Muwonge Timothy R, Nsubuga Rogers, Ware Norma C, Wyatt Monique A, Pisarski Emily, Kamusiime Brenda, Kasiita Vicent, Nalukwago Grace Kakoola, Brown Charles, Nakyanzi Agnes, Bagaya Monica, Bambia Felix, Ssebuliba Timothy, Katabira Elly, Kyambadde Peter, Baeten Jared M, Heffron Renee, Celum Connie, Mujugira Andrew, Haberer Jessica E
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Harvard Medical School, Boston, MA, United States.
Front Public Health. 2022 Apr 4;10:658826. doi: 10.3389/fpubh.2022.658826. eCollection 2022.
Scale-up of HIV pre-exposure prophylaxis (PrEP) services in Uganda is ongoing. However, health care workers (HCWs) may not be aware of PrEP nor what offering this service entails. We explored the impact of standardized HCW training on the knowledge and perspectives of PrEP service delivery in Uganda.
We recruited HCWs from facilities that offered HIV-related services in Central Uganda. Using the Uganda Ministry of Health curriculum, we trained HCWs on PrEP services. We collected data about PrEP knowledge, preparedness, and willingness to deliver PrEP to multiple key populations before the training, immediately after the training, and >6 months later (exit). We additionally conducted 15 qualitative interviews after the exit survey. Quantitative data were analyzed by Fisher exact test, while qualitative interview data were analyzed inductively.
We recruited 80 HCWs from 35 facilities in urban ( = 24, 30%), peri-urban ( = 30, 37%), and rural ( = 26, 33%) areas. Most HCWs were nurse counselors ( = 52, 65%) or medical/clinical officers ( = 15, 18%). Surveys indicated that awareness of PrEP increased after the training and remained high. Knowledge of PrEP (i.e., as an effective, short-term antiretroviral medication to use before HIV exposure for people at high risk) generally increased with training, but significant gaps remained, and knowledge decreased with time. Most HCWs recommended PrEP for female sex workers and HIV serodifferent couples, as well as other key populations. We observed increases in the number of HCW who felt their facility was prepared to cater for HIV prevention and provide PrEP, but this view was not universal. HCWs believed in PrEP effectiveness and embraced it as an additional HIV prevention method. Concerns included patient adherence and behavioral risk compensation. HCWs noted challenges in PrEP delivery in terms of inadequate clinic preparedness, infrastructure, staff capacity, and poor attitudes toward key populations by untrained health workers. They felt further training was needed to ensure a smooth scale-up of services without stigmatization.
Standardized training improved knowledge, willingness, and preparedness to offer PrEP services among most HCWs in Central Uganda. Ongoing training will be needed to optimize PrEP delivery services and expand delivery to levels needed for population-level impact.
乌干达正在扩大艾滋病毒暴露前预防（PrEP）服务。然而，医护人员可能并不了解PrEP，也不清楚提供这项服务需要承担什么。我们探讨了标准化的医护人员培训对乌干达PrEP服务提供的知识和观点的影响。
我们从乌干达中部提供艾滋病毒相关服务的机构招募医护人员。利用乌干达卫生部的课程，我们对医护人员进行了PrEP服务培训。我们在培训前、培训后立即以及6个月后（退出时）收集了有关PrEP知识、准备情况以及向多个关键人群提供PrEP的意愿的数据。我们还在退出调查后进行了15次定性访谈。定量数据采用Fisher精确检验进行分析，而定性访谈数据采用归纳法进行分析。
我们从城市（n = 24，30%）、城郊（n = 30，37%）和农村（n = 26，33%）地区的35个机构招募了80名医护人员。大多数医护人员是护士顾问（n = 52，65%）或医疗/临床官员（n = 15，18%）。调查表明，培训后对PrEP的认识有所提高且保持在较高水平。对PrEP的知识（即作为一种有效的短期抗逆转录病毒药物，供高危人群在接触艾滋病毒前使用）通常随着培训而增加，但仍存在显著差距，并且知识随着时间而减少。大多数医护人员建议为女性性工作者、艾滋病毒血清学不同的伴侣以及其他关键人群提供PrEP。我们观察到认为其所在机构准备好提供艾滋病毒预防和PrEP的医护人员数量有所增加，但这种观点并不普遍。医护人员相信PrEP的有效性，并将其作为一种额外的艾滋病毒预防方法接受。担忧包括患者的依从性和行为风险补偿。医护人员指出，在PrEP服务提供方面存在挑战，包括诊所准备不足、基础设施、工作人员能力以及未经培训的卫生工作者对关键人群态度不佳。他们认为需要进一步培训，以确保服务顺利扩大规模且不产生污名化。
标准化培训提高了乌干达中部大多数医护人员提供PrEP服务的知识、意愿和准备情况。需要持续培训以优化PrEP服务提供，并将服务扩大到产生人群层面影响所需的水平。
