Department of Global Health, University of Washington, Seattle, USA.
Department of Epidemiology, University of Washington, Seattle, WA, USA.
J Int AIDS Soc. 2021 May;24(5):e25703. doi: 10.1002/jia2.25703.
Post-abortion clinics located in regions with high HIV burden may ideal locations to integrate counselling and delivery of HIV pre-exposure prophylaxis (PrEP), aligning with normative goals for integrated delivery of HIV and reproductive health care. The objective of this study was to gauge the degree to which Kenyan women seeking care for a pregnancy loss, including induced abortion, are at risk for HIV and whether women would welcome an introduction to PrEP prior to discharge from post-abortion care.
We conducted a mixed-methods study from August 2019 to February 2020 with women ages 15 to 30 recruited sequentially as they were accessing post-abortion care at public and private facilities in Thika and Kisumu, Kenya. Data collection was through a cross-sectional survey and laboratory testing for common sexually transmitted infections (N = 200), and in-depth interviews (N = 30). Descriptive statistics summarize PrEP knowledge and referrals and a multivariable log-link binomial model estimated correlates of receiving a referral for PrEP. Qualitative data were analysed using inductive and deductive approaches.
Among 200 HIV-negative women (median age 21.0, interquartile range 19.0 to 22.0), the prevalence of Chlamydia trachomatis was 18.2% and Neisseria gonorrhoeae was 2.0%. Half of the women scored ≥5 on a validated tool that would correspond to an expected HIV incidence of 9.5% per year. Approximately half (55.8%) of women were familiar with PrEP prior to the study and 33.3% received a referral from study staff to a clinic offering PrEP. In qualitative interviews, women expressed interest in accessing PrEP from the gynaecology ward that provided post-abortion care but they preferred alternative locations for PrEP refills.
Kenyan women accessing post-abortion care have substantial HIV risk and were favourable about the idea of receiving support to initiate PrEP as part of care offered during post-abortion care. These settings can be integrated into national PrEP programmes as locations providing PrEP referrals and initiation.
位于艾滋病毒负担较高地区的流产后诊所可能是将咨询和提供艾滋病毒暴露前预防（PrEP）结合起来的理想场所，这符合将艾滋病毒和生殖保健综合提供的规范目标。本研究的目的是评估肯尼亚因妊娠丢失（包括人工流产）寻求医疗的女性感染艾滋病毒的风险程度，以及女性是否欢迎在流产后护理出院前介绍 PrEP。
我们于 2019 年 8 月至 2020 年 2 月在肯尼亚蒂卡和基苏木的公立和私立医疗机构中连续招募了 15 至 30 岁的女性，进行了一项混合方法研究。数据收集包括横断面调查和实验室检测常见性传播感染（N=200），以及深入访谈（N=30）。描述性统计总结了 PrEP 知识和转诊情况，多变量逻辑链接二项式模型估计了接受 PrEP 转诊的相关性。使用归纳和演绎方法对定性数据进行分析。
在 200 名 HIV 阴性女性中（中位数年龄 21.0 岁，四分位间距 19.0 至 22.0 岁），沙眼衣原体的患病率为 18.2%，淋病奈瑟菌为 2.0%。一半的女性在一个经过验证的工具上的得分≥5，这与每年预期 HIV 发病率为 9.5%相对应。在研究之前，大约一半（55.8%）的女性熟悉 PrEP，33.3%的女性接受了研究人员的转诊，前往提供 PrEP 的诊所。在定性访谈中，女性对从提供流产后护理的妇科病房获得 PrEP 表示感兴趣，但她们更喜欢其他地方进行 PrEP 续药。
肯尼亚接受流产后护理的女性有较高的艾滋病毒风险，她们对在流产后护理期间获得支持启动 PrEP 的想法表示赞成。这些场所可以纳入国家 PrEP 计划，作为提供 PrEP 转诊和启动的场所。
