitukuta M, Mutero P, Mutiti K, Mangxilana N, Nobula L, Bulterys MA, Atujuna M, Hosek S, Heffron R, Bekker L, Mgodi N, Chirenje M, Celum C, Delany‐Moretlwe S. The influence of HIV-related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study. J Int AIDS Soc 2020; 23:e25463. [PMID: 32144874 PMCID: PMC7060297 DOI: 10.1002/jia2.25463] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/02/2020] [Accepted: 01/27/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Stigma and disclosure concerns have been key barriers to oral pre‐exposure prophylaxis (PrEP) adherence for African adolescent girls and young women (AGYW) in efficacy trials. We aimed to understand the impact of these factors among African AGYW in an open‐label PrEP study. Methods HPTN 082 was an open‐label PrEP study among AGYW (ages 16 to 24) in Harare, Zimbabwe, and Cape Town and Johannesburg, South Africa from 2016 to 2018. Women starting PrEP were randomized to standard adherence support (counselling, two‐way SMS, monthly adherence clubs) or standard support plus drug‐level feedback. Serial in‐depth interviews were conducted among 67 AGYW after 13‐week and 26‐week study visits to explore experiences of stigma, disclosure and PrEP adherence. We analysed data by coding transcripts and memo‐writing and diagramming to summarize themes. Results AGYW described stigma related to sexual activity (e.g. “people say I'm a prostitute”) and being perceived to be living with HIV because of taking antiretrovirals (e.g. “my husband's friends say I'm HIV infected”). Participants who anticipated stigma were reluctant to disclose PrEP use and reported adherence challenges. Disclosure also resulted in stigmatizing experiences. Across all sites, negative descriptions of stigma and disclosure challenges were more common in the first interview. In the second interview, participants often described disclosure as an “empowering” way to combat community‐level PrEP stigma; many said that they proactively discussed PrEP in their communities (e.g. became a “community PrEP ambassador”), which improved their ability to take PrEP and encourage others to use PrEP. These empowering disclosure experiences were facilitated by ongoing HPTN 082 study activities (e.g. counselling sessions, adherence clubs) in which they could discuss PrEP‐related stigma, disclosure and PrEP adherence issues. Conclusions Stigma and disclosure challenges were initial concerns for African AGYW newly initiating PrEP but many were empowered to disclose PrEP use over their first six months of PrEP use, which helped them cope with stigma and feel more able to take PrEP regularly. PrEP programmes can foster disclosure through community and clinic‐based discussion, adherence clubs and activities normalizing sexual behaviour and PrEP use, which can reduce stigma and improve PrEP adherence and thus effectiveness.
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Affiliation(s)
| | - Nomhle Khoza
- Wits Reproductive Health & HIV Institute (Wits RHI)JohannesburgSouth Africa
| | - Fiona Scorgie
- Wits Reproductive Health & HIV Institute (Wits RHI)JohannesburgSouth Africa
| | - Miria Chitukuta
- Clinical Trials Research CentreUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | - Prisca Mutero
- Clinical Trials Research CentreUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | - Kudzai Mutiti
- Clinical Trials Research CentreUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | | | - Lumka Nobula
- Desmond Tutu HIV FoundationCape TownSouth Africa
| | | | | | - Sybil Hosek
- Stroger H. Hospital of Cook CountyChicagoILUSA
| | | | - Linda‐Gail Bekker
- Faculty of Health SciencesInstitute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Nyaradzo Mgodi
- Clinical Trials Research CentreUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | - Mike Chirenje
- Clinical Trials Research CentreUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
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4
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Okoro UJ, Carey KB, Johnson BT, Carey MP, Scott-Sheldon LAJ. Alcohol Consumption, Risky Sexual Behaviors, and HIV in Nigeria: A Meta-Analytic Review. Curr Drug Res Rev 2020; 11:92-110. [PMID: 31875782 DOI: 10.2174/1874473712666190114141157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/29/2018] [Accepted: 01/03/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alcohol consumption is associated with risky sex, which increases the risk of acquiring and transmitting HIV. OBJECTIVE To examine the prevalence of, and associations among alcohol, risky sex, and HIV, in Nigeria. METHODS We searched electronic databases and reviewed reference sections of relevant papers to locate studies that sampled people living in Nigeria and assessed both alcohol and sexual risk behavior. We calculated effect sizes to determine (a) prevalence of alcohol and sex behaviors and (b) associations between alcohol consumption and risky sex, and examined moderators to determine if sample characteristics predicted behavioral or biological outcomes. RESULTS Of the 696 unique records identified, 35 manuscripts reporting on 42 separate studies met the inclusion criteria. Participants in these studies (N = 83,350; M age = 26 years; 48% women; 10% HIV-infected) reported high rates of heavy drinking (63%) and low rates of consistent condom use (24%). One-third of participants (30%) also reported using alcohol before sexual activity. Participants who consumed alcohol were more likely to report sexual activity (OR = 3.66, 95% CI = 3.09, 4.33), multiple partners (OR = 3.22, 95% CI = 2.38, 4.36), and condomless sex or inconsistent use of condoms (OR = 2.30, 95% CI = 1.54, 3.43). CONCLUSION High rates of heavy drinking and low rates of condom use have been well-documented in Nigeria. Results from this meta-analysis can be used to inform critically needed alcohol-related HIV interventions.
