Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa.
J Int AIDS Soc. 2022 Jul;25(7):e25968. doi: 10.1002/jia2.25968.
Community-based delivery of HIV pre-exposure prophylaxis (PrEP) to South African adolescent girls and young women's (AGYW) could increase access but needs evaluation. We integrated PrEP services via home-based services and pop-up tents into existing community-based HIV testing services (CB-HTS) in Eastern Cape Province, South Africa.
After accessing CB-HTS via a "pop-up" tent or home-based services, HIV-negative AGYW aged 16-25 years were invited to complete a baseline questionnaire and referred for PrEP services at a community-based PrEP site co-located with pop-up HTS tents. A 30-day supply of PrEP was dispensed. PrEP uptake, time-to-initiation, cohort characteristics and first medication refill within 90 days were measured using descriptive statistics.
Of the 1164 AGYW who tested for HIV, 825 (74.3%) completed a questionnaire and 806 (97.7%) were referred for community-based PrEP. Of those, 624 (77.4%) presented for PrEP (482/483 [99.8%] from pop-up HTS and 142/323 [44.0%] from home-based HTS), of which 603 (96.6%) initiated PrEP. Of those initiating PrEP following home-based HTS, 59.1% initiated within 0-3 days, 25.6% within 4-14 days and 15.3% took ≥15 days to initiate; 100% of AGYW who used pop-up HTS initiated PrEP the same day. Among AGWY initiating PrEP, 37.5% had a detectable sexually transmitted infection (STI). Although AGYW reported a low self-perception of HIV risk, post-hoc application of HIV risk assessment measures to available data classified most study participants as high risk for HIV acquisition. Cumulatively, 329 (54.6%) AGYW presented for a first medication refill within 90 days of accepting their first bottle of PrEP.
Leveraging CB-HTS platforms to provide same-day PrEP initiation and refill services was acceptable to AGYW. A higher proportion of AGYW initiated PrEP when co-located with CB-HTS sites compared to those referred following home-based HTS, suggesting that proximity of CB-HTS and PrEP services facilitates PrEP uptake among AGYW. The high prevalence of STIs among those initiating PrEP necessitates the integration of STI and HIV prevention programs for AGYW. Eligibility for PrEP initiation should not be required among AHYW in high HIV burden communities. Community-based service delivery will be crucial to maintaining access to PrEP services during the COVID-19 pandemic and future health and humanitarian emergencies.
在南非东开普省，通过家庭服务和临时帐篷将艾滋病毒暴露前预防（PrEP）的社区提供服务融入现有的社区艾滋病毒检测服务（CB-HTS），可以增加获取途径，但需要进行评估。
HIV 阴性的年龄在 16-25 岁的 AGYW 通过“弹出”帐篷或家庭服务访问 CB-HTS 后，被邀请完成基线问卷调查，并在社区 PrEP 点接受 PrEP 服务，该社区 PrEP 点与弹出 HTS 帐篷位于同一地点。提供 30 天的 PrEP 药物供应。使用描述性统计方法测量 PrEP 的使用情况、起始时间、队列特征和在 90 天内的第一次药物续配情况。
在 1164 名接受 HIV 检测的 AGYW 中，825 名（74.3%）完成了问卷调查，806 名（97.7%）被转介接受社区 PrEP。其中，有 624 名（77.4%）接受了 PrEP（482/483[99.8%]来自弹出式 HTS，142/323[44.0%]来自家庭式 HTS），其中 603 名（96.6%）开始使用 PrEP。在接受家庭式 HTS 转介后开始使用 PrEP 的人群中，59.1%在 0-3 天内开始，25.6%在 4-14 天内开始，15.3%在 15 天以上开始；100%使用弹出式 HTS 的 AGYW 当天开始使用 PrEP。在开始使用 PrEP 的 AGWY 中，37.5%有可检测到的性传播感染（STI）。尽管 AGYW 对自身 HIV 风险的认知较低，但根据现有数据应用 HIV 风险评估措施后，大多数研究参与者被归类为 HIV 感染高风险。累计有 329 名（54.6%）AGYW 在接受第一瓶 PrEP 后的 90 天内接受了第一次药物续配。
利用 CB-HTS 平台提供当日 PrEP 起始和续配服务，被 AGYW 接受。与接受家庭式 HTS 转介后开始使用 PrEP 的人群相比，当与 CB-HTS 地点同时提供 PrEP 时，更多的 AGYW 开始使用 PrEP，这表明 CB-HTS 和 PrEP 服务的接近程度有助于 AGYW 接受 PrEP。在开始使用 PrEP 的人群中，性传播感染的高患病率需要为 AGYW 整合性传播感染和艾滋病毒预防计划。在高 HIV 负担社区中，不应该要求 AGYW 具备 PrEP 启动的资格。社区服务的提供将对在 COVID-19 大流行期间和未来的健康和人道主义紧急情况下维持 PrEP 服务的获取至关重要。
