Uptake of a patient-centred dynamic choice model for HIV prevention in rural Kenya and Uganda: SEARCH SAPPHIRE study.
Uptake of a patient-centred dynamic choice model for HIV prevention in rural Kenya and Uganda: SEARCH SAPPHIRE study.
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DOI：
10.1002/jia2.26121
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发表时间：
2023-07
影响因子：
6
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以人为本的艾滋病毒预防交付模式在产品、检测和访问地点方面提供结构化选择，可能会增加覆盖率。然而，缺乏关于南部非洲艾滋病毒感染风险人群实际接受选择情况的数据。在一项正在东非农村进行的随机研究（SEARCH; NCT04810650）中，我们评估了在以人为中心的艾滋病毒预防动态选择模型中所做选择的接受情况。使用pre框架，我们在肯尼亚和乌干达农村的三个环境中为有艾滋病毒风险的人开发了一种以个人为中心的动态选择艾滋病毒预防（DCP）干预措施：产前诊所（ANC）、门诊部（OPD）和社区。组成部分包括：供应商关于产品选择（倾向）的培训；对客户需求和选择的灵活性和响应性（暴露前预防[PrEP]/暴露后预防[PEP]，诊所与非现场访问以及自我或临床医生的艾滋病毒检测）（使能）；以及客户和员工的反馈（强化）。所有客户都接受了对障碍的结构化评估，并制定了个性化的解决方案，提供了与临床医生的移动电话联系（每周7天/ 24小时）和综合生殖健康服务。在这一中期分析中，我们描述了在随访的前24周（2021年4月至2022年3月）对产品选择、地点和测试的吸收情况。共有612名参与者（203名ANC， 197名OPD和212名社区）被随机分配到以人为中心的DCP干预。我们在所有三种不同人群的环境中实施了DCP干预：ANC: 39%的孕妇；中位年龄：24岁；门诊：39%男性，中位年龄27岁；社区：男性占42%，平均年龄29岁。基线PrEP选择在ANC（98%）高于OPD（84%）和社区（40%）；而社区中选择PEP的成年人比例（46%）高于OPD（8%）和ANC（1%）。个人对非现场访问的偏好随着时间的推移而增加（第24周为65%，基线为35%）。对替代HIV检测方式的兴趣随着时间的推移而增加（基线自我检测38% vs.第24周58%）。在肯尼亚和乌干达农村，一个以人为中心的模型将生物医学预防和护理提供方案的结构化选择纳入了人口统计学不同群体的环境中，该模型对艾滋病毒预防规划中随时间变化的个人偏好做出了响应。
Person‐centred HIV prevention delivery models that offer structured choices in product, testing and visit location may increase coverage. However, data are lacking on the actual uptake of choices among persons at risk of HIV in southern Africa. In an ongoing randomized study (SEARCH; NCT04810650) in rural East Africa, we evaluated the uptake of choices made when offered in a person‐centred, dynamic choice model for HIV prevention. Using the PRECEDE framework, we developed a persont‐centred, Dynamic Choice HIV Prevention (DCP) intervention for persons at risk of HIV in three settings in rural Kenya and Uganda: antenatal clinic (ANC), outpatient department (OPD) and in the community. Components include: provider training on product choice (predisposing); flexibility and responsiveness to client desires and choices (pre‐exposure prophylaxis [PrEP]/post‐exposure prophylaxis [PEP], clinic vs. off‐site visits and self‐ or clinician‐based HIV testing) (enabling); and client and staff feedback (reinforcing). All clients received a structured assessment of barriers with personalized plans to address them, mobile phone access to clinicians (24 hours/7 days/week) and integrated reproductive health services. In this interim analysis, we describe the uptake of choices of product, location and testing during the first 24 weeks of follow‐up (April 2021−March 2022). A total of 612 (203 ANC, 197 OPD and 212 community) participants were randomized to the person‐centred DCP intervention. We delivered the DCP intervention in all three settings with diverse populations: ANC: 39% pregnant; median age: 24 years; OPD: 39% male, median age 27 years; and community: 42% male, median age: 29 years. Baseline choice of PrEP was highest in ANC (98%) vs. OPD (84%) and community (40%); whereas the proportion of adults selecting PEP was higher in the community (46%) vs. OPD (8%) and ANC (1%). Personal preference for off‐site visits increased over time (65% at week 24 vs. 35% at baseline). Interest in alternative HIV testing modalities grew over time (38% baseline self‐testing vs. 58% at week 24). A person‐centred model incorporating structured choice in biomedical prevention and care delivery options in settings with demographically diverse groups, in rural Kenya and Uganda, was responsive to varying personal preferences over time in HIV prevention programmes.