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Sardarzehi R, Seyed Alinaghi SA, Kianimoghadam AS, Masjedi-Arani A, Bakhtiari M, Dehghan Manshadi SA, Mohraz M. An empirical test of the chronic illness quality of life model: the prominent role of barrier to health care and social support. AIDS Care 2024:1-10. [PMID: 39047158 DOI: 10.1080/09540121.2024.2378375] [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: 10/20/2023] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
The Chronic Illness Quality of Life (CIQOL) model highlights satisfaction with life in individuals with a chronic illness (i.e., HIV-related diseases) determined by factors such as barriers to health care, AIDS-related discrimination, social support, physical well-being, and engagement coping. Despite the empirical evidence supporting the CIQOL model, its validation in the Iranian population has not yet been conducted. This study aimed to validate the CIQOL model among Iranian patients with HIV-related diseases. Four hundred fifty-two patients completed the study questionnaire including Barriers to Care Scale (BACS), Satisfaction with Life Scale (SWLS), Chronic Illness Anticipated Stigma Scale (CIASS), Social Provision Scale (SPS), The Functional Assessment of Human Immunodeficiency Virus Infection (FAHI), and the Brief COPE Scale. Structural equation modeling (SEM) was used to analyze the data. The assumed model demonstrated an acceptable level of fit to study data. Findings showed that this model could explain 39% of variances in life satisfaction in Iranian patients with HIV-related diseases. Therefore, in psychological interventions aimed at enhancing life satisfaction, the CIQOL model factors especially barriers to health care and social support can be taken into consideration.
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Affiliation(s)
- Reyhaneh Sardarzehi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Seyed Alinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sam Kianimoghadam
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Masjedi-Arani
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Bakhtiari
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Department of Infectious Diseases and Tropical Medicine, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Hu S, Jing F, Fan C, Dai Y, Xie Y, Zhou Y, Lv H, He X, Wu D, Tucker JD, Tang W. Social network strategies to distribute HIV self-testing kits: a global systematic review and network meta-analysis. J Int AIDS Soc 2024; 27:e26342. [PMID: 39048927 PMCID: PMC11269052 DOI: 10.1002/jia2.26342] [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: 11/06/2023] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST). METHODS Using search terms related to social network interventions and HIVST, we searched five databases for trials published between 1st January 2010 and 30th June 2023. Outcomes included uptake of HIV testing, HIV prevalence and linkage to antiretroviral therapy (ART) or HIV care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI). RESULTS Among the 4496 manuscripts identified, 39 studies fulfilled the inclusion criteria, including one quasi-experimental study, 22 randomized controlled trials and 16 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 16 studies) and peer educators (distributed to unknown peers, 8 studies). Among social networks, simulating the possibilities of ranking position, peer distribution had the highest uptake of HIV testing (84% probability), followed by partner distribution (80% probability) and peer educator distribution (74% probability). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.76, 95% CI 1.50-2.07, 10 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. DISCUSSION All of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Linkage to ART or HIV care remained comparable to facility-based testing across the three HIVST distribution strategies. CONCLUSIONS Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally. PROSPERO NUMBER CRD42022361782.
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Affiliation(s)
- Siyue Hu
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- School of Public HealthSouthern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
| | - Fengshi Jing
- Faculty of Data ScienceCity University of MacauTaipaChina
| | - Chengxin Fan
- University of North Carolina Project – ChinaGuangzhouChina
- School of Public HealthNanjing Medical UniversityNanjingChina
| | - Yifan Dai
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- School of Public HealthSouthern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke‐NUS Medical SchoolSingapore
| | - Yi Zhou
- Zhuhai Center for Diseases Control and PreventionZhuhaiChina
| | - Hang Lv
- Zhuhai Center for Diseases Control and PreventionZhuhaiChina
| | - Xi He
- Zhuhai Xutong Voluntary Services CenterZhuhaiChina
| | - Dan Wu
- University of North Carolina Project – ChinaGuangzhouChina
- School of Public HealthNanjing Medical UniversityNanjingChina
- London School of Hygiene and Tropical MedicineLondonUK
| | - Joseph D. Tucker
- University of North Carolina Project – ChinaGuangzhouChina
- London School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
- University of North Carolina Project – ChinaGuangzhouChina
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Mpirirwe R, Mujugira A, Walusaga H, Ayebare F, Musanje K, Ndugga P, Muhumuza C, Nangendo J, Semitala FC, Kyambadde P, Kalyango J, Kiragga A, Karamagi C, Kamya MR, Armstrong-Hough M, Katahoire AR. Perspectives of female sex workers on HIV pre-exposure prophylaxis delivery in Uganda: A qualitative study. RESEARCH SQUARE 2024:rs.3.rs-4115528. [PMID: 38562811 PMCID: PMC10984088 DOI: 10.21203/rs.3.rs-4115528/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background HIV pre-exposure prophylaxis (PrEP) is underutilized by cisgender female sex workers (FSW) despite its proven effectiveness. This study aimed to understand the experiences of FSW with PrEP services in Uganda to inform HIV programming for this key population. Methods We conducted qualitative interviews with 19 FSW between June and July 2022 at the Most at Risk Populations Initiative clinic, Mulago Hospital, Kampala, to explore experiences with accessing PrEP Indepth interviews explored: (1) descriptions of where and how PrEP was obtained; (2) perspectives on current approaches for accessing PrEP; and (3) individual encounters with PrEP services. Data were analyzed through inductive thematic analysis. Results Three key themes emerged for FSW perspectives on PrEP service