以社区为基础的流动诊所模式为南非开普敦的少女和年轻女性提供艾滋病毒预防的 PrEP 服务。

A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa.

机构信息

Desmond Tutu Health Foundation, University of Cape Town, Cape Town, South Africa.

Department of Global Health, University of Washington, Seattle, USA.

出版信息

BMC Health Serv Res. 2021 Aug 28;21(1):888. doi: 10.1186/s12913-021-06920-4.

DOI:10.1186/s12913-021-06920-4

PMID:34454505

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8403426/

Abstract

BACKGROUND

Daily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities.

METHODS

We explored the feasibility and acceptability of providing PrEP to AGYW (aged 16-25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context.

RESULTS

A total of 585 young women started PrEP at the TTT between July 2017 - October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT's integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery.

CONCLUSIONS

PrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs.

摘要

背景

每日服用暴露前预防（PrEP）可将感染艾滋病毒的风险降低 95%以上。在撒哈拉以南非洲，少女和年轻妇女（AGYW）感染艾滋病毒的风险不成比例地高，占新感染人数的 25%。在高艾滋病毒负担社区中，向 AGYW 提供 PrEP 并使其有效获得该服务的实施方法的数据有限。

方法

我们探讨了在南非开普敦，通过名为 Tutu Teen Truck（TTT）的社区移动健康诊所（CMHC）向 AGYW（16-25 岁）提供 PrEP 的可行性和可接受性。TTT 将 PrEP 服务纳入其全面性与生殖健康服务（SRHS）提供中。我们分析了来自社区会议的数据和对 30 名接受 PrEP 的 AGYW 进行的深入访谈，以了解在这种情况下提供 PrEP 的益处和挑战。

结果

在 2017 年 7 月至 2019 年 10 月期间，共有 585 名年轻女性在 Tutu Teen Truck 开始服用 PrEP。在深入访谈中，一小部分 30 名 AGYW 认为 CMHC 干预措施提供 PrEP 是可以接受和方便的。TTT 在 AGYW 自然聚集的时间和社区地点提供服务，从而促进了服务的获取，并为 PrEP 的采用产生了同龄人需求。CMHC 的社区性质，以及其对青少年友好的医疗服务提供者，培养了信任的提供者-社区-客户关系，并增强了 AGYW 的艾滋病毒预防自我效能。PrEP 和 SRHS 服务的整合得到了 AGYW 的高度重视。尽管 TTT 在社区中的整合促进了 PrEP 提供模式的可接受性，但社区面临的挑战（社区骚乱、暴力和恶劣天气条件）有时也会中断 PrEP 的提供。