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Affiliation(s)
- Uzoamaka J Okoro
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Alpert School of Medicine, Brown University, Providence, RI, United States.,Brown University School of Public Health, Providence, RI, United States
| | - Kate B Carey
- Brown University School of Public Health, Providence, RI, United States
| | - Blair T Johnson
- Department of Psychology, University of Connecticut, Storrs, CT, United States
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Alpert School of Medicine, Brown University, Providence, RI, United States.,Brown University School of Public Health, Providence, RI, United States
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Alpert School of Medicine, Brown University, Providence, RI, United States.,Brown University School of Public Health, Providence, RI, United States
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5
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Emmanuel G, Folayan M, Undelikwe G, Ochonye B, Jayeoba T, Yusuf A, Aiwonodagbon B, Bilali C, Umoh P, Ojemeiri K, Kalaiwo A. Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria. BMC Public Health 2020; 20:69. [PMID: 31941469 PMCID: PMC6964078 DOI: 10.1186/s12889-020-8195-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 01/10/2020] [Indexed: 05/09/2023] Open
Abstract
Background Men who have sex with men (MSM), female sex workers (FSW) have critical needs for effective HIV prevention tools. This study identified perspectives of MSM, FSW and policy makers on the needs for, barriers to, and challenges with pre-exposure HIV prophylaxis (PrEP); and the logistics required to support roll-out of PrEP for MSM and FSW in Nigeria. Methods Qualitative and quantitative data were collected through a cross-sectional study. The quantitative data were collected through an online survey administered to 519 MSM, FSW and transgender respondents. The qualitative data were collected through 22 focus group discussions with 140 MSM and 80 FSW, and a two-day consultative workshop with 65 participants. Two open-ended questions in the online survey were also a source of qualitative data. Results of the quantitative data were reported descriptively; the qualitative data were inductively examined with a content analytic approach to construct descriptive categories. The findings from the quantitative and qualitative responses were triangulated. Results Four hundred and ninety-four (95.2%) online respondents had heard about PrEP through community dialogue (71.3%), and 439 (84.6%) supported its use by MSM and FSW. Fewer than half of the respondents were aware of the clinical care required for PrEP, and misconceptions about PrEP were common. Stated barriers to PrEP uptake were stigma, cost, frequency of HIV counseling and treatment services required, and possible drug-drug interactions. Concerns included possible condom migration, increased risk for sexually transmitted infections and pregnancy for FSW, and poor adherence to medication and hospital schedules. Participants felt that trained peer educators and HIV-test counselors could provide information and refer clients to clinics that provide PrEP. PrEP can be provided through peer-led facilities for MSM and FSW, though its access should be expanded to all persons who are at substantial risk for HIV to prevent negative labeling of PrEP. Public awareness about the use of antiretrovirals for HIV prevention is needed to prevent labeling of PrEP users as being HIV positive. Conclusion Although MSM and FSW are interested in the use of PrEP, numerous individual and structural barriers need to be addressed to facilitate access to it in Nigeria.