delivery. FSW highlighted the positive impact of a welcoming clinic environment, which motivated FSW to initiate PrEP and fostered a sense of connectedness within their community. They also reported feeling accepted, secure, and free from prejudice when accessing PrEP through facility-based services. The second explores the obstacles faced by FSW, such as lengthy wait times at clinics, inadequate provider support, and lack of sensitivity training which hindered their access to PrEP The third sheds light on how HIV-related stigma negatively impacted the delivery of community-based PrEP for FSW. While community-based distribution offered convenience and helped mitigate stigma, clinic-based care provided greater anonymity and was perceived as offering higher-quality care. Overall, FSWs emphasized the critical role of friendly healthcare providers, social support, and non-stigmatizing environments in promoting successful utilization of PrEP. Conclusion The study findings offer insights that can support HIV programs in optimizing PrEP delivery for FSW. Establishing easily accessible drug pick-up locations, prioritizing privacy, addressing and improving health workers' attitudes, and providing regular reminders could enhance PrEP access for FSW and decrease HIV acquisition.
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Hu S, Jing F, Fan C, Dai Y, Xie Y, Zhou Y, Lv H, He X, Wu D, Tucker JD, Tang W. Social Network Strategies to Distribute HIV Self-testing Kits: A Global Systematic Review and Network Meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.05.23298135. [PMID: 37986939 PMCID: PMC10659482 DOI: 10.1101/2023.11.05.23298135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Introduction Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST). Methods Using search terms related to social network interventions and HIVST, we searched five databases for trials published between January 1st, 2010, and June 30th, 2023. Outcomes included uptake of HIV testing, HIV seroconversion, and linkage to antiretroviral therapy (ART) or HIV Care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI). Results and discussion Among the 3,745 manuscripts identified, 33 studies fulfilled the inclusion criteria, including one quasi-experimental study, 17 RCTs and 15 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 10 studies), and peer educators (distributed to unknown peers, 8 studies). The results showed that all of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Among social networks, peer distribution had the highest uptake of HIV testing (79% probability, SUCRA 0.92), followed by partner distribution (72% probability, SUCRA 0.71), and peer educator distribution (66% probability, SUCRA 0.29). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.45, 95% CI 1.05-2.02, 7 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. Linkage to ART or HIV Care remained comparable to facility-based testing across the three HIVST distribution strategies. Conclusions Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally.PROSPERO Number: CRD42022361782.
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Affiliation(s)
- Siyue Hu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Fengshi Jing
- Faculty of Data Science, City University of Macau, Taipa, Macao SAR, China
| | - Chengxin Fan
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Dai
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Hang Lv
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project – China, Guangzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D. Tucker
- University of North Carolina Project – China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project – China, Guangzhou, China
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Logie CH, Okumu M, Berry I, Hakiza R, Baral SD, Musoke DK, Nakitende A, Mwima S, Kyambadde P, Loutet M, Batte S, Lester R, Neema S, Newby K, Mbuagbaw L. Findings from the Tushirikiane mobile health (mHealth) HIV self-testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda. J Int AIDS Soc 2023; 26:e26185. [PMID: 37850816 PMCID: PMC10583643 DOI: 10.1002/jia2.26185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Urban refugee youth remain underserved by current HIV prevention strategies, including HIV self-testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could increase HIV testing uptake and HIV status knowledge among refugee youth in Kampala, Uganda. METHODS We conducted a three-arm pragmatic controlled trial across five informal settlements grouped into three sites in Kampala from 2020 to 2021 with peer-recruited refugee youth aged 16-24 years. The intervention was HIVST and HIVST + mHealth (HIVST with bidirectional SMS), compared with standard of care (SOC). Primary outcomes were self-reported HIV testing uptake and correct status knowledge verified by point-of-care testing. Some secondary outcomes included: depression, HIV-related stigma, and adolescent sexual and reproductive health (SRH) stigma at three time points (baseline [T0], 8 months [T1] and 12 months [T2]). We used generalized estimating equation regression models to estimate crude and adjusted odds ratios comparing arms over time, adjusting for age, gender and baseline imbalances. We assessed study pragmatism across PRECIS-2 dimensions. RESULTS We enrolled 450 participants (50.7% cisgender men, 48.7% cisgender women, 0.7% transgender women; mean age: 20.0, standard deviation: 2.4) across three sites. Self-reported HIV testing uptake increased significantly from T0 to T1 in intervention arms: HIVST arm: (27.6% [n = 43] at T0 vs. 91.2% [n = 135] at T1; HIVST + mHealth: 30.9% [n = 47] at T0 vs. 94.2% [n = 113] at T1]) compared with SOC (35.5% [n = 50] at T0 vs. 24.8% [ = 27] at T1) and remained significantly higher than SOC at T2 (p<0.001). HIV status knowledge in intervention arms (HIVST arm: 100% [n = 121], HIVST + mHealth arm: 97.9% [n = 95]) was significantly higher than SOC (61.5% [n = 59]) at T2. There were modest changes in secondary outcomes in intervention arms, including decreased depression alongside increased HIV-related stigma and adolescent SRH stigma. The trial employed both pragmatic (eligibility criteria, setting, organization, outcome, analysis) and explanatory approaches (recruitment path, flexibility of delivery flexibility, adherence flexibility, follow-up). CONCLUSIONS Offering HIVST is a promising approach to increase HIV testing uptake among urban refugee youth in Kampala. We share lessons learned to inform future youth-focused HIVST trials in urban humanitarian settings.
