HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery
HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery
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DOI：
10.1002/jia2.25298
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发表时间：
2019-07-01
影响因子：
6
通讯作者：
Bekker, Linda-Gail
中科院分区：
文献类型：
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作者：
Celum, Connie L.;Delany-Moretlwe, Sinead;Bekker, Linda-Gail
简介：尽管扩大了艾滋病毒检测和艾滋病毒治疗，但非洲青春期女孩和年轻妇女 (AGYW) 的艾滋病毒发病率仍然很高。在不同人群中进行的基于替诺福韦的暴露前预防 (PrEP) 的安慰剂对照试验表明，如果坚持高度但并非完美的依从性，PrEP 的有效性接近 100%。非洲 AGYW 之间不同的功效估计导致了示范和实施项目，以更好地了解艾滋病毒预防、接受、坚持和坚持 PrEP 的动机。为了向 PrEP 计划提供信息，对 AGYW PrEP 示范项目的设计和初步结果进行了回顾。讨论：非洲年轻女性 PrEP 实施项目的早期经验教训包括：(1) 通过积极宣传 PrEP 的好处来提高认识和需求创造对于激励 AGYW 考虑这种新颖的预防技术并提高同伴、合作伙伴、父母和监护人的认识以支持 AGYW 有效使用 PrEP 至关重要； (2) 在将 PrEP 纳入青少年友好诊所、计划生育诊所和流动诊所的项目中，PrEP 启动率较高； (3) 根据行为特征、亲密伴侣暴力史、抑郁症以及 30% 的衣原体和/或淋病患病率，面临风险的年轻非洲女性正在启动 PrEP； (4) 提供适合青少年的 PrEP 实施方案，整合生殖健康服务，包括避孕以及性传播感染的诊断和治疗，增加健康影响； (5) 强调在面临艾滋病毒暴露潜在风险时高度坚持的必要性的信息以及解决 AGYW 坚持挑战的支持策略至关重要； (6) 很大一部分 AGYW 没有坚持 PrEP，需要制定策略来帮助 AGYW 评估他们持续进行 PrEP 的需求、动机和挑战。 结论：在综合生殖健康服务提供模式中实施 PrEP 是可行的，以惠及非洲 AGYW。虽然 PrEP 示范项目表明存在行为风险和性传播疾病高发率的女性正在启动 PrEP；需要有效的策略来支持 AGYW 坚持和坚持 PrEP。从口服 PrEP 给药（一种新型的第一代 HIV 预防产品）中吸取的经验教训与目前正在进行临床试验的长效且不太依赖依从性的策略相关。
Introduction: Adolescent girls and young women (AGYW) in Africa have high HIV incidence despite scale-up of HIV testing and HIV treatment. Placebo-controlled trials of tenofovir-based pre-exposure prophylaxi (PrEP) in diverse populations demonstrated that PrEP works with close to 100% effectiveness if taken with high, but not perfect, adherence. Divergent efficacy estimates among African AGYW led to demonstration and implementation projects to better understand motivations for HIV prevention, uptake, adherence and persistence to PrEP. To inform PrEP programmes, the design and initial findings from PrEP demonstration projects for AGYW are reviewed.Discussion: Early lessons from PrEP implementation projects among young African women include: (1) awareness and demand creation with positive messaging about the benefits of PrEP are critical to motivate AGYW to consider this novel prevention technology and to foster awareness among peers, partners, parents and guardians to support AGYW's effective PrEP use; (2) PrEP initiation is high in projects that are integrating PrEP into youth-friendly clinics, family planning clinics and mobile clinics; (3) young African women at risk are initiating PrEP, based on behavioural characteristics, history of intimate partner violence, depression and 30% prevalence of chlamydia and/or gonorrhoea; (4) provision of youth-friendly PrEP delivery programmes that integrate reproductive health services, including contraception and the diagnosis and treatment of sexually transmitted infections, increase health impact; (5) messages that emphasize the necessity for high adherence while at potential risk of HIV exposure and support strategies that addresses AGYW's adherence challenges are essential; and, (6) a substantial proportion of AGYW do not persist with PrEP, and strategies are needed to help AGYW assess their ongoing need, motivation and challenges with persisting with PrEP.Conclusions: PrEP is feasible to implement in integrated reproductive health service delivery models to reach African AGYW. While PrEP demonstration projects indicate that women with behavioural risks and high rates of sexually transmitted diseases are initiating PrEP; effective strategies to support AGYW's adherence and persistence with PrEP are needed. Lessons learned from oral PrEP delivery, a novel first generation HIV prevention product, are relevant to longer-acting and less adherence-dependent strategies which are currently in clinical trials.