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Wong CM, Munthali T, Mangunje FG, Katoka ML, Burke HM, Musonda B, Musonda M, Todd CS. Creating allies: qualitative exploration of young women's preferences for PrEP methods and parents' role in PrEP uptake and user support in urban and rural Zambia. BMC Womens Health 2024; 24:71. [PMID: 38273282 PMCID: PMC10809647 DOI: 10.1186/s12905-024-02913-7] [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: 05/11/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Zambian adolescent girls and young women (AGYW) have high HIV incidence and face barriers to the use of pre-exposure prophylaxis (PrEP). Parental support improves PrEP use and adherence in some settings, but negative parental attitudes toward HIV prevention may inhibit engagement with AGYW. We explored perceptions of future PrEP methods among AGYW and parents and parent-youth engagement on HIV prevention and PrEP use. METHODS We conducted a qualitative descriptive study among AGYW and parents of AGYW in five provinces in Zambia in September-October 2021. We conducted 10 focus group discussions (FGDs) and four in-depth interviews (IDIs) with AGYW participants (n = 87) and seven FGDs and four IDIs among parents of AGYW (n = 62). All FGDs and IDIs were audio-recorded, transcribed verbatim, and analyzed to identify qualitative themes. RESULTS Most AGYW participants preferred the discreet nature and longer duration of injectable PrEP compared to the PrEP ring and oral PrEP. Many AGYWs reported inability to disclose PrEP use to their parents due to lack of parental support based on cultural taboos against premarital sex. Nevertheless, AGYW participants said they would like to talk to their parents about PrEP so their parents could support their use. Many parents also described difficulties discussing PrEP with their daughters because of cultural and religious beliefs about abstinence from sex before marriage. However, parents acknowledged that the threat of HIV is real and said they need PrEP knowledge and guidance on speaking with their children about HIV prevention and PrEP. CONCLUSIONS Although many parents are currently not playing a role in daughters' decisions about PrEP use, both parents and AGYW are willing to engage with each other on HIV prevention issues. To foster parent-child engagement, HIV prevention programs should not only provide information about PrEP but also address social norms that impede discussion of HIV prevention and equip both parents and AGYW with skills and support for such conversations. Community sensitization is also needed as new PrEP products are introduced, to create an enabling environment for parent-child engagement by increasing awareness, countering misconceptions, and reducing stigma.
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Affiliation(s)
- Christina Misa Wong
- Global Health & Population, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | - Tendai Munthali
- Ministry of Health, Government of the Republic of Zambia, Ndeke House, Haile Selassie Avenue, P.O. Box 30205, Lusaka, Zambia
| | - Featherstone G Mangunje
- FHI 360 Zambia, Tiyende Pamodzi Road, Off Nangwenya Road, Farmers Village, Showgrounds Area, P.O. Box 320303, Lusaka, 10101, Zambia
| | - Mercy L Katoka
- FHI 360 Zambia, Tiyende Pamodzi Road, Off Nangwenya Road, Farmers Village, Showgrounds Area, P.O. Box 320303, Lusaka, 10101, Zambia
| | - Holly M Burke
- Reproductive, Maternal, Newborn, and Child Health, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Bupe Musonda
- Ministry of Health, Government of the Republic of Zambia, Ndeke House, Haile Selassie Avenue, P.O. Box 30205, Lusaka, Zambia
| | - Musonda Musonda
- United States Agency for International Development (USAID), Embassy of the United States of America, Subdivision 694/Stand 100 Ibex Hill Road, P.O. Box 320373, Lusaka, 10101, Zambia
| | - Catherine S Todd
- Global Health & Population, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
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Subramanian S, Namusoke-Magongo E, Edwards P, Atujuna M, Chimulwa T, Dow D, Jalil E, Torbunde N, Agot K, Arinaitwe I, Beizer J, Chelwa N, Mbalinda SN, Miti S, Mwangwa F. Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection: A Review of Models and Actions for Implementation. AIDS Behav 2023; 27:50-63. [PMID: 35841465 PMCID: PMC9287816 DOI: 10.1007/s10461-022-03787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 11/02/2022]
Abstract
Integrated service delivery, providing coordinated services in a convenient manner, is important in HIV prevention and treatment for adolescents as they have interconnected health care needs related to HIV care, sexual and reproductive health and disease prevention. This review aimed to (1) identify key components of adolescent-responsive integrated service delivery in low and middle-income countries, (2) describe projects that have implemented integrated models of HIV care for adolescents, and (3) develop action steps to support the implementation of sustainable integrated models. We developed an implementation science-informed conceptual framework for integrated delivery of HIV care to adolescents and applied the framework to summarize key data elements in ten studies or programs across seven countries. Key pillars of the framework included (1) the socioecological perspective, (2) community and health care system linkages, and (3) components of adolescent-focused care. The conceptual framework and action steps outlined can catalyze design, implementation, and optimization of HIV care for adolescents.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | | | - Patrick Edwards
