Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya.
Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya.
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DOI：
10.1186/s12889-021-11335-1
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发表时间：
2021-07-01
影响因子：
4.5
通讯作者：
Hirschhorn LR
中科院分区：
文献类型：
--
作者：
Jackson-Gibson M;Ezema AU;Orero W;Were I;Ohiomoba RO;Mbullo PO;Hirschhorn LR
虽然采用艾滋病毒暴露前预防作为艾滋病毒预防战略使妇女能够对降低艾滋病毒传播率行使更多的控制权，但撒哈拉以南非洲的少女和年轻妇女的艾滋病毒感染率仍然较高，并承受着最大的疾病负担。了解少女和年轻妇女在PrEP摄取方面的进展将有助于减少这一弱势群体的风险。坚定、有复原力、无艾滋病、有指导和安全的妇女倡议在这一减少风险战略中发挥关键作用。我们进行了一项定性研究，探讨促进者和障碍，以准备实施和评估因素影响的启动和持久性的准备在青少年女孩和年轻妇女参加梦想倡议在Pamoja社区为基础的组织在基苏穆，肯尼亚。我们进行了关键的线人采访（n = 15）与Pamoja社区组织的工作人员，医疗保健提供者和社区领导人。此外，我们与接受PrEP和同伴导师（n = 40）的年轻女性进行了焦点小组讨论。我们使用实施研究的统一框架进行了定向内容分析，以组织确定的促进因素和障碍。我们发现，安全空间模型的使用，PrEP支持和交付的分散化，同伴导师，与当地卫生保健设施的有效联系，父母和男性性伴侣的敏感性，受益人使用PrEP的披露，积极的利益相关者参与和社区参与是PrEP吸收的一些促进因素。PrEP实施、启动和持续存在的障碍包括与使用抗逆转录病毒药物相关的耻辱感、药物副作用、受益人频繁搬迁、常规筛查和药物监测资源有限以及PrEP分发和管理的合格卫生保健工作者数量有限。总体而言，由于一些关键的促进因素，在DREAMS倡议内社区推出PrEP是成功的，最终导致成功实施PrEP，增加PrEP启动并增强少女和年轻妇女的持久性。应解决已查明的障碍，以便将来有可能更大规模地推广PrEP。
While the introduction of HIV Pre-Exposure Prophylaxis (PrEP) as an HIV prevention strategy has allowed women to exercise more control over the reduction of HIV transmission rates, adolescent girls and young women in Sub-Saharan Africa continue to experience higher rates of HIV infections and bear the greatest disease burden. Understanding progress in PrEP uptake among adolescent girls and young women would enhance risk reduction in this vulnerable population. The Determined, Resilient, AIDS-Free, Mentored and Safe women (DREAMS) Initiative plays a key role in this risk reduction strategy. We performed a qualitative study to explore facilitators and barriers to PrEP implementation and assess factors effecting initiation and persistence on PrEP among adolescent girls and young women enrolled in the DREAMS Initiative at Pamoja Community Based Organization in Kisumu, Kenya. We conducted key informant interviews (n = 15) with Pamoja Community Based Organization staff, health care providers and community leaders. Additionally, we conducted focus group discussions with young women receiving PrEP and peer mentors (n = 40). We performed a directed content analysis using the Consolidated Framework for Implementation Research to organize the identified facilitators and barriers. We found that the use of the safe space model, decentralization of PrEP support and delivery, peer mentors, effective linkage to local health care facilities, the sensitization of parents and male sexual partners, disclosure of PrEP use by beneficiaries, active stakeholder involvement and community engagement were among some of the facilitators to PrEP uptake. Barriers to PrEP implementation, initiation and persistence included stigma associated with the use of anti-retroviral drugs, drug side effects, frequent relocation of beneficiaries, limited resources for routine screening and medication monitoring, and a limited number of qualified health care workers for PrEP distribution and administration. Overall, the community roll-out of PrEP within the DREAMS Initiative was successful due to a number of key facilitating factors, which ultimately led to successful PrEP implementation, increased PrEP initiation and enhanced persistence among adolescent girls and young women. The identified barriers should be addressed so that a larger scale-up of PrEP roll-out is possible in the future.
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影响因子：
3.7
作者：
Torpey KE;Kabaso ME;Mutale LN;Kamanga MK;Mwango AJ;Simpungwe J;Suzuki C;Mukadi YD
通讯作者：
Mukadi YD
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
3.7
作者：
Saul, Janet;Bachman, Gretchen;Beamon, Ta'Adhmeeka
通讯作者：
Beamon, Ta'Adhmeeka
影响因子：
4.4
作者：
Van der Elst, Elisabeth Maria;Mbogua, Judie;Operario, Don;Mutua, Gaudensia;Kuo, Caroline;Mugo, Peter;Kanungi, Jennifer;Singh, Sagri;Haberer, Jessica;Priddy, Frances;Sanders, Eduard Joachim
通讯作者：
Sanders, Eduard Joachim
影响因子：
4.1
作者：
Thomson KA;Baeten JM;Mugo NR;Bekker LG;Celum CL;Heffron R
通讯作者：
Heffron R