Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
Kenya Medical Research Institute, Nairobi, Kenya.
Front Public Health. 2022 Oct 6;10:932948. doi: 10.3389/fpubh.2022.932948. eCollection 2022.
BACKGROUND: Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but uptake remains low, especially among adolescent girls and young women (AGYW) in Kenya. A model in which trained AGYW using PrEP deliver HIV self-tests to their close friends and refer them to PrEP may help increase PrEP uptake in this population. To understand AGYW's potential willingness to engage in such a model, we conducted a qualitative formative study in Kenya. METHOD: We conducted semi-structured in-depth interviews (IDIs) with AGYW (16 to 24 years) in Kiambu County who were determined at risk of HIV acquisition. We purposively recruited "PrEP-naïve" (no prior PrEP use) and "PrEP-experienced" AGYW who used PrEP for at least 1 month within the previous year. We solicited perspectives on initiating/engaging in conversations about HIV risk and PrEP, distributing/receiving HIV self-test kits, and referring/following through on a referral to clinic-based HIV services. We analyzed verbatim transcripts using rapid qualitative analysis and a combination of inductive and deductive approaches, with the latter informed by the Integrated Behavior Model (IBM). RESULTS: From August to December 2020, we conducted 30 IDIs: 15 with PrEP-experienced and 15 with PrEP-naïve AGYW. Participants' median age was 20 [interquartile range (IQR): 20-22]. Overall, most participants anticipated that they would be willing to engage in this model. PrEP-experienced AGYW emphasized the salience of their concerns about friends' HIV risk behaviors, with several noting that they are already in the habit of discussing PrEP with friends. Many additionally expressed positive attitudes toward the proposed target behaviors, perceived these to be normative among AGYW, and expressed confidence in their ability to carry out the behaviors with proper support. Although few participants had HIVST experience, nearly all anticipated they would be able to use an HIV self-test kit correctly if provided instruction. CONCLUSION: The Kenyan AGYW who participated in this study generally anticipated that they would be willing to engage in a formal peer PrEP referral model enhanced with peer-delivered HIV self-tests. Future research is needed to pilot test this model to determine its acceptability, feasibility, and effect on HIVST and PrEP uptake within this population.
背景:暴露前预防(PrEP)对预防 HIV 非常有效,但使用率仍然很低,尤其是在肯尼亚的青少年女孩和年轻妇女(AGYW)中。一种模式是,经过培训的 AGYW 使用 PrEP 为她们的亲密朋友提供 HIV 自检,并将其转介到 PrEP 服务中,这可能有助于增加该人群对 PrEP 的使用。为了了解 AGYW 参与这种模式的潜在意愿,我们在肯尼亚进行了一项定性形成性研究。
方法:我们对基安布县的 AGYW(16 至 24 岁)进行了半结构式深入访谈(IDIs),这些 AGYW 被确定有感染 HIV 的风险。我们有目的地招募了“PrEP 初治”(以前未使用过 PrEP)和“PrEP 经验”的 AGYW,他们在过去一年中至少使用 PrEP 1 个月。我们征求了她们对发起/参与有关 HIV 风险和 PrEP 的对话、分发/接收 HIV 自检包以及转介/跟进到诊所为基础的 HIV 服务的看法。我们使用快速定性分析和归纳法和演绎法相结合的方法分析逐字记录,后者受综合行为模型(IBM)的启发。
结果:2020 年 8 月至 12 月,我们进行了 30 次 IDIs:15 次与 PrEP 经验丰富的 AGYW 进行,15 次与 PrEP 初治的 AGYW 进行。参与者的中位年龄为 20 岁[四分位距(IQR):20-22]。总体而言,大多数参与者预计他们会愿意参与这种模式。PrEP 经验丰富的 AGYW 强调了她们对朋友 HIV 风险行为的关注,一些人表示她们已经习惯了与朋友讨论 PrEP。许多人还对拟议的目标行为持积极态度,认为这些行为在 AGYW 中是正常的,并对自己在适当支持下实施这些行为的能力有信心。尽管很少有参与者有 HIVST 经验,但几乎所有人都预计,如果提供指导,他们将能够正确使用 HIV 自检试剂盒。
结论:参与这项研究的肯尼亚 AGYW 普遍预计他们愿意参与一个有同伴提供的 PrEP 转介模式,该模式辅以同伴提供的 HIV 自检。需要进一步研究来试点测试该模型,以确定其在该人群中对 HIVST 和 PrEP 使用的可接受性、可行性和效果。
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