PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia.
PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia.
复制标题
DOI：
10.1371/journal.pone.0289353
复制
发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
青春期女孩和年轻妇女(AGYW)在获得基于诊所的艾滋病毒暴露前预防(PrEP)服务方面面临障碍，社区模式是一种拟议的替代方案。然而，来自这些模型的证据是有限的。我们在纳米比亚通过社区和混合模式评估了AGYW接受服务的PrEP服务覆盖率、采用率和早期持久性。我们分析了15-24岁的AGYW在艾滋病毒预防规划中启动PrEP的常规数据。PREP通过三种模式提供：社区礼宾(完全基于社区的服务，有单独定制的充气地点)，社区固定(社区提供者在固定地点按设定的时间表提供基于社区的开始和重新填充)，以及混合社区-诊所(基于社区的开始和诊所提供者提供的重新填充的转介)。我们检查了AGYW参与服务的比例，总体上和按模型进行了规划的PrEP级联，并使用多变量广义估计方程评估了与PrEP摄取和早期持久性(在启动后15-44天内重新填充)相关的因素。在10个月的时间里，7593名青年妇女参加了艾滋病毒预防方案编制工作。其中，7516人(99.0%)接受了预防接种计划教育，6105人(81.2%)接受了艾滋病毒检测服务，6035人(98.9%)检测为阴性，2225人(36.9%)启动了预防接种计划。在研究期间预计将进行PrEP补充的2047年AGYW中，有254人(12.4%)在开始治疗一个月后继续使用PrEP。结构性和行为性HIV危险因素，包括早期辍学、食物不安全、安全套使用不一致和交易性行为，与PrEP感染有关。推迟开始PrEP的AGYW的持续可能性是2.89倍(95%可信区间：1.52-5.46)，通过社区-礼宾模式接受服务的持续可能性是混合模式的8.7倍(95%CI：5.44-13.9)。以社区为基础的向AGYW提供PrEP服务的模式可以实现较高的PrEP教育和艾滋病毒检测覆盖率，以及中等程度的PrEP接受。以AGYW为中心的方法提供PrEP再灌装可以促进更高的持久性。
Adolescent girls and young women (AGYW) face barriers in accessing clinic-based HIV pre-exposure prophylaxis (PrEP) services and community-based models are a proposed alternative. Evidence from such models, however, is limited. We evaluated PrEP service coverage, uptake, and early persistence among AGYW receiving services through community and hybrid models in Namibia. We analyzed routine data for AGYW aged 15–24 who initiated PrEP within HIV prevention programming. PrEP was delivered via three models: community-concierge (fully community-based services with individually-tailored refill locations), community-fixed (community-based initiation and refills delivered by community providers on a set schedule at fixed sites), and hybrid community-clinic (community-based initiation and referral to clinics for refills delivered by clinic providers). We examined proportions of AGYW engaged in services along a programmatic PrEP cascade, overall and by model, and assessed factors associated with PrEP uptake and early persistence (refill within 15–44 days after initiation) using multivariable generalized estimating equations. Over 10-months, 7593 AGYW participated in HIV prevention programming. Of these, 7516 (99.0%) received PrEP education, 6105 (81.2%) received HIV testing services, 6035 (98.9%) tested HIV-negative, and 2225 (36.9%) initiated PrEP. Of the 2047 AGYW expected for PrEP refill during the study period, 254 (12.4%) persisted with PrEP one-month after initiation. Structural and behavioral HIV risk factors including early school dropout, food insecurity, inconsistent condom use, and transactional sex were associated with PrEP uptake. AGYW who delayed starting PrEP were 2.89 times more likely to persist (95% confidence interval (CI): 1.52–5.46) and those receiving services via the community-concierge model were 8.7 times (95% CI: 5.44–13.9) more likely to persist (compared to the hybrid model). Community-based models of PrEP service delivery to AGYW can achieve high PrEP education and HIV testing coverage and moderate PrEP uptake. AGYW-centered approaches to delivering PrEP refills can promote higher persistence.
登录
查看更多内容
影响因子：
4.5
作者：
Jackson-Gibson M;Ezema AU;Orero W;Were I;Ohiomoba RO;Mbullo PO;Hirschhorn LR
通讯作者：
Hirschhorn LR
影响因子：
4.6
作者：
Golub SA
通讯作者：
Golub SA
DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Duncombe C;Rosenblum S;Hellmann N;Holmes C;Wilkinson L;Biot M;Bygrave H;Hoos D;Garnett G
通讯作者：
Garnett G
影响因子：
16.1
作者：
Koss, Catherine A.;Charlebois, Edwin D.;Havlir, Diane V.
通讯作者：
Havlir, Diane V.
影响因子：
--
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
通讯作者：
O'Malley, Gabrielle