Department of International Health, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Wilmer Eye Institute, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.
Int J STD AIDS. 2022 Oct;33(11):995-1004. doi: 10.1177/09564624221121208. Epub 2022 Aug 25.
Effective models of support for HIV pre-exposure prophylaxis (PrEP) are needed for populations at elevated risk. In a hyperendemic Ugandan fishing community, PrEP counseling was provided through a situated Information, Motivation, and Behavioral Skills (sIMB)-based community health worker (CHW) intervention. We evaluated the intervention using a mixed-methods, implementation science design.
We surveyed all community members aged 15-49 through the Rakai Community Cohort Study. We used multivariable logistic regressions with generalized estimating equations to estimate the intervention's effect on PrEP knowledge and utilization. To understand intervention experiences and mechanisms, we conducted 74 qualitative interviews with 5 informant types (clients, CHWs, program staff, community leaders, health clinic staff) and analyzed data using an iterative, deductive approach. A mobile phone application provided intervention process implementation data.
Individuals self-reporting receipt of the CHW intervention showed significantly higher PrEP knowledge (N = 1848, PRR: 1.10, 95% CI: 1.06-1.14, = <.0001), PrEP ever use (N = 1176, PRR: 1.77, 95% CI: 1.33-2.36, = <.0001), and PrEP current use (N = 1176, PRR: 1.86, 95% CI: 1.22-2.82, p = 0.0039) compared to those who did not. Qualitative findings attributed positive PrEP outcomes to CHW counseling and effective use of motivational interviewing skills by CHWs. Salient themes across the RE-AIM framework included support for the CHW intervention and PrEP across clients, community, and implementers. Mobile application data demonstrated consistent delivery of the PrEP module throughout implementation.
CHWs improved PrEP knowledge and use among clients in an HIV hyperendemic fishing community. Mixed-methods, implementation science evaluations can inform adaptation of similar PrEP implementation strategies.
需要为高危人群提供有效的 HIV 暴露前预防（PrEP）支持模式。在乌干达一个高度流行的渔业社区中，PrEP 咨询是通过基于情境的信息、动机和行为技能（sIMB）的社区卫生工作者（CHW）干预提供的。我们采用混合方法、实施科学设计来评估该干预。
我们通过 Rakai 社区队列研究对所有年龄在 15-49 岁的社区成员进行了调查。我们使用广义估计方程的多变量逻辑回归来估计干预对 PrEP 知识和利用的影响。为了了解干预经验和机制，我们对 5 种信息来源类型（客户、CHW、项目工作人员、社区领导、卫生诊所工作人员）进行了 74 次定性访谈，并使用迭代、演绎方法进行了数据分析。移动电话应用程序提供了干预过程实施数据。
自我报告接受 CHW 干预的个体表现出 PrEP 知识显著更高（N=1848，PRR：1.10，95%CI：1.06-1.14， = <.0001）、PrEP 既往使用（N=1176，PRR：1.77，95%CI：1.33-2.36， = <.0001）和 PrEP 当前使用（N=1176，PRR：1.86，95%CI：1.22-2.82，p=0.0039）高于未接受干预者。定性结果归因于 CHW 咨询和 CHW 有效使用动机访谈技巧对 PrEP 的积极影响。RE-AIM 框架中的突出主题包括客户、社区和实施者对 CHW 干预和 PrEP 的支持。移动应用程序数据表明，在整个实施过程中 PrEP 模块始终得到一致交付。
CHW 提高了 HIV 高度流行的渔业社区中客户对 PrEP 的知识和使用。混合方法、实施科学评估可以为类似的 PrEP 实施策略的调整提供信息。
