U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
J Int AIDS Soc. 2024 Nov;27(11):e26372. doi: 10.1002/jia2.26372.
Despite the increasing availability of prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa. We examined PrEP awareness, uptake and persistence among participants enrolling into an HIV incidence cohort in Kenya.
We used cross-sectional enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) in Homa Bay and Kericho, Kenya. The cohort recruited individuals aged 14-55 years with a recent history of sexually transmitted infection, transactional sex, condomless sex and/or injection drug use. Participants completed questionnaires on PrEP, demographics and sexual behaviours. We used multivariable robust Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations with never hearing of PrEP, never taking PrEP and ever stopping PrEP.
Between 12/2021 and 5/2023, 399 participants attempted the PrEP questionnaire, of whom 316 (79.2%) were female and median age was 22 years (interquartile range 19-24); 316 of 390 participants (81.0%) engaged in sex work or transactional sex. Of 396 participants who responded to the question, 120 (30.3%) had never heard of PrEP. Of 275 participants who had heard of PrEP, 206 (74.9%) had never taken it. Of 69 participants who had ever taken PrEP, 50 (72.5%) stopped it at some time prior to enrolment. Participants aged 15-19 years more often reported never taking PrEP compared with those 25-36 years (aPR 1.31, 95% CI: 1.06-1.61). Participants who knew someone who took PrEP less often reported never hearing about PrEP (aPR 0.10, 95% CI: 0.04-0.23) and never taking PrEP (aPR: 0.69, 95% CI: 0.60-0.80). Stopping PrEP was more common among participants with a weekly household income ≤1000 versus >1000 Kenyan shillings (aPR 1.40, 95% CI: 1.02-1.93) and those using alcohol/drugs before sex (aPR 1.53, 95% CI: 1.03-2.26). Stopping PrEP was less common among those engaging in sex work or transactional sex (aPR 0.6, 95% CI: 0.40-0.92).
We identified substantial gaps in PrEP awareness, uptake and persistence, which were associated with potential system- and individual-level risk factors. Our analyses also highlight the importance of increasing PrEP engagement among individuals who do not know others taking PrEP.
尽管预防性传播感染工具（如暴露前预防[PrEP]）的可及性不断增加，但在撒哈拉以南非洲，艾滋病毒发病率仍居高不下。我们研究了肯尼亚一项艾滋病毒发病率队列研究中的参与者对 PrEP 的认知、使用和持续使用情况。
我们使用了来自肯尼亚霍马湾和克里乔的多国观察性艾滋病毒和其他传染病队列（MOCHI）的横断面入组数据。该队列招募了年龄在 14-55 岁之间、近期有性传播感染史、交易性行为、无保护性行为和/或注射吸毒史的个体。参与者完成了 PrEP、人口统计学和性行为问卷。我们使用多变量稳健泊松回归来估计从未听说过 PrEP、从未使用过 PrEP 和曾经停止使用 PrEP 与关联的调整后患病率比（aPR）和 95%置信区间（CI）。
在 2021 年 12 月至 2023 年 5 月期间，399 名参与者尝试了 PrEP 问卷，其中 316 名（79.2%）为女性，中位年龄为 22 岁（四分位距 19-24 岁）；390 名参与者中有 316 名（81.0%）从事性工作或交易性行为。在回答问题的 396 名参与者中，有 120 名（30.3%）从未听说过 PrEP。在 275 名听说过 PrEP 的参与者中，有 206 名（74.9%）从未使用过。在 69 名曾经使用过 PrEP 的参与者中，有 50 名（72.5%）在入组前的某个时间停止了使用。15-19 岁的参与者比 25-36 岁的参与者更常报告从未使用过 PrEP（aPR 1.31，95%CI：1.06-1.61）。知道有人使用 PrEP 的参与者较少报告从未听说过 PrEP（aPR 0.10，95%CI：0.04-0.23）和从未使用过 PrEP（aPR：0.69，95%CI：0.60-0.80）。每周家庭收入≤1000 肯尼亚先令与>1000 肯尼亚先令相比，参与者停止 PrEP 的情况更为常见（aPR 1.40，95%CI：1.02-1.93），在性行为前使用酒精/毒品的参与者停止 PrEP 的情况更为常见（aPR 1.53，95%CI：1.03-2.26）。从事性工作或交易性行为的参与者停止 PrEP 的情况较少（aPR 0.6，95%CI：0.40-0.92）。
我们发现 PrEP 的认知、使用和持续使用方面存在显著差距，这与潜在的系统和个体层面的风险因素有关。我们的分析还强调了增加那些不了解他人使用 PrEP 的个体参与 PrEP 的重要性。
