Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Int AIDS Soc. 2020 Jun;23 Suppl 3(Suppl 3):e25502. doi: 10.1002/jia2.25502.
As a user-controlled HIV prevention method, oral pre-exposure prophylaxis (PrEP) holds particular promise for adolescent girls and young women (AGYW). HIV prevention cascades, critical frameworks for the design and evaluation of PrEP programmes, outline the priorities of identifying individuals at greatest HIV risk and motivating them to initiate PrEP through perceived HIV risk. To inform future iterations of these cascades and PrEP delivery for AGYW, the objective of this study was to understand the level of interest in PrEP among AGYW at highest HIV risk, and the potential role of perceived risk in motivating PrEP interest.
Using data from a cohort study of HIV-negative AGYW in Lilongwe, Malawi (February 2016 to August 2017), we assessed the relationship between epidemiologic HIV risk (risk index developed in a previous analysis) and PrEP interest, and the extent to which perceived risk explains the relationship between HIV risk and PrEP interest. We further aimed to operationalize the pre-initiation steps of the HIV prevention cascade in the study population.
In total, 825 AGYW were included in analyses, of which 43% met the criterion for high epidemiologic HIV risk. While epidemiologic risk scores were positively associated with PrEP interest, high numbers of AGYW both above and below the high-risk cutoff were very interested in PrEP (68% vs. 63%). Perceived risk partially explained the relationship between HIV risk and PrEP interest; greater epidemiologic HIV risk was associated with high perceived risk, which was in turn associated with PrEP interest. Many more high-risk AGYW were interested in PrEP (68%) than expressed a high level of perceived HIV risk (26%).
These results highlight key relationships between epidemiologic HIV risk, risk perception and interest in PrEP. While risk perception did partially explain the relationship between epidemiologic risk and PrEP interest, there may be other important motivational mechanisms that are not captured in many HIV prevention cascades. The high number of participants with risk scores below the high-risk cutoff who both expressed high perceived risk and interest in PrEP suggests that demand for PrEP among AGYW may not be well aligned with epidemiologic risk.
作为一种用户控制的 HIV 预防方法，口服暴露前预防（PrEP）对少女和年轻妇女（AGYW）特别有希望。HIV 预防级联，PrEP 计划设计和评估的关键框架，概述了确定处于最大 HIV 风险的个体并通过感知的 HIV 风险促使他们启动 PrEP 的优先事项。为了为 AGYW 提供未来迭代的这些级联和 PrEP 服务，本研究的目的是了解处于最高 HIV 风险的 AGYW 对 PrEP 的兴趣程度，以及感知风险在激发 PrEP 兴趣方面的潜在作用。
使用来自马拉维利隆圭一项针对 HIV 阴性 AGYW 的队列研究（2016 年 2 月至 2017 年 8 月）的数据，我们评估了流行病学 HIV 风险（以前的分析中开发的风险指数）与 PrEP 兴趣之间的关系，以及感知风险在多大程度上解释了 HIV 风险与 PrEP 兴趣之间的关系。我们还旨在在研究人群中实现 HIV 预防级联的启动前步骤。
共有 825 名 AGYW 纳入分析，其中 43% 符合高流行病学 HIV 风险标准。虽然流行病学风险评分与 PrEP 兴趣呈正相关，但处于高风险截止值以上和以下的大量 AGYW 都对 PrEP 非常感兴趣（68% vs. 63%）。感知风险部分解释了 HIV 风险与 PrEP 兴趣之间的关系；较高的流行病学 HIV 风险与高感知风险相关，而高感知风险又与 PrEP 兴趣相关。与表达高感知 HIV 风险（26%）相比，更多的高风险 AGYW 对 PrEP 感兴趣（68%）。
这些结果突出了流行病学 HIV 风险、风险感知和对 PrEP 兴趣之间的关键关系。虽然风险感知确实部分解释了流行病学风险与 PrEP 兴趣之间的关系，但在许多 HIV 预防级联中可能还有其他重要的激励机制没有被捕获。处于高风险截止值以下的风险评分较高的参与者数量众多，他们既表达了高感知风险，又对 PrEP 感兴趣，这表明 AGYW 对 PrEP 的需求可能与流行病学风险不一致。