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Affiliation(s)
- G Emmanuel
- Heartland Alliance International, Chicago, Nigeria
| | - M Folayan
- New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria. .,Department of Child Dental Health, Obafemi Awolowo University, Ife, Nigeria.
| | - G Undelikwe
- Joint United Nations Programme on HIV/AIDS, Lagos, Nigeria
| | - B Ochonye
- Heartland Alliance International, Lagos, Nigeria
| | - T Jayeoba
- Heartland Alliance International, Lagos, Nigeria
| | - A Yusuf
- Heartland Alliance International, Lagos, Nigeria
| | | | - C Bilali
- Heartland Alliance International, Lagos, Nigeria
| | - P Umoh
- Joint United Nations Programme on HIV/AIDS, Lagos, Nigeria
| | - K Ojemeiri
- Heartland Alliance International, Lagos, Nigeria
| | - A Kalaiwo
- United States Agency for International Development, Abuja, Nigeria
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6
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Characterizing Sociostructural Associations With New HIV Diagnoses Among Female Sex Workers in Cameroon. J Acquir Immune Defic Syndr 2019; 80:e64-e73. [PMID: 30762674 DOI: 10.1097/qai.0000000000001920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Female sex workers (FSW) are disproportionately affected by HIV in Cameroon, with an estimated 23.6% HIV prevalence. Given the unavailability of HIV incidence data, to better understand associations with acquiring HIV we assessed the prevalence and associations with new HIV diagnoses among FSW in Cameroon. METHODS In 2016, FSW were recruited through respondent-driven sampling from 5 cities for a biobehavioral survey. Participants self-reporting living with HIV or with an indeterminate test status were excluded from analysis. New diagnoses were defined as testing HIV-positive when participants self-reported HIV-negative or unknown status. A multivariable modified Poisson regression model was developed to assess determinants of new HIV diagnosis (referent group: HIV-negative) using key covariates; adjusted prevalence ratios (aPR) are reported if statistically significant (P < 0.05). RESULTS Overall 2255 FSW were recruited. Excluding participants who self-reported living with HIV (n = 297) and indeterminate test results (n = 7), 260/1951 (13.3%) FSW were newly diagnosed with HIV. Variables significantly associated with new HIV diagnosis were: no secondary/higher education [aPR: 1.56, 95% confidence interval (CI): 1.12 to 2.15], 5+ dependents compared with none (aPR: 2.11, 95% CI: 1.01 to 4.40), 5+ years involved in sex work compared with <1 year (aPR: 2.84, 95% CI: 1.26 to 6.42), history of incarceration (aPR: 2.13, 95% CI: 1.13 to 3.99), and low social capital (aPR: 1.53, 95% CI: 1.12 to 2.10). Higher monthly income (>250,000 FCFA vs. <50,000 FCFA) was associated with lower prevalence of new HIV diagnosis (aPR: 0.22, 95% CI: 0.05 to 0.86). CONCLUSIONS There are significant sociostructural factors that seem to potentiate risk of HIV infection and delay diagnosis among FSW in Cameroon. Initiatives to build social capital and integrate services such as pre-exposure prophylaxis and HIV self-testing into HIV programs may reduce new infections and decrease time to diagnosis and treatment.
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7
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Sexual practices, sexual behavior and HIV risk profile of key populations in Nigeria. BMC Public Health 2019; 19:1210. [PMID: 31477063 PMCID: PMC6721228 DOI: 10.1186/s12889-019-7553-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. Methods This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. Results The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05–0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02–0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59–9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06–3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey. Conclusion HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups. Electronic supplementary material The online version of this article (10.1186/s12889-019-7553-z) contains supplementary material, which is available to authorized users.
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Reza-Paul S, Lazarus L, Jana S, Ray P, Mugo N, Ngure K, Folayan MO, Durueke F, Idoko J, Béhanzin L, Alary M, Gueye D, Sarr M, Mukoma W, Kyongo JK, Bothma R, Eakle R, Dallabetta G, Presley J, Lorway R. Community Inclusion in PrEP Demonstration Projects: Lessons for Scaling Up. Gates Open Res 2019; 3:1504. [PMID: 31942537 PMCID: PMC6943951 DOI: 10.12688/gatesopenres.13042.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/23/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects attempted to better engage communities and create spaces for community involvement in the planning and roll out of these projects. We briefly describe the community engagement strategies employed by seven Bill & Melinda Gates Foundation-funded PrEP demonstration projects and the lessons these projects offer for community engagement in PrEP implementation.