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Affiliation(s)
- Carmen H. Logie
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoOntarioCanada
- Women's College Research InstituteWomen's College HospitalTorontoOntarioCanada
- United Nations University Institute for Water, Environment & HealthHamiltonOntarioCanada
- Centre for Gender & Sexual Health EquityVancouverBritish ColumbiaCanada
| | - Moses Okumu
- School of Social WorkUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
- School of Social SciencesUganda Christian UniversityMukonoUganda
| | - Isha Berry
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID)KampalaUganda
| | - Stefan D. Baral
- Johns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | | | - Simon Mwima
- School of Social WorkUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
- National AIDS and STI Control Programme, Ministry of HealthKampalaUganda
| | - Peter Kyambadde
- National AIDS and STI Control Programme, Ministry of HealthKampalaUganda
- Most at Risk Population InitiativeMulago HospitalKampalaUganda
| | - Miranda Loutet
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy (OGERA Uganda)KampalaUganda
| | - Richard Lester
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Stella Neema
- Department of Sociology and AnthropologyMakerere UniversityKampalaUganda
| | - Katie Newby
- Centre for Research in Psychology and Sport SciencesSchool of Life and Medical SciencesUniversity of HertfordshireHatfieldUK
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
- Department of AnesthesiaMcMaster UniversityHamiltonOntarioCanada
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
- Biostatistics Unit, Father Sean O'Sullivan Research CentreSt Joseph's HealthcareHamiltonOntarioCanada
- Centre for Development of Best Practices in Health (CDBPH)Yaoundé Central HospitalYaoundéCameroon
- Division of Epidemiology and BiostatisticsDepartment of Global HealthStellenbosch UniversityCape TownSouth Africa
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Green HD, Grant JD, Henschel B, Johnson L, Wei X, Wagner KD. Characteristics of Individuals Seen as Sources of Social Support in Populations at Increased Risk for HIV. AIDS Behav 2023; 27:3447-3459. [PMID: 37052786 DOI: 10.1007/s10461-023-04059-3] [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: 03/31/2023] [Indexed: 04/14/2023]
Abstract
Access to social support from one's social network can serve as a protective factor against HIV infection; however, research exploring the availability of support in diverse populations that include high proportions of people at increased risk for HIV and the characteristics of network members associated with access to such support is limited. Multi-level dyadic analyses of social network data collected from women at risk for HIV and their network members reveal which individual and relationship characteristics of network members are associated with providing emotional, material, and/or health informational support. Results indicate that access to all three types of support was associated with a network member being a friend, a member of a participant's 'core' group, someone whose opinion matters to the respondent, and the respondent trusting them. These findings have implications for interventions designed to increase access to support among individuals at risk for HIV.
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Affiliation(s)
- Harold D Green
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA.
