Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda.
IAVI, Nairobi, Kenya.
J Int AIDS Soc. 2022 May;25(5):e25909. doi: 10.1002/jia2.25909.
Oral pre-exposure prophylaxis (PrEP) has been scaled up; however, data from real-world settings are limited. We studied oral PrEP preference, uptake, adherence and continuation among adolescent girls and young women (AGYW) vulnerable to HIV in sub-Saharan Africa.
We conducted a prospective cohort study among 14- to 24-year-old AGYW without HIV who were followed for 12 months in Kampala, Uganda. Within at least 14 days of enrolment, they received two education sessions, including demonstrations on five biomedical interventions that are; available (oral PrEP), will be available soon (long-acting injectable PrEP and anti-retroviral vaginal ring) and in development (PrEP implant and HIV vaccine). Information included mode and frequency of delivery, potential side effects and method availability. Volunteers ranked interventions, 1 = most preferred to 5 = least preferred. Oral PrEP was "preferred" if ranked among the top two choices. All were offered oral PrEP, and determinants of uptake assessed using Poisson regression with robust error variance. Adherence was assessed using plasma tenofovir levels and self-reports.
Between January and October 2019, 532 volunteers were screened; 285 enrolled of whom 265 received two education sessions. Mean age was 20 years (SD±2.2), 92.8% reported paid sex, 20.4% reported ≥10 sexual partners in the past 3 months, 38.5% used hormonal contraceptives, 26.9% had chlamydia, gonorrhoea and/or active syphilis. Of 265 volunteers, 47.6% preferred oral PrEP. Willingness to take PrEP was 90.2%; however, uptake was 30.6% (n = 81). Following enrolment, 51.9% started PrEP on day 14 (same day PrEP offered), 20.9% within 30 days and 27.2% after 30 days. PrEP uptake was associated with more sexual partners in the past 3 months: 2-9 partners (aRR = 2.36, 95% CI: 1.20-4.63) and ≥10 partners (aRR 4.70, 95% CI 2.41-9.17); oral PrEP preference (aRR 1.53, 95% CI 1.08-2.19) and being separated (aRR 1.55, 95% CI 1.04-2.33). Of 100 samples from 49 volunteers during follow up, 19 had quantifiable tenofovir levels (>10 μg/L) of which only three were protective (>40 μg/L).
Half of AGYW preferred oral PrEP, uptake and adherence were low, uptake was associated with sexual behavioural risk and oral PrEP preference. Development of alternative biomedical products should be expedited to meet end-user preferences and, community delivery promoted during restricted movement.
口腔暴露前预防（PrEP）已经得到了推广；然而，来自真实世界环境的数据有限。我们研究了撒哈拉以南非洲地区易感染艾滋病毒的青少年女孩和年轻女性（AGYW）中口腔 PrEP 的偏好、采用、依从性和持续性。
我们在乌干达坎帕拉对年龄在 14 至 24 岁之间、未感染艾滋病毒的 AGYW 进行了一项前瞻性队列研究。在登记后的至少 14 天内，他们接受了两次教育课程，包括对五种生物医学干预措施的演示，这些干预措施是：可获得（口服 PrEP）、即将获得（长效注射型 PrEP 和抗逆转录病毒阴道环）和正在开发中（PrEP 植入物和 HIV 疫苗）。信息包括模式和频率的交付、潜在的副作用和方法的可用性。志愿者对干预措施进行了排名，1=最受欢迎，5=最不受欢迎。如果排名在前两名，则认为口服 PrEP“受欢迎”。所有志愿者都提供了口服 PrEP，并使用泊松回归和稳健误差方差评估了采用的决定因素。通过检测血浆替诺福韦水平和自我报告评估依从性。
2019 年 1 月至 10 月期间，共筛查了 532 名志愿者；其中 285 名入组，其中 265 名接受了两次教育课程。平均年龄为 20 岁（标准差±2.2），92.8%报告有有偿性行为，20.4%报告在过去 3 个月内有≥10 个性伴侣，38.5%使用激素避孕药，26.9%有衣原体、淋病和/或活动性梅毒。在 265 名志愿者中，47.6%首选口服 PrEP。愿意服用 PrEP 的比例为 90.2%；然而，采用率为 30.6%（n=81）。登记后，51.9%的人在第 14 天（即提供同日 PrEP）开始服用 PrEP，20.9%在 30 天内，27.2%在 30 天后。PrEP 的采用与过去 3 个月内更多的性伴侣有关：2-9 个伴侣（ARR=2.36，95%CI：1.20-4.63）和≥10 个伴侣（ARR 4.70，95%CI 2.41-9.17）；口服 PrEP 偏好（ARR 1.53，95%CI 1.08-2.19）和分居（ARR 1.55，95%CI 1.04-2.33）。在随访期间，49 名志愿者中有 100 个样本进行了检测，其中 19 个样本的替诺福韦水平可量化（>10μg/L），其中只有 3 个水平具有保护作用（>40μg/L）。
一半的 AGYW 更喜欢口服 PrEP，但采用率和依从性较低，采用与性行为风险和口服 PrEP 偏好有关。应加快开发替代生物医学产品，以满足最终用户的偏好，并在限制行动期间促进社区提供服务。