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Affiliation(s)
- Sushena Reza-Paul
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Ashodaya Samithi, Mysore, India
| | - Lisa Lazarus
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Protim Ray
- Durbar Mahila Samanawaya Committee, Kolkata, India
| | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Florita Durueke
- New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria
| | - John Idoko
- Department of Medicine, University of Jos, Jos, Nigeria
| | - Luc Béhanzin
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Benin
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Benin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada
- Département de médecine sociale et préventive, Université Laval, Quebec, Canada
- Institut national de santé publique du Québec, Quebec, Canada
| | - Daouda Gueye
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation (IRESSEF), Dakar, Senegal
| | | | | | | | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Robyn Eakle
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Robert Lorway
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Reza-Paul S, Lazarus L, Jana S, Ray P, Mugo N, Ngure K, Folayan MO, Durueke F, Idoko J, Béhanzin L, Alary M, Gueye D, Sarr M, Mukoma W, Kyongo JK, Bothma R, Eakle R, Dallabetta G, Presley J, Lorway R. Community Inclusion in PrEP Demonstration Projects: Lessons for Scaling Up. Gates Open Res 2019. [PMID: 31942537 DOI: 10.12688/gatesopenres.13042.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects attempted to better engage communities and create spaces for community involvement in the planning and roll out of these projects. We briefly describe the community engagement strategies employed by seven Bill & Melinda Gates Foundation-funded PrEP demonstration projects and the lessons these projects offer for community engagement in PrEP implementation.
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Affiliation(s)
- Sushena Reza-Paul
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Ashodaya Samithi, Mysore, India
| | - Lisa Lazarus
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Protim Ray
- Durbar Mahila Samanawaya Committee, Kolkata, India
| | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Florita Durueke
- New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria
| | - John Idoko
- Department of Medicine, University of Jos, Jos, Nigeria
| | - Luc Béhanzin
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Benin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Benin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada.,Département de médecine sociale et préventive, Université Laval, Quebec, Canada.,Institut national de santé publique du Québec, Quebec, Canada
| | - Daouda Gueye
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation (IRESSEF), Dakar, Senegal
| | | | | | | | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Robyn Eakle
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Robert Lorway
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Mullens AB, Kelly J, Debattista J, Phillips TM, Gu Z, Siggins F. Exploring HIV risks, testing and prevention among sub-Saharan African community members in Australia. Int J Equity Health 2018; 17:62. [PMID: 29784050 PMCID: PMC5963033 DOI: 10.1186/s12939-018-0772-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background Significant health disparities persist regarding new and late Human Immunodeficiency Virus (HIV) diagnoses among sub-Saharan African (SSA) communities in Australia. Personal/cultural beliefs and practices influence HIV (risk, prevention, testing) within Australia and during visits to home countries. Method A community forum was conducted involving 23 male and female adult African community workers, members and leaders, and health workers; facilitated by cultural workers and an experienced clinician/researcher. The forum comprised small/large group discussions regarding HIV risk/prevention (responses transcribed verbatim; utilising thematic analysis). Results Stigma, denial, social norms, tradition and culture permeated perceptions/beliefs regarding HIV testing, prevention and transmission among African Australians, particularly regarding return travel to home countries. Conclusions International travel as a risk factor for HIV acquisition requires further examination, as does the role of the doctor in HIV testing and Pre-exposure Prophylaxis (PrEP). Further assessment of PrEP as an appropriate/feasible intervention is needed, with careful attention regarding negative community perceptions and potential impacts.
