Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: Results of a consultation with community stakeholders
Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: Results of a consultation with community stakeholders
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DOI：
10.1186/1472-6963-14-231
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发表时间：
2014-05-21
影响因子：
2.8
通讯作者：
Agot, Kawango
中科院分区：
文献类型：
--
作者：
Mack, Natasha;Odhiambo, Jacob;Agot, Kawango
背景资料：随着暴露前预防（PrEP）在发展中国家越来越接近可用性，实施的实际考虑变得重要。我们与在肯尼亚邦多和拉列达的高危人群艾滋病毒预防干预方面经验丰富的地区一级社区利益相关者进行了磋商，以制定基于当地的方法，以便将来向四个人群推出口服PrEP：渔民，寡妇，女性性工作者和血清不一致的夫妇。20名协商与会者代表卫生部、宗教和社区组织、卫生设施、社区团体和非政府组织。参与者分成分组，并遵循结构化讨论指南，要求他们确定对每个人群实施艾滋病毒预防干预措施（包括PrEP）的障碍。问题还要求解决这些障碍的解决方案，以及实施PrEP的其他促进因素。特别是，问题集中在如何鼓励人们通过艾滋病毒和其他血液检测筛选PrEP资格，以及如何鼓励遵守正在进行的HIV testing.Results：的障碍和促进者/解决方案讨论者提供了经常是特定人群，但也有广泛的水平在人群之间的相似性。艾滋病毒预防干预措施在提供服务方面的障碍涉及到需要经过培训的工作人员来满足特定人群的需要。提供服务的促进者提供持续的艾滋病毒检测，包括提供除基于设施的检测之外的检测选择。成见是所有群体在社区一级面临的主要障碍，而目标人口一级的障碍包括流动性;生活方式和生活环境，特别是渔民和寡妇的文化规范;以及恐惧、缺乏认识和错误信息。为消除社区和人口一级的障碍而提出的促进者和战略包括在人口和社区内进行专题教育、让伙伴和家庭成员参与、大规模艾滋病毒检测和同伴教育者。PrEP吸收的障碍包括不坚持服药和错过门诊。对于药物依从性，促进者是咨询和涉及家庭成员。讨论者建议，客户提醒，例如，家访，需要鼓励客户保持他们的诊所appoints.Conclusions：策略，鼓励资格筛选和持续的HIV检测将有当地和人口的具体方面。尽管如此，我们的研究结果适用于整个撒哈拉以南非洲的类似人群，并超越了口服PrEP到其他基于ARV的PrEP制剂。
Background: As pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. We conducted a consultation with district-level community stakeholders experienced in HIV-prevention interventions with at-risk populations in Bondo and Rarieda, Kenya to generate locally grounded approaches to the future rollout of oral PrEP to four populations: fishermen, widows, female sex workers, and serodiscordant couples.Methods: The 20 consultation participants represented the Ministry of Health, faith-and community-based organizations, health facilities, community groups, and nongovernmental organizations. Participants divided into breakout groups and followed a structured discussion guide asking them to identify barriers to implementing HIV-prevention interventions (including PrEP) with each population. Questions also solicited solutions for addressing these barriers, as well as other facilitators for PrEP implementation. In particular, questions focused on how to encourage people to screen for PrEP eligibility by having HIV and other blood tests and how to encourage compliance with ongoing HIV testing.Results: The barriers and facilitators/solutions discussants provided were frequently population-specific, but there were also broad-level similarities across populations. Service delivery barriers to HIV-prevention interventions concerned the need for staff trained to address the needs of particular populations. Service delivery facilitators to provision of ongoing HIV testing consisted of offering testing options besides facility-based testing. Stigma was the main community-level barrier for all groups, whereas barriers at the level of target populations included mobility; lifestyle and life circumstances, especially cultural norms among fishermen and widows; and fears, lack of awareness, and misinformation. Proposed facilitators and strategies for addressing community-and population-level barriers included topic-specific education within the populations and community, involvement of partners and family members, mass HIV testing, and peer educators. Barriers to PrEP uptake included non-adherence to pill taking and missing clinic visits. For drug adherence, facilitators were counselling and involving family members. Discussants suggested that client reminders, e.g., home visits, were needed to encourage clients to keep their clinic appointments.Conclusions: Strategies for encouraging eligibility screening and ongoing HIV testing will have local and population-specific aspects. Our results nonetheless apply to similar populations throughout sub-Saharan Africa and reach beyond oral PrEP to other ARV-based PrEP formulations.