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Millicent Atujuna
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | | | - Dorothy Dow
- Duke Global Health Institute, Durham, NC, USA
| | | | | | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | | | - Jenny Beizer
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | | | | | - Sam Miti
- Copperbelt University School of Medicine, Ndola, Zambia
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Atujuna M, Tucker J, Crooks N, Zanoni B, Donenberg GR. Disseminating Evidence-Based Interventions for Adolescent HIV Treatment and Prevention in Sub-Saharan Africa. AIDS Behav 2022; 27:64-72. [PMID: 36166109 PMCID: PMC9514160 DOI: 10.1007/s10461-022-03794-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
Over two-thirds of adolescents living with HIV worldwide reside in sub-Saharan Africa (SSA). Despite widespread availability and access to evidence-based HIV prevention and treatment, dissemination has been inadequate. This commentary distinguishes between implementation and dissemination, reflecting on the unique barriers to dissemination of evidence-based programs in SSA. We present a seven-strategy blueprint developed by United States Agency for International Development (USAID) that emphasizes targeted communication about research findings. Two case studies from the Adolescent HIV Implementation Science Alliance are presented to illustrate the value of planning for dissemination. We propose recommendations to strengthen dissemination recognizing that these may not be possible or appropriate in all situations, including developing a plan early in the process, engaging a dissemination technical team for support, the application of methodological rigor and theory to inform dissemination, active involvement of youth voices and digital tools to maximize message reach, and a keen recognition of evolving contexts and shifting priorities in order to nimbly tailor messages as needed.
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Affiliation(s)
- Millicent Atujuna
- Desmond Tutu HIV Centre, Faculty of Health Sciences, School of Medicine, University of Cape Town, Level 1, Wernher Beit North Building, Cape Town, 7505, South Africa.
| | - Joseph Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Natasha Crooks
- Department of Human Development and Nursing Science, University of Illinois at Chicago, Chicago, USA
| | - Brian Zanoni
- Departments of Medicine and Paediatric Infectious Diseases, Emory University School of Medicine, Atlanta, USA
| | - Geri R Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science (CDIS), University of Illinois at Chicago, Chicago, USA
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Duby Z, Bunce B, Fowler C, Jonas K, Govindasamy D, Wagner C, Mangoale K, Ambrose A, Mathews C. Adaptation and Resilience: Lessons Learned From Implementing a Combination Health and Education Intervention for Adolescent Girls and Young Women in South Africa During the COVID-19 Pandemic. FRONTIERS IN HEALTH SERVICES 2022; 2:903583. [PMID: 36925833 PMCID: PMC10012768 DOI: 10.3389/frhs.2022.903583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022]
Abstract
The COVID-19 pandemic has been associated with reduced access to health services and worsening health outcomes for HIV and sexual and reproductive health (SRH). Through the analysis of data from an evaluation study of a combination intervention for adolescent girls and young women (AGYW) in South Africa, we sought to examine the way in which implementation and service provision were impacted by the COVID-19 pandemic and related restrictions, describing the adaptation implementers made to respond to this context. The intervention was implemented from 2019 in South African districts identified as high priority, given the high rates of HIV and teenage pregnancy amongst AGYW. The South African government introduced the first COVID-19 lockdown in March 2020. We conducted in-depth interviews with 38 intervention implementers in the period from November 2020 to March 2021. Respondents described various ways in which the COVID-19 pandemic and related restrictions had limited their ability to implement the intervention and provide services as planned. As a result, AGYW intervention beneficiary access to SRH and psychosocial services was disrupted. Implementers described several ways in which they attempted to adapt to the pandemic context, such as offering services remotely or door-to-door. Despite attempts to respond to the context and adapt services, overall COVID-19 negatively affected implementation and service provision, and heightened issues around community acceptability of the programs. Our findings can help to inform efforts to reduce health service disruption, increase health system resilience, and ensure continuous SRH service provision to AGYW in times of pandemics and other crises.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, 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, Cape Town, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Colleen Wagner
- NACOSA (Networking HIV/AIDS Community of South Africa), Cape Town, South Africa
| | - Kgahliso Mangoale
- NACOSA (Networking HIV/AIDS Community of South Africa), Cape Town, South Africa
| | - Anthony Ambrose
- NACOSA (Networking HIV/AIDS Community of South Africa), Cape Town, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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