Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
Friends in Global Health, Maputo, Mozambique.
Glob Health Action. 2021 Jan 1;14(1):1940764. doi: 10.1080/16549716.2021.1940764.
Pre-exposure prophylaxis (PrEP) has the potential to reduce HIV transmission and stem the HIV epidemic. Unfortunately, PrEP uptake in rural sub-Saharan Africa has been slow and medication adherence has been suboptimal.
To explore the perspectives, attitudes, and experiences of HIV serodiscordant partners taking PrEP and develop a messaging campaign to improve PrEP uptake in rural Mozambique to reduce HIV transmission among serodiscordant partners.
In this qualitative study, we interviewed 20 people in serodiscordant relationships using PrEP at a rural health center in Zambézia province, Mozambique and employed inductive and deductive coding to elicit their perspectives, attitudes, and experiences related to learning their partner's HIV status, barriers to PrEP uptake, obstacles to PrEP adherence, and decisions to disclose their PrEP use with family and friends using thematic analysis.
Our analysis generated nine themes across various levels of the socioecological model. Participants reported a strong desire to stay in the discordant relationship and highlighted the importance of working together to ensure PrEP and antiretroviral therapy adherence, with the majority skeptical that adherence could be achieved without both partners' support (individual and interpersonal). Although most participants were reticent about sharing their serodiscordant status with family and friends (individual and interpersonal), those who did found their family and friends supportive (interpersonal). Participants suggested increasing community health agent availability to help people navigate HIV prevention and treatment (organizational). We then created three oral stories, using themes from the interviews, with examples from various levels of the socioecological model that will be used to generate support for PrEP use among community members.
Our findings informed oral template stories that will be used to emphasize how couples can work together to improve PrEP uptake and reduce incident HIV infections in serodiscordant couples elsewhere in rural Mozambique.
暴露前预防（PrEP）有可能减少 HIV 传播并遏制 HIV 疫情。不幸的是，撒哈拉以南非洲农村地区的 PrEP 使用率一直较低，药物依从性也不理想。
探索正在服用 PrEP 的 HIV 血清不一致伴侣的观点、态度和经验，制定信息宣传活动，以提高莫桑比克农村地区的 PrEP 使用率，减少血清不一致伴侣之间的 HIV 传播。
在这项定性研究中，我们采访了赞比西亚省农村卫生中心正在使用 PrEP 的 20 对血清不一致的伴侣，采用归纳和演绎编码方法，从了解伴侣 HIV 状况、PrEP 使用率的障碍、PrEP 坚持的障碍以及决定向家人和朋友透露 PrEP 使用情况等方面，引出他们的观点、态度和经验，采用主题分析法进行分析。
我们的分析在社会生态模型的各个层面生成了 9 个主题。参与者报告了强烈的维持血清不一致关系的愿望，并强调了共同努力确保 PrEP 和抗逆转录病毒治疗依从性的重要性，大多数人怀疑如果没有双方的支持（个人和人际间），就不可能实现依从性。尽管大多数参与者对与家人和朋友分享血清不一致状况持保留态度（个人和人际间），但那些确实这样做的人发现他们的家人和朋友是支持的（人际间）。参与者建议增加社区卫生工作者的可用性，以帮助人们了解 HIV 预防和治疗（组织）。然后，我们使用访谈中的主题，从社会生态模型的各个层面创建了三个口头故事示例，这些故事将用于在社区成员中争取对 PrEP 使用的支持。
我们的研究结果为口头模板故事提供了信息，这些故事将用于强调夫妻如何共同努力提高 PrEP 使用率，并减少莫桑比克农村其他地区血清不一致夫妇中的新发 HIV 感染。
