Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia.
Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia.
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DOI：
10.3389/frph.2022.1048702
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发表时间：
2022
影响因子：
--
通讯作者：
O'Malley, Gabrielle
中科院分区：
文献类型：
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作者：
Barnabee, Gena;O'Bryan, Gillian;Ndeikemona, Lylie;Billah, Idel;Silas, Lukas;Morgan, Karie L;Shulock, Katherine;Mawire, Susan;MacLachlan, Ellen;Nghipangelwa, Josua;Muremi, Elizabeth;Ensminger, Alison;Forster, Norbert;O'Malley, Gabrielle
尽管以社区为基础的方法有可能增加青春期女孩和年轻妇女（AGYW）获得暴露前预防（PrEP）的机会，但关于它们是否以及如何改善PrEP持续性的证据有限。我们比较了在纳米比亚通过社区和混合模式接受服务的AGYW与基于设施的服务之间的PrEP持久性。随后，我们确定了潜在的机制，以解释如何以及为什么社区和混合模型实现（或不）提高持久性，为进一步的服务提供创新提供信息。收集了纳米比亚霍马斯地区两年多来向AGYW提供PrEP服务的数据。我们使用Kaplan-Meier分析来估计开始后超过三个月的PrEP持续性的生存曲线，并报告一个月和三个月的累积持续性概率。持续性定义为开始后三个月内使用任何PrEP，随后在三个月访视时补充PrEP或之前规定的供应至少30天。访谈进行了28 AGYW和19个供应商，并使用演绎归纳的主题方法进行分析。从2017年10月到2019年9月，372名（18.7%）AGYW通过设施模式获得服务，302名（15.1%）通过社区模式获得服务，1，320名（66.2%）通过混合模式获得服务。在社区模型中，一个月和三个月的PrEP持续性分别为41.2%和34.9%，在混合模型中分别为6.2%和4.8%，而在设施模型中分别为36.8%和26.7%。在社区和混合模型中，我们确定了与PrEP持久性相关的三种潜在机制。个性化的服务提供了方便和简单，使青年志愿者协会能够克服获得补充的障碍，但对于高度移动的青年志愿者协会来说，效果并不好。一致的互动和分享经验促进了与提供者和同行的社会联系，建立了社交网络和PrEP使用的支持系统。然而，在这些网络之外，人们普遍经历了PrEP和艾滋病毒相关的耻辱。社区到设施转介PrEP补充引发了对AGYW中不熟悉的PrEP服务和提供者的担忧，这阻碍了坚持。提供便利和简单并促进社会联系的服务提供方法可以减少访问障碍并增加社会支持，使AGYW能够自我管理其PrEP使用并实现改进的PrEP持久性。
Despite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services through community and hybrid models in Namibia to facility-based services. We subsequently identify potential mechanisms to explain how and why community and hybrid models achieved (or not) improved persistence to inform further service delivery innovation. Data were collected from PrEP service delivery to AGYW over two-years in Namibia's Khomas Region. We used Kaplan-Meier analysis to estimate survival curves for PrEP persistence beyond three-months after initiation and report the cumulative probability of persistence at one- and three-months. Persistence was defined as any PrEP use within three months after initiation followed by a PrEP refill or previously prescribed supply of at least 30 days at the three-month visit. Interviews were conducted with 28 AGYW and 19 providers and analyzed using a deductive-inductive thematic approach. From October 2017 through September 2019, 372 (18.7%) AGYW received services through a facility model, 302 (15.1%) through a community model, and 1,320 (66.2%) through a hybrid model. PrEP persistence at one- and three-months was 41.2% and 34.9% in the community model and 6.2% and 4.8% in the hybrid model compared to 36.8% and 26.7% in the facility model. Within the community and hybrid models, we identified three potential mechanisms related to PrEP persistence. Individualized service delivery offered convenience and simplicity which enabled AGYW to overcome barriers to obtaining refills but did not work as well for highly mobile AGYW. Consistent interactions and shared experiences fostered social connectedness with providers and with peers, building social networks and support systems for PrEP use. PrEP and HIV-related stigma, however, was widely experienced outside of these networks. Community-to-facility referral for PrEP refill triggered apprehension towards unfamiliar PrEP services and providers in AGYW, which discouraged persistence. Service delivery approaches that offer convenience and simplicity and foster social connectedness may reduce access barriers and increase social support enabling AGYW to self-manage their PrEP use and achieve improved PrEP persistence.
影响因子：
4.4
作者：
Atukunda EC;Matthews LT;Musiimenta A;Agaba A;Najjuma JN;Lukyamuzi EJ;Kaida A;Obua C;Mugyenyi GR
通讯作者：
Mugyenyi GR