University of California San Francisco, San Francisco California, USA.
Kenya Medical Research Institute, Kisumu, Kenya.
AIDS. 2024 Mar 1;38(3):339-349. doi: 10.1097/QAD.0000000000003763. Epub 2023 Oct 19.
HIV prevention service delivery models that offer product choices, and the option to change preferences over time, may increase prevention coverage. Outpatient departments in sub-Saharan Africa diagnose a high proportion of new HIV infections, but are an understudied entry point to biomedical prevention.
Individually randomized trial of dynamic choice HIV prevention (DCP) intervention vs. standard-of-care (SOC) among individuals with current/anticipated HIV exposure risk at outpatient departments in rural Kenya and Uganda (SEARCH; NCT04810650).
Our DCP intervention included 1) product choice (oral preexposure prophylaxis [PrEP] or postexposure prophylaxis [PEP]) with an option to switch over time, 2) HIV provider- or self-testing, 3) service location choice (community vs. clinic-based), and 4) provider training on patient-centered care. Primary outcome was proportion of follow-up covered by PrEP/PEP over 48 weeks assessed via self-report.
We enrolled 403 participants (61% women; median 27 years, IQR 22-37). In the DCP arm, 86% ever chose PrEP, 15% ever chose PEP over 48 weeks; selection of HIV self-testing increased from 26 to 51% and of out-of-facility visits from 8 to 52%. Among 376 of 403 (93%) with outcomes ascertained, time covered by PrEP/PEP was higher in DCP (47.5%) vs. SOC (18.3%); difference = 29.2% (95% confidence interval: 22.7-35.7; P < 0.001). Effects were similar among women and men (28.2 and 31.0% higher coverage in DCP, respectively) and larger during periods of self-reported HIV risk (DCP 64.9% vs. SOC 26.3%; difference = 38.6%; 95% confidence interval: 31.0-46.2; P < 0.001).
A dynamic choice HIV prevention intervention resulted in two-fold greater time covered by biomedical prevention products compared to SOC in general outpatient departments in eastern Africa.
提供产品选择，并允许随着时间的推移改变偏好的艾滋病毒预防服务提供模式，可能会增加预防的覆盖面。撒哈拉以南非洲的门诊部诊断出很高比例的新艾滋病毒感染病例，但作为生物医学预防的一个切入点，还研究得不够充分。
在肯尼亚和乌干达农村的门诊部，对有当前/预期艾滋病毒暴露风险的个体进行动态选择艾滋病毒预防（DCP）干预与标准护理（SOC）的个体进行随机试验（SEARCH；NCT04810650）。
我们的 DCP 干预措施包括：1）产品选择（口服暴露前预防[PrEP]或暴露后预防[PEP]），并允许随着时间的推移进行切换；2）HIV 提供者或自我检测；3）服务地点选择（社区与诊所）；4）对以患者为中心的护理的提供者培训。主要结果是通过自我报告评估的 48 周内 PrEP/PEP 随访的比例。
我们共招募了 403 名参与者（61%为女性；中位数年龄为 27 岁，IQR 为 22-37 岁）。在 DCP 组中，86%的人曾选择 PrEP，15%的人在 48 周内曾选择 PEP；HIV 自我检测的选择率从 26%增加到 51%，而离开设施的就诊率从 8%增加到 52%。在 403 名中有 376 名（93%）的结果确定的参与者中，DCP（47.5%）组的 PrEP/PEP 覆盖时间高于 SOC（18.3%）组；差异为 29.2%（95%置信区间：22.7-35.7；P ＜0.001）。女性和男性之间的效果相似（DCP 分别高出 28.2%和 31.0%），在自我报告的艾滋病毒风险期间更高（DCP 为 64.9%，SOC 为 26.3%；差异为 38.6%；95%置信区间：31.0-46.2；P ＜0.001）。
与一般门诊部的标准护理相比，在东非的综合门诊部中，动态选择艾滋病毒预防干预措施使生物医学预防产品的覆盖时间增加了两倍。
