Mataboge Paballo, Nzenze Susan, Mthimkhulu Nqaba, Mazibuko Mbali, Kutywayo Alison, Butler Vusile, Naidoo Nicolette, Mullick Saiqa
Faculty of Health Sciences, Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa.
Front Reprod Health. 2023 Jan 9;4:1081049. doi: 10.3389/frph.2022.1081049. eCollection 2022.
In South Africa, youth experience challenges with oral Pre-Exposure Prophylaxis (PrEP) access and uptake. Taking services out of healthcare settings has the potential to increase reach and overcome these challenges. This paper presents young and older people's preferences for decentralized, simplified PrEP service delivery and new long-acting HIV prevention methods, in Ga-Rankuwa, South Africa.
Between May and August 2021, both PrEP user and non-user adolescent girls and young women (AGYW), pregnant AGYW, female sex workers, adolescent boys and young men (ABYM), and men who have sex with men (MSM) were recruited to participate in focus group discussions (FDGs) in Ga-Rankuwa, Gauteng. Twenty-two FGDs were conducted. Participants were asked about PrEP uptake, potential acceptability of long-acting HIV prevention products, provision of integrated, simplified, and decentralized services, and digital tools to facilitate access to PrEP and other SRH services. A qualitative approach using inductive thematic analysis was carried out to explore emerging themes on decentralized, simplified delivery and the acceptability of long-acting methods.
Of the 109 participants included in the study approximately 45% ( = 50) were female, the median age was 23 years ± 5.3. A third ( = 37) were current or previous PrEP users, of which, 59.5% ( = 22) collected PrEP refills from the clinic. Decentralized, simplified service delivery was appealing; health facilities, pharmacies and institutions of learning were preferred as service points for PrEP and SRH services, and recreational spaces preferred for dissemination of health information and engagement. ABYM were more open to having recreational spaces as service points. Long-acting Cabotegravir was preferred over the Dapivirine Vaginal Ring due to concerns around perceived side-effects, efficacy, and comfort.
Providing long-acting PrEP methods through decentralized, simplified service delivery was appealing to this population. They provided practical locations for decentralized service provision to potentially increase their engagement with and uptake of HIV prevention and SRH services.
在南非，年轻人在获取和使用口服暴露前预防（PrEP）方面面临挑战。将服务带出医疗保健机构有可能扩大覆盖范围并克服这些挑战。本文介绍了南非加兰夸瓦地区年轻人和年长者对分散化、简化的PrEP服务提供方式以及新型长效艾滋病毒预防方法的偏好。
2021年5月至8月期间，招募了PrEP使用者和非使用者中的青春期少女和年轻女性（AGYW）、怀孕的AGYW、女性性工作者、青春期男孩和年轻男性（ABYM）以及男男性行为者（MSM），在豪登省加兰夸瓦地区参与焦点小组讨论（FDG）。共进行了22次焦点小组讨论。参与者被问及PrEP的使用情况、长效艾滋病毒预防产品的潜在可接受性、提供综合、简化和分散化服务以及便于获取PrEP和其他性与生殖健康服务的数字工具。采用归纳主题分析的定性方法来探索关于分散化、简化服务提供以及长效方法可接受性的新出现主题。
在纳入研究的109名参与者中，约45%（n = 50）为女性，中位年龄为23岁±5.3岁。三分之一（n = 37）为当前或以前的PrEP使用者，其中59.5%（n = 22）从诊所领取PrEP补充剂。分散化、简化的服务提供方式很有吸引力；卫生设施、药店和学习机构被选为PrEP和性与生殖健康服务的服务点，而娱乐场所则被选为传播健康信息和进行互动的首选地点。ABYM对将娱乐场所作为服务点更为开放。由于对感知到的副作用、疗效和舒适度的担忧，长效卡博特韦比达匹维林阴道环更受青睐。
通过分散化、简化的服务提供方式提供长效PrEP方法对这一人群具有吸引力。它们为分散化服务提供提供了实际地点，有可能增加他们对艾滋病毒预防和性与生殖健康服务的参与度和使用率。
