Ndimande-Khoza Makhosazane Nomhle, Velloza Jennifer, Chauke Hlukelo, Mills Lisa, Poovan Nicole, Ndlovu Nontokozo, Concepcion Tessa, Hosek Sybil, Celum Connie, Delany-Moretlwe Sinead
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2000, South Africa.
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA.
AIDS Behav. 2025 May 13. doi: 10.1007/s10461-025-04705-y.
The World Health Organization recommends differentiated service delivery (DSD) models for HIV prevention, including alternatives to clinic-based PrEP services. This study assessed the acceptability and feasibility of remote PrEP delivery-including HIV and pregnancy self-testing, and phone-based adherence counselling-among adolescent girls and young women (AGYW) in Johannesburg. The research was nested within the PrEP SMART trial (2019-2022), which evaluated scalable adherence support strategies for AGYW aged 18-25. During COVID-19 lockdowns, PrEP refills and testing kits were delivered to participants' homes, and counselling was provided by phone. Using a phenomenological qualitative method, we conducted in-depth interviews with AGYW (n = 14) who had the option to complete remote PrEP visits (accepting or declining), study staff (n = 12), and key informants (n = 10) involved in PrEP programming. Thematic analysis explored experiences of remote delivery, focusing on acceptability and feasibility. AGYW found remote PrEP visits convenient, empowering, and time-saving. Procedures such as self-testing and phone counselling were generally acceptable, though some expressed anxiety about performing tests incorrectly and concerns over privacy, stigma, and unintentional disclosure of PrEP use at home. About half still preferred clinic-based visits. Staff and key informants recognized benefits, but highlighted challenges related to cost, sustainability, and provider workload. Suggestions for improvement included integrating contraception and partnering with community organizations. In conclusion, remote PrEP delivery is acceptable and feasible for many AGYW but not universally suitable. These findings support the inclusion of remote PrEP options in DSD models, with attention to privacy concerns and support for self-testing in this age group.
世界卫生组织建议采用差异化服务提供（DSD）模式来预防艾滋病毒，包括诊所式暴露前预防（PrEP）服务的替代方案。本研究评估了在约翰内斯堡的少女和年轻女性（AGYW）中进行远程PrEP服务——包括艾滋病毒和妊娠自我检测以及基于电话的依从性咨询——的可接受性和可行性。该研究嵌套在PrEP SMART试验（2019 - 2022年）中，该试验评估了针对18 - 25岁AGYW的可扩展依从性支持策略。在新冠疫情封锁期间，PrEP补充剂和检测试剂盒被送到参与者家中，并通过电话提供咨询。我们采用现象学定性方法，对有选择完成远程PrEP就诊（接受或拒绝）的AGYW（n = 14）、研究人员（n = 12）以及参与PrEP项目的关键信息提供者（n = 10）进行了深入访谈。主题分析探讨了远程服务的体验，重点关注可接受性和可行性。AGYW发现远程PrEP就诊方便、赋权且节省时间。自我检测和电话咨询等程序总体上是可接受的，不过一些人对检测操作错误表示焦虑，对隐私、耻辱感以及在家中意外暴露PrEP使用情况表示担忧。约一半人仍然更喜欢基于诊所的就诊。工作人员和关键信息提供者认识到了好处，但也强调了与成本、可持续性和提供者工作量相关的挑战。改进建议包括整合避孕措施以及与社区组织合作。总之，远程PrEP服务对许多AGYW来说是可接受且可行的，但并非普遍适用。这些发现支持在DSD模式中纳入远程PrEP选项，同时关注该年龄组的隐私问题并支持自我检测。
