Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS One. 2023 Oct 9;18(10):e0285132. doi: 10.1371/journal.pone.0285132. eCollection 2023.
HIV remains a leading contributor to the disease burden in sub-Saharan Africa, with adolescents and young people disproportionately affected. Optimising pre-exposure prophylaxis (PrEP) uptake has predominantly focused on women and adult men who have sex with men. We explore adolescent boys and young men's PrEP uptake preferences in South Africa, Uganda, and Zimbabwe.
A cross-sectional sequential exploratory mixed-methods study amongst males aged 13-24 years was conducted between April and September 2019 as part of the CHAPS trial. Group discussions (GDs) and In-Depth Interviews (IDIs) focused on motivations and hindrances for HIV testing, PrEP preference, and reasons for the uptake of PrEP. A thematic approach was used to analyse the qualitative data. A quantitative survey following the qualitative work covered questions on demographics, HIV risk and PrEP preferences (on-demand vs. daily). For quantitative analysis, we fitted logistic regression models to determine factors associated with on-demand vs daily PrEP preference.
Overall, 647 adolescent boys and young men (median age 20, IQR: 17-22) were enrolled. Of these, 422 (65.22%) preferred on-demand PrEP (South Africa 45.45%, Uganda 76.80%, Zimbabwe 70.35%; p<0.001). Factors independently associated with on-demand PrEP included country (South Africa, adjusted odds ratio (aOR) = 0.19 [95%CI:0.1-0.3] compared to Uganda) and advanced planning of sex [>24 hours in advance aOR = 1.4 (0.9-2.3) compared to <2 hours]. Qualitatively, participants commonly believed they were not at risk of HIV acquisition most of the time and thought that on-demand PrEP would be suitable as they tend to plan sexual activity in advance.
Preference for on-demand PrEP is high in young males. The qualitative data support a preference for on-demand PrEP in those who plan sex in advance. HIV intervention programs should offer both on-demand and daily PrEP to engage more adolescent boys and young men in HIV prevention practices.
艾滋病毒仍然是撒哈拉以南非洲地区疾病负担的主要原因，青少年和年轻人受影响的比例不成比例。优化暴露前预防 (PrEP) 的使用率主要集中在女性和与男性发生性关系的成年男性身上。我们探讨了南非、乌干达和津巴布韦的青少年男孩和年轻男性使用 PrEP 的情况。
这是一项横断面序贯探索性混合方法研究，研究对象为年龄在 13-24 岁之间的男性，于 2019 年 4 月至 9 月期间作为 CHAPS 试验的一部分进行。小组讨论 (GDs) 和深入访谈 (IDIs) 重点关注艾滋病毒检测的动机和障碍、PrEP 偏好以及使用 PrEP 的原因。采用主题方法分析定性数据。在定性工作之后进行的定量调查涵盖了人口统计学、艾滋病毒风险和 PrEP 偏好（按需与每日）的问题。对于定量分析，我们拟合了逻辑回归模型来确定与按需与每日 PrEP 偏好相关的因素。
共有 647 名青少年男孩和年轻男性（中位数年龄 20 岁，IQR：17-22）入组。其中，422 名（65.22%）更喜欢按需 PrEP（南非 45.45%，乌干达 76.80%，津巴布韦 70.35%；p<0.001）。与按需 PrEP 相关的独立因素包括国家（南非，调整后的优势比 (aOR) = 0.19 [95%CI：0.1-0.3]，与乌干达相比）和提前规划性行为[提前 24 小时以上 aOR = 1.4（0.9-2.3），与提前 2 小时相比]。从定性角度来看，参与者普遍认为他们大部分时间都没有感染艾滋病毒的风险，并且认为按需 PrEP 会很合适，因为他们往往会提前计划性行为。
年轻男性对按需 PrEP 的偏好很高。定性数据支持那些提前计划性行为的人对按需 PrEP 的偏好。艾滋病毒干预项目应同时提供按需和每日 PrEP，以促使更多的青少年男孩和年轻男性参与艾滋病毒预防实践。
