Effectiveness of PrEP product choice on HIV prevention coverage among young women in Kenya seeking reproductive health services

摘要 在肯尼亚，为许多人扩大了每日口服预习的规模，包括患有大量 有感染艾滋病毒的风险。对于许多开始口服PrEP的年轻女性来说，许多研究表明 戒毒率很高，他们不太可能从长期的艾滋病毒保护中受益。较新的PrEP产品 更长的作用时间，包括达匹韦林洗脱阴道环和肌肉注射卡替格列韦，提供1- 2个月的保护，减少对使用者记住每日服药的依赖。追随世界卫生组织 根据指南，这些产品正在肯尼亚和其他国家纳入临床指南。每天的 OraclePrEP，有效扩大规模的一个关键战略是整合到现有计划中，例如 生殖保健(如计划生育、产前、产后保健)，我们一直在研究如何 优化PrEP与这些设置的集成。通过实施科学研究协议，我们有 一直与公共诊所工作人员合作介绍PrEP，培训提供商提供PrEP，发展 针对PrEP的诊所和国家供应链机制，以及支持提供商和计划 挑战。尽管人们对PrEP的兴趣很高，但PrEP启动-13的频率很高- 在我们的计划生育和堕胎后诊所伴侣中，年龄在15-30岁之间的合格妇女占35%-我们有 继续看到高水平的计划退出、不遵守，并且只有中等能力来跟踪 PREP重新启动，以适应波动的性行为和潜在的艾滋病毒暴露。这些障碍阻碍了 准备延续是由年轻女性对PrEP产品需求驱动的，这些产品能够提供谨慎、方便 和安全。 目前尚不清楚在PrEP计划中提供多种HIV PrEP产品是否会产生一定程度的 选择，支持长期使用PrEP，并最终扩大艾滋病毒预防覆盖面。通过多个步骤 过程调用形成性工作和阶梯式楔形群随机试验，研究团队建议 确定提供一套PrEP选项是否会在以下3个方面产生更大的艾滋病毒保护覆盖范围- 6个月，相对于每天只有口服PrEP的时间段。建议的研究旨在：1) 开发一种途径，将可注射的卡波替格韦和达匹韦林环添加到通过以下方式提供的现有PrEP服务中 肯尼亚生殖健康诊所利用定性和基于社区的研究方法，2) 确定可注射卡波替格韦和达匹韦林环是否整合到现有的PrEP计划中 提高年轻女性通过生殖健康服务获得PrEP的接受率和持久性 在12个设施中进行阶梯-楔形整群随机试验，以及3)询问PrEP中的潜在弱点 选择干预措施包括：a)提供者犹豫不决和客户体验，b)基于选择的艾滋病毒质量 预防咨询。

ABSTRACT Daily oral PrEP has been scaled up in Kenya for numerous populations, including young women with substantial risk for HIV. For many young women who start oral PrEP, numerous studies have demonstrated that discontinuation rates are high and they unlikely benefit from long-term HIV protection. Newer PrEP products that are longer acting, including dapivirine-eluting vaginal rings and intramuscular injections of cabotegravir, offer 1- 2 months of protection and less dependence on the user to remember to take a daily pill. Following WHO guidelines, these products are being integrated into clinical guidelines in Kenya and other countries. For daily oral PrEP, a key strategy for efficient scale up was integration into existing programs, such as those for reproductive health care (e.g., family planning, antenatal, postabortal care) and we have been studying ways to optimize integration of PrEP into these settings. Through implementation science research protocols, we have been working with public clinic staff to introduct PrEP, train providers to delivery PrEP, develop linkages between clinics and national supply chain mechanisms for PrEP, and support providers and programs to overcome challenges. Despite documented high levels of interest in PrEP yielding high frequency of PrEP initiation – 13- 35% of eligible women ages 15-30 years in our family planning and post-abortal clinic partners – we have continued to see high levels of program drop out, non-adherence, and only moderate ability to track whether PrEP is re-started in alignment with fluctuating sexual behavior and potential exposure to HIV. These barriers to PrEP continuation are driven by young women’s needs for PrEP products that afford discretion, convenience, and safety. It is yet unknown whether the availability of multiple HIV PrEP products in a PrEP program will yield a degree of choice, support longer term use of PrEP, and ultimately, greater HIV prevention coverage. Through a multi-step process invoking formative work and a stepped-wedge cluster randomized trial, the research team proposes to determine whether the availability of a suite of PrEP options yields greater HIV protection coverage over a 3- and 6- month period relative to periods when only daily oral PrEP is available. The proposed study aims to: 1) develop a pathway to add injectable cabotegravir and dapivirine ring into existing PrEP services offered through in reproductive health clinics in Kenya leveraging qualitative and community-based research methods, 2) determine whether integration of injectable cabotegravir and dapivirine ring into existing PrEP programs improves PrEP uptake and persistence among young women accessing reproductive health services via a stepped-wedge cluster randomized trial in 12 facilities, and 3) interrogate potential weak points in the PrEP choice intervention including: a) provider hesitancy and client experiences, b) quality of choice-based HIV prevention counseling.