FHI 360, Durham, NC, USA.
Pangaea Zimbabwe AIDS Trust, Harare, Zimbabwe.
Glob Health Sci Pract. 2021 Mar 31;9(1):40-54. doi: 10.9745/GHSP-D-20-00444.
As HIV testing increases worldwide, programs are reaching individuals without HIV infection who are at risk of exposure and may be candidates for oral pre-exposure prophylaxis (PrEP). Although linkage of individuals with HIV infection to treatment is a global priority (referred to as "test and treat"), less attention is given to individuals with negative HIV test results. We developed the "Test and Prevent" pilot program to intentionally link at-risk clients with negative HIV test results to PrEP services. The intervention included risk assessment of all clients with a negative result from HIV testing (with national risk assessment tool), accompanied referral, fast-tracking, and targeting follow-up.
The intervention was conducted in Bulawayo, Zimbabwe, at 6 public sector sites from October 2019 to February 2020. We collected routine monitoring data from all study sites and tracked referral completion and PrEP initiation among clients who enrolled. We conducted in-depth interviews with providers (n=12), facility managers (n=5), and female clients (n=17) to explore acceptability.
Among clients referred for PrEP (n=206), 98% completed their referrals and started PrEP. However, only 3% of clients who received a negative test result during the study period were referred. Low referrals stemmed from lack of screening (39% of clients with negative HIV test results were not screened) and lack of eligibility among clients who were screened (only 6% of those screened qualified as candidates for PrEP per the national screening tool). Qualitative results indicate that some providers purposefully did not complete screening with clients they felt were not at risk and that workload could have contributed to low screening uptake.Qualitative interviews showed that Test and Prevent was acceptable among both providers and clients. Clients were happy to learn about PrEP following HIV testing, and the additional support of accompanied referrals and fast-tracking encouraged them to access PrEP and made them feel valued. Providers were burdened by workload constraints but felt that Test and Prevent was important and should be scaled to other sites.
Intentionally linking clients with negative results to PrEP immediately following HIV testing was found to be acceptable from both provider and client perspectives, yet screening procedures need closer examination and reinforcement for the program to realize a larger impact.
随着全球范围内 HIV 检测的增加，越来越多的项目开始接触那些没有感染 HIV 但有暴露风险的人群，这些人群可能是口服暴露前预防（PrEP）的候选者。虽然将感染 HIV 的人联系到治疗方案是全球的优先事项（称为“检测并治疗”），但对 HIV 检测结果为阴性的人关注较少。我们开发了“检测与预防”试点项目，旨在将有感染 HIV 风险且 HIV 检测结果为阴性的客户与 PrEP 服务联系起来。该干预措施包括对所有 HIV 检测结果为阴性的客户进行风险评估（使用国家风险评估工具），并伴随转介、快速跟踪和针对性的随访。
该干预措施于 2019 年 10 月至 2020 年 2 月在津巴布韦布拉瓦约的 6 个公共部门地点进行。我们从所有研究地点收集了常规监测数据，并跟踪了参加研究的客户的转介完成情况和 PrEP 启动情况。我们对提供者（n=12）、设施经理（n=5）和女性客户（n=17）进行了深入访谈，以探讨其可接受性。
在接受 PrEP 转介的客户中（n=206），98%完成了转介并开始服用 PrEP。然而，在研究期间接受阴性 HIV 检测结果的客户中，只有 3%被转介。低转介率源于缺乏筛查（39%的 HIV 检测结果为阴性的客户未被筛查）和筛查出的客户中缺乏资格（仅 6%的筛查者符合国家筛查工具规定的 PrEP 候选人标准）。定性结果表明，一些提供者故意不与他们认为没有风险的客户进行筛查，而工作量可能导致筛查率低。定性访谈表明，提供者和客户都接受了 Test and Prevent。客户在 HIV 检测后了解到 PrEP 非常高兴，而伴随转介和快速跟踪的额外支持鼓励他们接受 PrEP，使他们感到自己很有价值。提供者因工作量受限而感到负担沉重，但认为 Test and Prevent 很重要，应该在其他地点推广。
从提供者和客户的角度来看，发现将 HIV 检测结果为阴性的客户立即与 PrEP 联系起来是可以接受的，但为了使该方案产生更大的影响，还需要更仔细地检查和加强筛查程序。
