A decision support tool has similar high PrEP uptake and increases early PrEP persistence in adolescent girls and young women in South Africa: results from a randomized controlled trial.
A decision support tool has similar high PrEP uptake and increases early PrEP persistence in adolescent girls and young women in South Africa: results from a randomized controlled trial.
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DOI：
10.1002/jia2.26154
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发表时间：
2023-08
影响因子：
6
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中科院分区：
文献类型：
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非洲少女和年轻妇女（AGYW）艾滋病毒感染率很高，是艾滋病毒暴露前预防（PrEP）的优先人群。由于AGYW认为艾滋病毒风险低和提供者的要求，PrEP的实施受到限制。包含PrEP信息的决策支持工具（DST）可以改善客户的风险感知，PrEP知识，知情决策和基于风险使用PrEP的动机，促进初级医疗保健（PHC）诊所的PrEP交付。我们设计了MyPrEP，这是一个面向客户的关于PrEP和艾滋病预防的DST，提供了青少年友好的信息和图像。MyPrEP工具的影响在2019年3月至2020年在南非约翰内斯堡的一家PHC诊所就诊的18-25岁艾滋病毒阴性女性中进行了评估。AGYW按天随机分配到DST或一般健康网站作为对照条件。对DST与对照分配不知情的临床医生提供了关于PrEP的标准护理咨询，提供了PrEP，进行了问卷调查并进行了性传播感染检测。主要结局是PrEP启动，次要结局是1个月时的PrEP持续性，由药房分发记录确定。在筛选的386名AGYW中，（DST n = 172，对照n = 181），中位年龄为21岁（四分位数间距[IQR] 20，23）和56%（199/353）到诊所进行艾滋病毒检测，46%（164/353）使用避孕措施，15%（53/353）的人坚持使用避孕套，37%（108/353）的人患有可治愈的性传播感染。DST组和对照组分别有97%和94%的患者开始PrEP（OR 1.79; 95%置信区间，CI = 0.79-1.53），其中三分之二的人计划继续PrEP，直到他们决定是否喜欢PrEP。在1个月时，DST组的PrEP持续率为19%，对照组为10%（OR 1.97，95% CI 1.08-3.69）。99%的随机分配至DST的患者报告了对MyPrEP的满意度。在参加南非PHC诊所的AGYW中，PrEP摄取率>90%，随机使用MyPrEP DST的患者在1个月时PrEP持续性高出两倍。鉴于需要制定战略，以支持PrEP的实施，并改善非洲AGYW中PrEP低的持续性，PrEP DST值得进一步评估。
African adolescent girls and young women (AGYW) have high rates of HIV acquisition and are a priority population for HIV pre‐exposure prophylaxis (PrEP). PrEP implementation has been limited by AGYW's low perceived HIV risk and provider demands. A decision support tool (DST) with information about PrEP could improve clients’ risk perception, knowledge about PrEP, informed decision‐making and motivation to use PrEP based on their risk, facilitating PrEP delivery in primary healthcare (PHC) clinics. We designed MyPrEP, a client‐facing DST about PrEP and HIV prevention, with youth‐friendly information and images. The impact of the MyPrEP tool was assessed among HIV‐negative women aged 18–25 years presenting to a PHC clinic in Johannesburg, South Africa from March 2019 to 2020. AGYW were randomized by day to the DST or a general health website as the control condition. A clinician blinded to DST versus control allocation provided standard of care counselling about PrEP, offered PrEP, administered a questionnaire and conducted sexually transmitted infection testing. The primary outcome was PrEP initiation and the secondary outcome was PrEP persistence at 1 month, determined by pharmacy dispensation records. Of 386 AGYW screened, 353 were randomized (DST n = 172, control n = 181) with a median age of 21 years (interquartile range [IQR] 20, 23) and 56% (199/353) attending the clinic for HIV testing, 46% (164/353) using contraception, 15% (53/353) using condoms consistently and 37% (108/353) with a curable sexually transmitted infection. PrEP was initiated by 97% in the DST group and 94% in the control group (OR 1.79; 95% confidence interval, CI = 0.79–1.53), of whom two‐thirds planned to continue PrEP until they decided if they liked PrEP. At 1 month, PrEP persistence was 19% in the DST and 10% in the control group (OR 1.97, 95% CI 1.08–3.69). Ninety‐nine percent randomized to the DST reported satisfaction with MyPrEP. Among AGYW attending a South African PHC clinic, PrEP uptake was >90% with two‐fold higher PrEP persistence at 1 month in those randomized to use the MyPrEP DST. Given the need for strategies to support PrEP implementation and improve low PrEP persistence among African AGYW, a PrEP DST warrants further evaluation.
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影响因子：
16.1
作者：
Velloza, Jennifer;Donnell, Deborah;Hosek, Sybil;Anderson, Peter L.;Chirenje, Z. Mike;Mgodi, Nyaradzo;Bekker, Linda-Gail;Marzinke, Mark A.;Delany-Moretlwe, Sinead;Celum, Connie
通讯作者：
Celum, Connie
影响因子：
2.9
作者：
Dehlendorf, Christine;Reed, Reiley;Kimport, Katrina
通讯作者：
Kimport, Katrina
影响因子：
6
作者：
Celum, Connie L.;Delany-Moretlwe, Sinead;Bekker, Linda-Gail
通讯作者：
Bekker, Linda-Gail
影响因子：
6
作者：
Celum, Connie L.;Bukusi, Elizabeth A.;Bekker, Linda Gail;Delany-Moretlwe, Sinead;Kidoguchi, Lara;Omollo, Victor;Rousseau, Elzette;Travill, Danielle;Morton, Jennifer F.;Mogaka, Felix;O'Malley, Gabrielle;Barnabee, Gena;van der Straten, Ariane;Donnell, Deborah;Parikh, Urvi M.;Kudrick, Lauren;Anderson, Peter L.;Haberer, Jessica E.;Wu, Linxuan;Heffron, Renee;Johnson, Rachel;Morrison, Susan;Baeten, Jared M.
通讯作者：
Baeten, Jared M.
影响因子：
16.1
作者：
Zhang, Jing;Li, Chunyan;Xu, Junjie;Hu, Zhili;Rutstein, Sarah E.;Tucker, Joseph D.;Ong, Jason J.;Jiang, Yongjun;Geng, Wenqing;Wright, Sarah T.;Cohen, Myron S.;Shang, Hong;Tang, Weiming
通讯作者：
Tang, Weiming