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Affiliation(s)
- Amy B Mullens
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Ipswich Campus, 11 Salisbury Road, Ipswich, Qld 4305, Australia.
| | - Jennifer Kelly
- School of Health and Wellbeing, University of Southern Queensland, Ipswich Campus, 11 Salisbury Road, Ipswich, Qld 4305, Australia
| | - Joseph Debattista
- Queensland Health, Metro North Public Health Unit, Bryden Street, Windsor, Qld 4030, Australia
| | - Tania M Phillips
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Ipswich Campus, 11 Salisbury Road, Ipswich, Qld 4305, Australia
| | - Zhihong Gu
- Ethnic Communities Council of Queensland, PO Box 5916, West End, Qld 4101, Australia
| | - Fungisai Siggins
- Kalpa purru Wirranjarlki, Anyinginyi Health Aboriginal Corporation, 1 Irvine Street, PO Box 40, Tennant Creek, NT, 0861, Australia
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11
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Koechlin FM, Fonner VA, Dalglish SL, O'Reilly KR, Baggaley R, Grant RM, Rodolph M, Hodges-Mameletzis I, Kennedy CE. Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature. AIDS Behav 2017; 21:1325-1335. [PMID: 27900502 PMCID: PMC5378753 DOI: 10.1007/s10461-016-1627-z] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative people to prevent HIV infection. WHO released new guidelines in 2015 recommending PrEP for all populations at substantial risk of HIV infection. To prepare these guidelines, we conducted a systematic review of values and preferences among populations that might benefit from PrEP, women, heterosexual men, young women and adolescent girls, female sex workers, serodiscordant couples, transgender people and people who inject drugs, and among healthcare providers who may prescribe PrEP. A comprehensive search strategy reviewed three electronic databases of articles and HIV-related conference abstracts (January 1990-April 2015). Data abstraction used standardised forms to categorise by population groups and relevant themes. Of 3068 citations screened, 76 peer-reviewed articles and 28 conference abstracts were included. Geographic coverage was global. Most studies (N = 78) evaluated hypothetical use of PrEP, while 26 studies included individuals who actually took PrEP or placebo. Awareness of PrEP was low, but once participants were presented with information about PrEP, the majority said they would consider using it. Concerns about safety, side effects, cost and effectiveness were the most frequently cited barriers to use. There was little indication of risk compensation. Healthcare providers would consider prescribing PrEP, but need more information before doing so. Findings from a rapidly expanding evidence base suggest that the majority of populations most likely to benefit from PrEP feel positively towards it. These same populations would benefit from overcoming current implementation challenges with the shortest possible delay.
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Affiliation(s)
- Florence M Koechlin
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland.
| | - Virginia A Fonner
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Sarah L Dalglish
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kevin R O'Reilly
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Rachel Baggaley
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Robert M Grant
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Michelle Rodolph
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Ioannis Hodges-Mameletzis
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Caitlin E Kennedy
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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12
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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13
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Cáceres CF, Borquez A, Klausner JD, Baggaley R, Beyrer C. Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy. J Int AIDS Soc 2016; 19:21108. [PMID: 27760685 PMCID: PMC5071779 DOI: 10.7448/ias.19.7.21108] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In this article, we present recent evidence from studies focused on the implementation, effectiveness and cost-effectiveness of pre-exposure prophylaxis (PrEP) for HIV infection; discuss PrEP scale-up to date, including the observed levels of access and policy development; and elaborate on key emerging policy and research issues to consider for further scale-up, with a special focus on lower-middle income countries. DISCUSSION The 2015 WHO Early Release Guidelines for HIV Treatment and Prevention reflect both scientific evidence and new policy perspectives. Those guidelines present a timely challenge to health systems for the scaling up of not only treatment for every person living with HIV infection but also the offer of PrEP to those at substantial risk. Delivery and uptake of both universal antiretroviral therapy (ART) and PrEP will require nation-wide commitment and could reinvigorate health systems to develop more comprehensive "combination prevention" programmes and support wider testing linked to both treatments and other prevention options for populations at highest risk who are currently not accessing services. Various gaps in current health systems will need to be addressed to achieve strategic scale-up of PrEP, including developing prioritization strategies, strengthening drug regulations, determining cost and funding sources, training health providers, supporting user adherence and creating demand. CONCLUSIONS The initial steps in the scale-up of PrEP globally suggest feasibility, acceptability and likely impact. However, to prevent setbacks in less well-resourced settings, countries will need to anticipate and address challenges such as operational and health systems barriers, drug cost and regulatory policies, health providers' openness to prescribing PrEP to populations at substantial risk, demand and legal and human rights issues. Emerging problems will require creative solutions and will continue to illustrate the complexity of PrEP implementation.
