Admassu Metasebia, Nöstlinger Christiana, Hensen Bernadette
Department of Public Health Institute of Tropical Medicine, Antwerp, Belgium.
BMC Womens Health. 2024 Dec 26;24(1):665. doi: 10.1186/s12905-024-03516-y.
Adolescent girls and young women (AGYW) are disproportionately affected by HIV. Globally, in 2022, an estimated 4000 AGYW 15-24 were newly infected with HIV weekly, and nearly 78% of these infections occurred in sub-Saharan Africa. Oral Pre-Exposure Prophylaxis (PrEP) is a key HIV prevention option within an overall HIV combination prevention approach with an efficacy of over 90% when taken correctly. However, uptake of and adherence to PrEP remains low, particularly among AGYW. This scoping review aims to map available evidence on factors that limit PrEP use among AGYW in Eastern, Southern, and Western African countries to inform research, policy, and practice on delivery of PrEP. Our review identified factors that affect PrEP journey among AGYW along the HIV prevention cascade.
Guided by Arksey and O'Malley framework and using the PRISMA extension for scoping reviews, we searched the Web of Science, Global Health, and PubMed databases. Our review focused on oral PrEP, specifically papers reporting on barriers to PrEP experienced by AGYW, and peer-reviewed English-language articles published between 2012 and 2023.
Of 1063 papers screened, 25 were included. Over half (60%) of the studies were qualitative; 72% were conducted in Kenya and South Africa. The barriers affecting motivation were, fear of side effects and pill burden, percieved low HIV risk, perceived stigma, PrEP use disapproval from parents and partners. PrEP access was limited by healthcare providers' stigma, isolated clinic setup, and lack of resources. Effective PrEP use was limited by a lack of parental or partner support, stigma, and lifestyle changes.
Adolescent girls and young women face multiple and often intersecting barriers to effective PrEP use with stigma being a factor cross-cutting all steps of the prevention cascade. Similarly, lack of social support, reflected through disapproval and judgmental attitudes and low HIV risk perception, also affected two steps of the prevention cascade. Our review identified gaps in available evidence, with most studies conducted in only two countries and few quantitative studies available. Improving PrEP uptake and adherence requires interventions that address barriers across the cascade, with a particular focus on stigma and social support.
青少年女孩和年轻女性（AGYW）受艾滋病毒影响的比例过高。2022年，全球估计每周有4000名15至24岁的AGYW新感染艾滋病毒，其中近78%的感染发生在撒哈拉以南非洲。口服暴露前预防（PrEP）是整体艾滋病毒综合预防方法中的一项关键艾滋病毒预防选择，正确服用时疗效超过90%。然而，PrEP的使用和依从性仍然很低，尤其是在AGYW中。本范围审查旨在梳理有关限制东非、南非和西非国家AGYW使用PrEP的因素的现有证据，以为PrEP提供方面的研究、政策和实践提供参考。我们的审查确定了在艾滋病毒预防级联中影响AGYW使用PrEP过程的因素。
以阿克西和奥马利框架为指导，并使用PRISMA扩展进行范围审查，我们检索了科学网、《全球健康》和PubMed数据库。我们的审查聚焦于口服PrEP，特别是报告AGYW使用PrEP所面临障碍的论文，以及2012年至2023年发表的经同行评审的英文文章。
在筛选的1063篇论文中，纳入了25篇。超过一半（60%）的研究是定性研究；72%在肯尼亚和南非进行。影响动机的障碍包括：担心副作用和服药负担、认为感染艾滋病毒风险低、感知到的耻辱感、父母和伴侣不赞成使用PrEP。医疗服务提供者的耻辱感、诊所设置偏僻以及资源匮乏限制了PrEP的获取。缺乏父母或伴侣的支持、耻辱感和生活方式改变限制了PrEP的有效使用。
青少年女孩和年轻女性在有效使用PrEP方面面临多重且往往相互交织的障碍，耻辱感是贯穿预防级联所有步骤的一个因素。同样，通过不赞成和评判态度以及低艾滋病毒风险认知所反映出的社会支持不足，也影响了预防级联的两个步骤。我们的审查发现现有证据存在差距，大多数研究仅在两个国家进行，且定量研究很少。提高PrEP的使用和依从性需要采取干预措施来消除级联中的障碍，尤其要关注耻辱感和社会支持。
