Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa and African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2022 Aug;25(8):e25975. doi: 10.1002/jia2.25975.
INTRODUCTION: Sub-Saharan Africa (SSA) carries the burden of the HIV epidemic, especially among adolescents and young people (AYP). Little is known about pre-exposure prophylaxis (PrEP) uptake and preferences among AYP in SSA. We describe preferences for daily and on-demand PrEP among AYP in South Africa, Uganda and Zimbabwe. METHODS: A cross-sectional survey was conducted in 2019 among 13- to 24-year olds, capturing socio-demographics, HIV risk behaviours and preferences for daily or on-demand PrEP. Logistic regression models were used to estimate odds ratios, adjusting for site, sex and age. RESULTS AND DISCUSSION: A total of 1330 participants from Cape Town (n = 239), Johannesburg (n = 200), Entebbe (n = 491) and Chitungwiza (n = 400) were enrolled; 673 (51%) were male, and the median age was 19 years (interquartile range 17-22 years). Of 1287 participants expressing a preference, 60% indicated a preference for on-demand PrEP with differences by site (p < 0.001), sex (p < 0.001) and age group (p = 0.003). On-demand PrEP was most preferred in Entebbe (75%), among males (65%) versus females (54%) and in older participants (62% in 18- to 24-year-olds vs. 47% in 13- to 15-year-olds). After adjusting for site, sex and age group, preference for on-demand PrEP decreased as sex frequency over the past month increased (p-trend = 0.004) and varied with the number of partners in the last 6 months, being least popular among those reporting four or more partners (p = 0.02). Participants knowing further in advance that they were likely to have sex were more likely to prefer on-demand PrEP (p-trend = 0.02). Participants having a larger age gap with their most recent partner and participants whose last partner was a transactional sex partner or client were both less likely to prefer on-demand compared to daily PrEP (p = 0.05 and p = 0.09, respectively). Participants who knew their most recent partner was living with HIV or who did not know the HIV status of their most recent partner were less likely to prefer on-demand PrEP (p = 0.05). CONCLUSIONS: Our data show that AYP in four SSA communities prefer on-demand over daily PrEP options, with differences seen by site, age and sex. PrEP demand creation needs to be reviewed, optimized and tailored to socio-demographic differences and designed in conjunction with AYP.
简介：撒哈拉以南非洲（SSA）承担着艾滋病毒流行的负担，尤其是在青少年和年轻人（AYP）中。关于 AYP 在 SSA 中使用暴露前预防（PrEP）的情况和偏好知之甚少。我们描述了 AYP 在南非、乌干达和津巴布韦对每日 PrEP 和按需 PrEP 的偏好。
方法：2019 年在 13 至 24 岁的人群中进行了一项横断面调查，收集社会人口统计学、艾滋病毒风险行为以及对每日或按需 PrEP 的偏好。使用逻辑回归模型估计优势比，并根据地点、性别和年龄进行调整。
结果和讨论：共纳入来自开普敦（n=239）、约翰内斯堡（n=200）、恩德培（n=491）和奇通圭扎（n=400）的 1330 名参与者；673 名（51%）为男性，中位年龄为 19 岁（四分位距 17-22 岁）。在表示偏好的 1287 名参与者中，60%表示更喜欢按需 PrEP，不同地点（p<0.001）、性别（p<0.001）和年龄组（p=0.003）之间存在差异。按需 PrEP 在恩德培最受欢迎（75%），男性（65%）比女性（54%）和年龄较大的参与者（18-24 岁的参与者中 62%，13-15 岁的参与者中 47%）更喜欢。在调整了地点、性别和年龄组后，按需 PrEP 的偏好随着过去一个月性行为频率的增加而降低（p 趋势=0.004），并随过去 6 个月的伴侣数量而变化，与报告有四个或更多伴侣的参与者相比，该偏好最低（p=0.02）。参与者如果提前知道他们很可能发生性行为，他们更有可能选择按需 PrEP（p 趋势=0.02）。与每日 PrEP 相比，与最近的伴侣年龄差距较大的参与者和最近的伴侣是交易性性伴侣或客户的参与者不太可能选择按需 PrEP（p=0.05 和 p=0.09）。知道最近的伴侣感染艾滋病毒或不知道最近的伴侣艾滋病毒状况的参与者不太可能选择按需 PrEP（p=0.05）。
结论：我们的数据表明，来自 SSA 四个社区的 AYP 更倾向于选择按需而非每日 PrEP 方案，不同地点、年龄和性别之间存在差异。需要审查、优化和调整 PrEP 的需求创造，使其与社会人口统计学差异相适应，并与 AYP 共同设计。
Open Forum Infect Dis. 2019-6-14
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