A multi-country cross-sectional study to assess predictors of daily versus on-demand oral pre-exposure prophylaxis in youth from South Africa, Uganda and Zimbabwe.
A multi-country cross-sectional study to assess predictors of daily versus on-demand oral pre-exposure prophylaxis in youth from South Africa, Uganda and Zimbabwe.
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DOI：
10.1002/jia2.25975
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发表时间：
2022-08
影响因子：
6
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撒哈拉以南非洲地区 (SSA) 承受着艾滋病毒流行的负担，特别是在青少年 (AYP) 中。对于 SSA 中 AYP 的暴露前预防 (PrEP) 吸收和偏好知之甚少。我们描述了南非、乌干达和津巴布韦 AYP 对每日和按需 PrEP 的偏好。 2019 年对 13 至 24 岁的人群进行了一项横断面调查，了解社会人口统计数据、艾滋病毒风险行为以及对每日或按需 PrEP 的偏好。使用逻辑回归模型来估计比值比，并根据地点、性别和年龄进行调整。共有来自开普敦（n = 239）、约翰内斯堡（n = 200）、恩德培（n = 491）和奇通威萨（n = 400）的 1330 名参与者参加； 673 名 (51%) 为男性，中位年龄为 19 岁（四分位数范围 17-22 岁）。在 1287 名表示偏好的参与者中，60% 的人表示偏好按需 PrEP，不同地点 (p < 0.001)、性别 (p < 0.001) 和年龄组 (p = 0.003) 存在差异。按需 PrEP 在恩德培 (75%)、男性 (65%) 与女性 (54%) 以及老年参与者中最受欢迎（18 至 24 岁的参与者为 62%，13 至 15 岁的参与者为 47%）。在对地点、性别和年龄组进行调整后，随着过去一个月性行为频率的增加（p 趋势 = 0.004），对按需 PrEP 的偏好下降，并且随着过去 6 个月的性伴侣数量的变化而变化，在那些报告有四个或更多性伴侣的人中最不受欢迎（p = 0.02）。提前进一步了解自己可能发生性行为的参与者更有可能更喜欢按需 PrEP（p-趋势 = 0.02）。与每日 PrEP 相比，与最近的伴侣年龄差距较大的参与者以及最后一个伴侣是交易性伴侣或客户的参与者都不太可能喜欢按需 PrEP（分别为 p = 0.05 和 p = 0.09）。知道最近伴侣感染 HIV 或不知道最近伴侣感染 HIV 状况的参与者不太可能选择按需 PrEP（p = 0.05）。我们的数据显示，四个 SSA 社区的 AYP 更喜欢按需使用而不是每日 PrEP 选项，并且因地点、年龄和性别而存在差异。 PrEP 需求的创建需要根据社会人口差异进行审查、优化和定制，并与 AYP 结合设计。
Sub‐Saharan Africa (SSA) carries the burden of the HIV epidemic, especially among adolescents and young people (AYP). Little is known about pre‐exposure prophylaxis (PrEP) uptake and preferences among AYP in SSA. We describe preferences for daily and on‐demand PrEP among AYP in South Africa, Uganda and Zimbabwe. A cross‐sectional survey was conducted in 2019 among 13‐ to 24‐year olds, capturing socio‐demographics, HIV risk behaviours and preferences for daily or on‐demand PrEP. Logistic regression models were used to estimate odds ratios, adjusting for site, sex and age. A total of 1330 participants from Cape Town (n = 239), Johannesburg (n = 200), Entebbe (n = 491) and Chitungwiza (n = 400) were enrolled; 673 (51%) were male, and the median age was 19 years (interquartile range 17–22 years). Of 1287 participants expressing a preference, 60% indicated a preference for on‐demand PrEP with differences by site (p < 0.001), sex (p < 0.001) and age group (p = 0.003). On‐demand PrEP was most preferred in Entebbe (75%), among males (65%) versus females (54%) and in older participants (62% in 18‐ to 24‐year‐olds vs. 47% in 13‐ to 15‐year‐olds). After adjusting for site, sex and age group, preference for on‐demand PrEP decreased as sex frequency over the past month increased (p‐trend = 0.004) and varied with the number of partners in the last 6 months, being least popular among those reporting four or more partners (p = 0.02). Participants knowing further in advance that they were likely to have sex were more likely to prefer on‐demand PrEP (p‐trend = 0.02). Participants having a larger age gap with their most recent partner and participants whose last partner was a transactional sex partner or client were both less likely to prefer on‐demand compared to daily PrEP (p = 0.05 and p = 0.09, respectively). Participants who knew their most recent partner was living with HIV or who did not know the HIV status of their most recent partner were less likely to prefer on‐demand PrEP (p = 0.05). Our data show that AYP in four SSA communities prefer on‐demand over daily PrEP options, with differences seen by site, age and sex. PrEP demand creation needs to be reviewed, optimized and tailored to socio‐demographic differences and designed in conjunction with AYP.