南非医疗保健使用者对艾滋病毒预防服务提供方式的偏好：一项离散选择实验
Preferences for Delivery of HIV Prevention Services Among Healthcare Users in South Africa: A Discrete Choice Experiment.
作者信息
Martin Catherine Elizabeth, Blaauw Duane, Nongena Pelisa, Chidumwa Glory, Dada Siphokazi, Jack Samantha, Butler Vusile, Mullick Saiqa
机构信息
Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Faculty of Health Sciences, Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
AIDS Behav. 2025 Jan;29(1):331-341. doi: 10.1007/s10461-024-04519-4. Epub 2024 Oct 1.
Progress has been made to scale oral pre-exposure prophylaxis (PrEP) as part of combination HIV prevention, with the WHO recommending differentiated, simplified and demedicalized approaches. This study explored user preferences for components of a PrEP service delivery package, through a discrete choice experiment (DCE) among 307 people accessing primary healthcare services in South Africa between November 2022 and February 2023. Attributes included were: Source of information about HIV prevention and PrEP; Site for PrEP initiation and follow-up; Frequency of follow-up; PrEP pick-up point; HIV testing whilst using PrEP; Contact between appointments. A D-efficient DCE design was created with 16 choice sets in 2 blocks. DCE data were analysed using generalised multinomial logistic models. Compared to printed materials, participants preferred getting information about PrEP online (aOR = 7.73, 95% CI = 5.13-11.66) and through WhatsApp (aOR = 2.23, 95% CI = 0.98-5.55). PrEP initiation at a pharmacy or mobile clinic was valued equally to initiating PrEP at a clinic, but a community pop-up site was less preferred (aOR = 0.46, 95% CI = 0.33-0.64). There was a preference for 6-monthly over 3-monthly follow-up (aOR = 11.88, 95% CI = 5.44-25.94). Participants preferred collecting PrEP from a pharmacy (aOR = 5.02, 95% CI = 3.45-7.31), through home delivery (aOR = 2.18, 95% CI = 1.26-3.78) and from a vending machine (aOR = 1.43, 95% CI = 1.02-1.99) relative to where they initiated PrEP. Participants also preferred HIV self-testing over a healthcare provider test (aOR = 5.57, 95% CI = 3.72, 8.36). WhatsApp or Facebook groups (aOR = 4.12, 95% CI = 3.00-5.67), monthly phone calls (aOR = 2.84, 95% CI = 1.73-4.67) and weekly messages (aOR = 1.47, 95% CI = 1.10-1.97) were preferred contact between appointments, relative to no contact. To meet users' preferences, there is a need to expand decentralised and self-led HIV prevention services.
作为艾滋病病毒综合预防的一部分，扩大口服暴露前预防（PrEP）的工作已取得进展，世界卫生组织建议采用差异化、简化和非医疗化的方法。本研究通过离散选择实验（DCE），对2022年11月至2023年2月期间在南非接受初级医疗服务的307人进行了调查，以探索他们对PrEP服务提供包各组成部分的偏好。纳入的属性包括：艾滋病病毒预防和PrEP的信息来源；PrEP启动和随访地点；随访频率；PrEP领取点；使用PrEP期间的艾滋病病毒检测；预约之间的联系。创建了一个D效率的DCE设计，分为2个模块，共16个选择集。使用广义多项逻辑模型对DCE数据进行分析。与印刷材料相比，参与者更喜欢通过网络（调整后比值比[aOR]=7.73，95%置信区间[CI]=5.13-11.66）和WhatsApp（aOR=2.23，95%CI=0.98-5.55）获取PrEP信息。在药店或移动诊所启动PrEP与在诊所启动PrEP受到同等重视，但社区临时站点较不受青睐（aOR=0.46，95%CI=0.33-0.64）。相比于每3个月随访一次，参与者更喜欢每6个月随访一次（aOR=11.88，95%CI=5.44-25.94）。相对于启动PrEP的地点，参与者更喜欢从药店领取PrEP（aOR=5.02，95%CI=3.45-7.31）、通过送货上门领取（aOR=2.18，95%CI=1.26-3.78）以及从自动售货机领取（aOR=1.43，95%CI=1.02-1.99）。参与者也更喜欢艾滋病病毒自我检测而非由医疗服务提供者进行检测（aOR=5.57，95%CI=3.72，8.36）。相对于没有联系，WhatsApp或Facebook群组（aOR=4.12，95%CI=3.00-5.67）、每月电话沟通（aOR=2.84，95%CI=1.73-4.67）和每周信息沟通（aOR=1.47，95%CI=1.10-1.97）是参与者更喜欢的预约之间的联系方式。为满足用户偏好，有必要扩大分散式和自我主导的艾滋病病毒预防服务。
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