肯尼亚和南非青春期女孩和年轻女性中使用预防用抗逆转录病毒药物（PrEP）与 HIV 血清转化率：POWER 示范项目。
PrEP use and HIV seroconversion rates in adolescent girls and young women from Kenya and South Africa: the POWER demonstration project.
机构信息
Department of Global Health, University of Washington, Seattle, Washington, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
出版信息
J Int AIDS Soc. 2022 Jul;25(7):e25962. doi: 10.1002/jia2.25962.
INTRODUCTION
HIV incidence remains high among African adolescent girls and young women (AGYW). The primary objective of this study is to assess pre-exposure prophylaxis (PrEP) initiation, use, persistence and HIV acquisition among African AGYW offered PrEP in order to inform PrEP scale-up.
METHODS
POWER was a prospective implementation science evaluation of PrEP delivery for sexually active HIV-negative AGYW ages 16-25 in family planning clinics in Kisumu, Kenya and youth and primary healthcare clinics in Cape Town and Johannesburg, South Africa. Follow-up visits occurred at month 1 and quarterly for up to 36 months. PrEP users were defined based on the month 1 refill. PrEP persistence through month 6 was assessed using Kaplan-Meier survival analysis among AGYW with a month 1 visit, defining non-persistence as an ≥15 day gap in PrEP availability for daily dosing. PrEP execution was evaluated in a subset with PrEP supply from the prior visit sufficient for daily dosing by measuring blood tenofovir diphosphate (TFV-DP) levels.
RESULTS
From June 2017 to September 2020, 2550 AGYW were enrolled (1000 in Kisumu, 787 in Cape Town and 763 in Johannesburg). Median age was 21 years, 66% had a sexual partner of unknown HIV status, and 29% had chlamydia and 10% gonorrhoea. Overall, 2397 (94%) initiated PrEP and 749 (31%) had a refill at 1 month. Of AGYW who could reach 6 months of post-PrEP initiation follow-up, 128/646 (20%) persisted with PrEP for 6 months and an additional 92/646 (14%) had a gap and restarted PrEP. TFV-DP levels indicated that 47% (91/193) took an average of ≥4 doses/week. Sixteen HIV seroconversions were observed (incidence 2.2 per 100 person-years, 95% CI 1.2, 3.5); 13 (81%) seroconverters either did not have PrEP dispensed in the study interval prior to seroconversion or TFV-DP levels indicated <4 doses/week in the prior 6 weeks.
CONCLUSIONS
In this study of PrEP integration with primary care and reproductive health services for African AGYW, demand for PrEP was high. Although PrEP use decreased in the first months, an important fraction used PrEP through 6 months. Strategies are needed to simplify PrEP delivery, support adherence and offer long-acting PrEP options to improve persistence and HIV protection.
简介
艾滋病毒在非洲青春期女孩和年轻妇女（AGYW）中的发病率仍然很高。本研究的主要目的是评估在提供 PrEP 的非洲 AGYW 中 PrEP 的起始、使用、持续时间和 HIV 获得情况，以便为 PrEP 的扩大提供信息。
方法
POWER 是一项针对在肯尼亚基苏木计划生育诊所和南非开普敦和约翰内斯堡青年和初级保健诊所中对活跃的艾滋病毒阴性年龄在 16-25 岁的 AGYW 进行 PrEP 交付的前瞻性实施科学评估。随访在第 1 个月和每 3 个月进行，最长可达 36 个月。PrEP 用户是根据第 1 个月的补充定义的。对于在第 1 个月就诊的 AGYW，通过 Kaplan-Meier 生存分析评估第 6 个月时的 PrEP 持续时间，将 PrEP 可用性中断≥15 天定义为非持续。在 PrEP 供应足以每日剂量的亚组中评估 PrEP 的执行情况，通过测量血液中的替诺福韦二磷酸酯（TFV-DP）水平来衡量。
结果
从 2017 年 6 月至 2020 年 9 月，共纳入 2550 名 AGYW（基苏木 1000 名，开普敦 787 名，约翰内斯堡 763 名）。中位年龄为 21 岁，66%的人有未知 HIV 状况的性伴侣，29%的人有衣原体感染，10%的人有淋病。总体而言，2397 名（94%）开始使用 PrEP，749 名（31%）在第 1 个月进行了补充。在可以进行 6 个月的 PrEP 起始后随访的 AGYW 中，128/646（20%）在 6 个月时持续使用 PrEP，另外 92/646（14%）有间隔并重新开始使用 PrEP。TFV-DP 水平表明，47%（91/193）平均每周服用≥4 剂。观察到 16 例 HIV 血清转换（发病率为每 100 人年 2.2 例，95%CI1.2，3.5）；13 例（81%）血清转换者在血清转换前的研究间隔内没有开具 PrEP，或在之前的 6 周内 TFV-DP 水平表明每周服用<4 剂。
结论
在这项针对非洲 AGYW 的将 PrEP 与初级保健和生殖健康服务相结合的研究中，PrEP 的需求很高。尽管在前几个月 PrEP 的使用有所减少，但仍有相当一部分人使用 PrEP 6 个月。需要采取简化 PrEP 提供、支持依从性和提供长效 PrEP 选择的策略，以提高持续时间和 HIV 保护。
Zotero 插件