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Affiliation(s)
- Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru;
| | - Annick Borquez
- Division of Global Public Health, University of California, San Diego, CA, USA
| | - Jeffrey D Klausner
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Rachel Baggaley
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Chris Beyrer
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, USA
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Kalibala S, Woelk GB, Gloyd S, Jani N, Kay L, Sarna A, Okal J, Ndwiga C, Haberland N, Sinai I. Experiences in implementation and publication of operations research interventions: gaps and a way forward. J Int AIDS Soc 2016; 19:20842. [PMID: 27443272 PMCID: PMC4956737 DOI: 10.7448/ias.19.5.20842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION According to UNAIDS, the world currently has an adequate collection of proven HIV prevention, treatment and diagnostic tools, which, if scaled up, can lay the foundation for ending the AIDS epidemic. HIV operations research (OR) tests and promotes the use of interventions that can increase the demand for and supply of these tools. However, current publications of OR mainly focus on outcomes, leaving gaps in reporting of intervention characteristics, which are essential to address for the utilization of OR findings. This has prompted WHO and other international public health agencies to issue reporting requirements for OR studies. The objective of this commentary is to review experiences in HIV OR intervention design, implementation, process data collection and publication in order to identify gaps, contribute to the body of knowledge and propose a way forward to improve the focus on "implementation" in implementation research. DISCUSSION Interventions in OR, like ordinary service delivery programmes, are subject to the programme cycle, which continually uses insights from implementation and the local context to modify service delivery modalities. Given that some of these modifications in the intervention may influence study outcomes, the documentation of process data becomes vital in OR. However, a key challenge is that study resources tend to be skewed towards documentation and the reporting of study outcomes to the detriment of process data, even though process data is vital for understanding factors influencing the outcomes. CONCLUSIONS Interventions in OR should be viewed using the lens of programme evaluation, which includes formative assessment (to determine concept and design), followed by process evaluation (to monitor inputs and outputs) and effectiveness evaluation (to assess outcomes and effectiveness). Study resources should be equitably used between process evaluation and outcome measurement to facilitate inclusion of data about fidelity and dose in publications in order to enable explanation of the relationship between dosing and study outcomes for purposes of scaling up and further refinement through research.
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Affiliation(s)
| | - Godfrey B Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nrupa Jani
- HIVCore/Population Council, Washington, DC, USA
| | | | - Avina Sarna
- HIVCore/Population Council, Washington, DC, USA
| | - Jerry Okal
- HIVCore/Population Council, Washington, DC, USA
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Lessons learned and study results from HIVCore, an HIV implementation science initiative. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.5.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Mugo NR, Ngure K, Kiragu M, Irungu E, Kilonzo N. The preexposure prophylaxis revolution; from clinical trials to programmatic implementation. Curr Opin HIV AIDS 2016; 11:80-6. [PMID: 26575147 PMCID: PMC4900687 DOI: 10.1097/coh.0000000000000224] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW An investment in preexposure prophylaxis (PrEP) delivery must have public health impact in reducing HIV infections. Sustainable delivery of PrEP requires policy, integration of services, and synergy with other existing HIV prevention programs. This review discusses key policy and programmatic considerations for implementation and scale up of PrEP in Africa. RECENT FINDINGS PrEP delivery has been delayed by concerns about adherence and delivery in 'real world' settings. Demonstration projects and clinical service delivery models are providing evidence of PrEP effectiveness with an impact much higher than that found in randomized clinical trials. Data confirm that PrEP uptake, adherence, and retention has been high, more so by persons who perceive themselves at high risk for HIV infection, and PrEP is well tolerated. PrEP delivery is more than dispensation of a pill and programs should address other risk drivers, which differ by population. In Africa, barriers to PrEP uptake and adherence include stigma among MSM and low HIV risk perception among young women. Additional data have provided insight into optimal points of service delivery, provider training requirements and quality assurance needs. Of the 2 million new HIV infections in 2014, 70% were in Africa. PrEP use is not lifelong, and use limited to periods of risk may be both effective and cost-effective for the continent. SUMMARY HIV prevention programs should determine strategies to identify those at substantial risk for HIV infection, formulate and deliver PrEP in combination with interventions that target social drivers of HIV vulnerability specific to each population. Policy guidance for optimal combination of interventions and service delivery avenues, clinical protocols, health infrastructure requirements are required. Cost-effectiveness and efficiency data are essential for policy guidance to navigate ethical questions over use of antiretroviral therapy for HIV-negative individuals when treatment coverage has not been attained in many parts of Africa. Countries need to invest in purposeful advocacy at both local and global forums. Failure to implement PrEP will be a failure to protect future generations.