- Department of Applied Health Science, Indiana University School of Public Health, 809 E. 9th St., Room 201, Bloomington, IN, 47405, USA.
| | - Jeffrey D Grant
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Beate Henschel
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Laura Johnson
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | - Xing Wei
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | - Karla D Wagner
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
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Arinaitwe B, Ariho P, Naturinda CH, Byoleko B, Base A, Atwijukiire H, Matavu H, Kabami J, Obua C, Wakida EK, Otwine A. Enrollment and retention of female sex workers in HIV care in health facilities in Mbarara city. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1089663. [PMID: 36743824 PMCID: PMC9890177 DOI: 10.3389/frph.2022.1089663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023] Open
Abstract
Background Sex work is a global driver of the HIV epidemic, and the risk of acquiring HIV is 13 times higher for female sex workers (FSWs) compared to the general population. The enrollment and retention of FSWs in HIV care is a challenge and has been a major contributing factor to increased new HIV infections. Methods We conducted a qualitative study among 30 FSWs and 21 healthcare workers (HCWs) working in antiretroviral therapy (ART) clinics at the selected three primary health facilities in Mbarara City, Southwestern Uganda. The study participants were enrolled by both purposive and snowball sampling techniques. We obtained informed consent from all the participants, and data were collected using in-depth interviews and thematically analyzed. Results Three themes emerged as facilitators toward enrollment and retention of FSWs into HIV care, namely, (1) good health living, (2) receptive HCWs and availability of health services, and (3) community outreach services and peer support. The barriers are summarized into four major themes: (1) stigma, community discrimination, and beliefs; (2) social obstacles; (3) adverse effects of ART; and (4) inadequate services at the health facilities. Conclusion FSWs are challenged by unsupportive environments and communities where they live and work, which hinders their enrollment and retention in HIV care. Creating awareness of the utilization of HIV care services and extending such services to hotspot communities could enhance the response of HIV-positive FSWs to ART.
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Affiliation(s)
- Bridget Arinaitwe
- Department of Nursing Science, Bishop Stuart University, Mbarara, Uganda
| | - Philbert Ariho
- Department of Nursing Science, Bishop Stuart University, Mbarara, Uganda
| | | | - Brian Byoleko
- Department of Nursing Science, Bishop Stuart University, Mbarara, Uganda
| | - Anitah Base
- Department of Nursing Science, Bishop Stuart University, Mbarara, Uganda
| | | | - Hariat Matavu
- Department of Public Health and Biomedical Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Jane Kabami
- Department of Nursing, Kabale University, Kabale, Uganda
| | - Celestine Obua
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K. Wakida
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Anne Otwine
- Department of Public Health and Biomedical Sciences, Bishop Stuart University, Mbarara, Uganda
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McGowan M, Casmir E, Wairimu N, Mogere P, Jahn A, Ngure K, Ortblad KF, Roche SD. Assessing young Kenyan women's willingness to engage in a peer-delivered HIV self-testing and referral model for PrEP initiation: A qualitative formative research study. Front Public Health 2022; 10:932948. [PMID: 36276357 PMCID: PMC9583529 DOI: 10.3389/fpubh.2022.932948] [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: 04/30/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but uptake remains low, especially among adolescent girls and young women (AGYW) in Kenya. A model in which trained AGYW using PrEP deliver HIV self-tests to their close friends and refer them to PrEP may help increase PrEP uptake in this population. To understand AGYW's potential willingness to engage in such a model, we conducted a qualitative formative study in Kenya. Method We conducted semi-structured in-depth interviews (IDIs) with AGYW (16 to 24 years) in Kiambu County who were determined at risk of HIV acquisition. We purposively recruited "PrEP-naïve" (no prior PrEP use) and "PrEP-experienced" AGYW who used PrEP for at least 1 month within the previous year. We solicited perspectives on initiating/engaging in conversations about HIV risk and PrEP, distributing/receiving HIV self-test kits, and referring/following through on a referral to clinic-based HIV services. We analyzed verbatim transcripts using rapid qualitative analysis and a combination of inductive and deductive approaches, with the latter informed by the Integrated Behavior Model (IBM). Results From August to December 2020, we conducted 30 IDIs: 15 with PrEP-experienced and 15 with PrEP-naïve AGYW. Participants' median age was 20 [interquartile range (IQR): 20-22]. Overall, most participants anticipated that they would be willing to engage in this model. PrEP-experienced AGYW emphasized the salience of their concerns about friends' HIV risk behaviors, with several noting that they are already in the habit of discussing PrEP with friends. Many additionally expressed positive attitudes toward the proposed target behaviors, perceived these to be normative among AGYW, and expressed confidence in their ability to carry out the behaviors with proper support. Although few participants had HIVST experience, nearly all anticipated they would be able to use an HIV self-test kit correctly if provided instruction. Conclusion The Kenyan AGYW who participated in this study generally anticipated that they would be willing to engage in a formal peer PrEP referral model enhanced with peer-delivered HIV self-tests. Future research is needed to pilot test this model to determine its acceptability, feasibility, and effect on HIVST and PrEP uptake within this population.
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Affiliation(s)
- Maureen McGowan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany,*Correspondence: Maureen McGowan
| | | | - Njeri Wairimu
- Partners in Health and Research Development, Thika, Kenya
| | - Peter Mogere
- Partners in Health and Research Development, Thika, Kenya
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Katrina F. Ortblad
- Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Stephanie D. Roche
- Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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