The Infectious Diseases Institute Limited, Makerere University, Kampala, Uganda.
Department of Global Health, University of Washington, Seattle, Washington, USA.
J Int AIDS Soc. 2023 Dec;26(12):e26201. doi: 10.1002/jia2.26201.
Peer delivery is a client-centred approach that could maximize the coverage and impact of HIV services for transgender women (TGW). We conducted qualitative interviews to examine how peer-delivered HIV self-testing (HIVST), sexually transmitted infection self-sampling (STISS) and oral pre-exposure prophylaxis (PrEP) influenced prevention choices among TGW and their intimate partners in Uganda.
Within a cluster randomized trial of peer-delivered HIVST, STISS and PrEP among HIV-negative TGW (NCT04328025), we conducted 55 qualitative interviews with 30 TGW, 15 intimate partners and 10 TGW peers (August 2021-February 2022). TGW interviews explored: (1) HIV self-test and PrEP experiences; (2) HIVST with intimate partners; and (3) descriptions of self-sampling for STI testing. Partner interviews covered: (1) experiences with HIVST; (2) disclosure of HIV status to intimate partner; and (3) descriptions of sexual behaviours after testing. Peer interview topics included: (1) intervention delivery experiences; and (2) recommendations for peer-delivered HIV prevention services to TGW, including psychological support and coping strategies. Qualitative data were analysed using an inductive content analytic approach.
Peer-delivered combination prevention was valued by this group of TGW and their partners. (1) Peer services extended beyond delivering HIV/STI kits and PrEP refills to caring for individual health and wellbeing by providing stigma coping strategies. Peer psychosocial support empowered research participants to become "HIVST ambassadors," teach non-study TGW about self-testing and PrEP, and encourage linkage to care. (2) HIVST with intimate partners and mutual disclosure of HIV status strengthened partnered relationships. PrEP use after both partners tested HIV negative implied infidelity. (3) Self-sampling enabled TGW to take control of their STI testing and avoid the embarrassment of exposing their bodies. Privacy and confidentiality motivated the uptake of STI testing and treatment.
In this sample of TGW from Uganda, peer delivery of HIVST, STISS and PrEP refills benefitted individual prevention efforts and extended to a new linkage of TGW not engaged in care. Integrating peer services into differentiated PrEP delivery could increase HIV/STI test coverage and PrEP use in this vulnerable population.
同伴提供服务是以客户为中心的方法，可以最大限度地扩大艾滋病毒服务在跨性别女性（TGW）中的覆盖范围和影响。我们进行了定性访谈，以研究在乌干达，同伴提供的艾滋病毒自我检测（HIVST）、性传播感染自我采样（STISS）和口服暴露前预防（PrEP）如何影响 TGW 及其亲密伴侣的预防选择。
在一项针对 HIV 阴性 TGW 的同伴提供的 HIVST、STISS 和 PrEP 的集群随机试验（NCT04328025）中，我们对 30 名 TGW、15 名亲密伴侣和 10 名 TGW 同伴进行了 55 次定性访谈（2021 年 8 月至 2022 年 2 月）。TGW 访谈探讨了：（1）HIV 自我检测和 PrEP 体验；（2）与亲密伴侣进行 HIVST；（3）STI 检测自我采样描述。伴侣访谈涵盖：（1）HIVST 体验；（2）向亲密伴侣披露 HIV 状况；（3）检测后的性行为描述。同伴访谈主题包括：（1）干预提供经验；（2）为 TGW 提供同伴提供的艾滋病毒预防服务的建议，包括心理支持和应对策略。定性数据采用归纳内容分析方法进行分析。
同伴提供的综合预防措施受到了这群 TGW 和他们的伴侣的重视。（1）同伴服务不仅提供 HIV/性传播感染试剂盒和 PrEP 续药，还提供应对污名的策略，从而延伸到照顾个人健康和幸福。同伴心理社会支持使研究参与者能够成为“HIVST 大使”，向非研究 TGW 教授自我检测和 PrEP，并鼓励他们寻求医疗服务。（2）与亲密伴侣进行 HIVST 和共同披露 HIV 状况加强了伴侣关系。如果双方都检测出 HIV 阴性，使用 PrEP 就意味着不忠。（3）自我采样使 TGW 能够控制他们的性传播感染检测，避免暴露身体的尴尬。隐私和保密性促使人们接受性传播感染检测和治疗。
在乌干达的这组 TGW 样本中，HIVST、STISS 和 PrEP 续药的同伴提供服务有利于个人预防工作，并将新的未参与护理的 TGW 联系起来。将同伴服务纳入差异化 PrEP 提供中，可以提高这一脆弱人群的 HIV/性传播感染检测覆盖率和 PrEP 使用。