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Affiliation(s)
- Nelly R Mugo
- aCenter for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya bDepartment of Global Health, University of Washington, Seattle, WA, USA cPartners in Health Research and Development, Thika dDepartment of Public Health, Jomo Kenyatta University of Agriculture and Technology, Juja eLVCT-Health fNational AIDS Control Council, Nairobi, Kenya
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Haire BG. Preexposure prophylaxis-related stigma: strategies to improve uptake and adherence - a narrative review. HIV AIDS (Auckl) 2015; 7:241-9. [PMID: 26508889 PMCID: PMC4610795 DOI: 10.2147/hiv.s72419] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite high levels of efficacy, the implementation of preexposure prophylaxis (PrEP) as a strategy to prevent new HIV infection has been slow. Studies show that PrEP works so long as it is taken, making adherence one of the great challenges of effective PrEP implementation alongside issues of access and uptake. Given that effective PrEP use requires ongoing self-administration of pills by people at high risk of HIV acquisition, it is a strategy best understood not as simply biomedical, but as biobehavioral or biopsychosocial, meaning that that social, psychological, cultural, and structural factors all contribute to the success or failure of the intervention. The willingness of people at risk of HIV to take up and adhere to PrEP depends greatly upon social understandings - whether it is seen as effective, as a healthy option, and a socially acceptable strategy for preventing HIV. Stigma - unfavorable associations - can negatively influence the implementation of PrEP. Because it is associated with high-risk sexual activity, PrEP risks multiple stigmas that can differ according to specific cultural conditions. This includes the stigma of being related to HIV (which may also relate to other stigmas, such as homosexuality, sex work, and/or drug use) and the stigma of PrEP being an alternative to condoms (as condom use is associated with responsible sexual activity). PrEP-related stigma has emerged as a significant social harm that can arise from PrEP research participation, reported by trial participants from a range of different trial sites, different trial populations, and spanning different continents. Social marketing needs to redress PrEP-related stigmas through health promotion campaigns aimed at clinicians, HIV-affected communities, and people at high risk of HIV who might benefit from PrEP access. PrEP access needs to be reframed as a positive and responsible option to help people remain HIV-negative.
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Affiliation(s)
- Bridget G Haire
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
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Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria. AIDS 2015; 29:2035-44. [PMID: 26355574 PMCID: PMC4568890 DOI: 10.1097/qad.0000000000000798] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria. Design: Mathematical and cost modelling. Methods: A deterministic model of HIV-1 transmission within a cohort of serodiscordant couples and to/from external partners was parameterized using data from Nigeria and other African settings. The impact and cost-effectiveness were estimated for condom promotion, PrEP and/or TasP, compared with a baseline where antiretroviral therapy (ART) was offered according to 2010 national guidelines (CD4+ <350 cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4+ <350 cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective. Results: Substantial benefits came from scaling up ART to all HIV-positive partners according to 2010 national guidelines, with additional smaller benefits of providing TasP, PrEP or condom promotion. Compared with a baseline of offering ART to all HIV-positive partners at the 2010 national guidelines, condom promotion was the most cost-effective strategy [US $1206/disability-adjusted-life-year (DALY)], the next most cost-effective intervention was to additionally give TasP to HIV-positive partners (incremental cost-effectiveness ratio US $1607/DALY), followed by additionally giving PrEP to HIV-negative partners until their HIV-positive partners initiate ART (US $7870/DALY). When impact was measured in terms of infections averted, PrEP with condom promotion prevented double the number of infections as condom promotion alone. Conclusions: The first priority intervention for serodiscordant couples in Nigeria should be scaled up ART access for HIV-positive partners. Subsequent incremental benefits are greatest with condom promotion and TasP, followed by PrEP.
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