Qualitative accounts of PrEP discontinuation from the general population in Eswatini
Qualitative accounts of PrEP discontinuation from the general population in Eswatini
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DOI：
10.1080/13691058.2020.1770333
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发表时间：
2020-05-28
影响因子：
2.2
通讯作者：
McMahon, Shannon A.
中科院分区：
文献类型：
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作者：
Barnighausen, Kate;Geldsetzer, Pascal;McMahon, Shannon A.
在撒哈拉以南非洲，接受暴露前预防（PrEP）以预防艾滋病毒的人经常停止服用药物。我们对已经开始PrEP但在1，2或3个月后没有返回诊所重新填充的男性和女性进行了27次半结构化访谈。这些“中断”的客户参加了斯威士兰护士领导的公共部门初级保健诊所为普通人群举办的PrEP示范项目。中止的原因包括自我感知的艾滋病毒风险的变化，如妊娠结束和伴侣缺席。其他人则将PrEP描述为离家工作时无法获得，许多人描述了与每日药丸方案和管理副作用有关的困难。女性客户描述了他们的伴侣和共同妻子禁止使用PrEP。从这些结果中，我们建议以客户为中心的咨询强调预防有效的坚持范式，这促进了在可识别的风险期使用PrEP，并在风险期结束时停止PrEP。在全国范围内扩大PrEP可能会减轻获得PrEP的问题。扩展咨询和支持可以帮助坚持和管理副作用。对PrEP客户的合作伙伴和家庭的教育和支持也可能有助于更好地继续PrEP。
People in receipt of pre-exposure prophylaxis (PrEP) for the prevention of HIV in Sub-Saharan Africa often discontinue taking the medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to the clinic for a refill after a 1, 2 or 3-month period. These 'discontinuation' clients were enrolled in a PrEP demonstration project for the general population in nurse-led, public-sector, primary-care clinics in Eswatini. Reasons for discontinuation included changes to self-perceived HIV risk such as the end of pregnancy and absent partners. Others described PrEP as inaccessible when working away from home and many described difficulties relating to a daily pill regimen and managing side effects. Female clients described being prohibited from using PrEP by their partners and co-wives. From these results, we recommend that client-centred counselling stresses the prevention-effective adherence paradigm, which promotes PrEP use in risk periods that are identifiable and PrEP discontinuation when the risk period has finished. A national scale up of PrEP may mitigate problems accessing PrEP. Extended counselling and support could assist with adherence and the management of side effects. Education and support for partners and families of PrEP clients may also contribute to better PrEP continuation.