Akatukwasa Cecilia, Velloza Jennifer, Korukiiko Milliam, Aruho Richard, Balzer Laura B, Rooney James F, Kamya Moses R, Koss Catherine A, Kabami Jane
Infectious Diseases Research Collaboration, Kampala, Uganda.
Department of Epidemiology & Biostatistics, University of California San Francisco, 550 16th Street 2nd Floor, San Francisco, CA, 94158, USA.
AIDS Behav. 2025 Jun 9. doi: 10.1007/s10461-025-04782-z.
HIV prevalence among Ugandan women who engage in sex work (WESW) is 31%, yet uptake of oral pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) is suboptimal due to multiple factors, including stigma and barriers to accessing healthcare. "Peer mentors" (peer leaders within WESW networks) could facilitate community-based delivery of biomedical HIV prevention products for WESW. We conducted formative research with key stakeholders to refine a potential community-based, peer mentor-led PrEP/PEP intervention. From July-August 2023, we conducted focus group discussions (FGDs) and key informant interviews (KIIs), informed by the Capability, Opportunity, Motivation and Behavior (COM-B) model. Interview guides explored determinants of PrEP/PEP use, acceptability of hypothesized intervention components (monthly PrEP/PEP counseling, HIV self-testing [HIVST], peer delivery of oral PrEP refills, phone/SMS hotline for peer support, rapid PEP access), and elicited ideas about additional intervention components. We recruited WESW, peer mentors, providers, and implementing partners in southwestern Uganda. FGD and KII transcripts were analyzed using a rapid qualitative analysis approach. We conducted four FGDs with WESW (N = 20) and peer mentors (N = 21) and nine KIIs with providers (N = 4) and implementing partners (N = 5). Most described substantial interest in a peer-led oral PrEP/PEP model for WESW. Community-based PrEP/PEP delivery with flexible hours and locations (e.g., bars, lodges) was suggested to address barriers to accessing health facilities. Peer mentors were perceived as trusted agents to increase PrEP/PEP awareness and deliver person-centered care for WESW, in partnership with clinicians. Participants emphasized the need for comprehensive and ongoing peer mentor training and supervision. Integrated PrEP/PEP and HIVST provision were also described as key intervention components to empower WESW and support differentiated service delivery. A peer-led oral PrEP/PEP delivery strategy could address key barriers to biomedical HIV prevention use among WESW in Uganda. Subsequent research is needed to test the impact of this approach on PrEP/PEP use among WESW.
在乌干达从事性工作的女性（WESW）中，艾滋病毒感染率为31%，然而，由于多种因素，包括耻辱感和获得医疗保健的障碍，口服暴露前预防（PrEP）和暴露后预防（PEP）的使用率并不理想。“同伴导师”（WESW网络中的同伴领袖）可以促进为WESW提供基于社区的生物医学艾滋病毒预防产品。我们与关键利益相关者进行了形成性研究，以完善一种潜在的基于社区、由同伴导师主导的PrEP/PEP干预措施。2023年7月至8月，我们以能力、机会、动机和行为（COM-B）模型为指导，进行了焦点小组讨论（FGD）和关键信息访谈（KII）。访谈指南探讨了PrEP/PEP使用的决定因素、假设干预组成部分（每月PrEP/PEP咨询、艾滋病毒自我检测[HIVST]、同伴提供口服PrEP补充剂、同伴支持电话/短信热线、快速获得PEP）的可接受性，并征集了关于其他干预组成部分的想法。我们在乌干达西南部招募了WESW、同伴导师、提供者和实施伙伴。使用快速定性分析方法对FGD和KII的记录进行了分析。我们对WESW（N = 20）和同伴导师（N = 21）进行了四次FGD，对提供者（N = 4）和实施伙伴（N = 5）进行了九次KII。大多数人表示对为WESW提供由同伴主导的口服PrEP/PEP模式非常感兴趣。建议提供基于社区的PrEP/PEP服务，工作时间和地点灵活（如酒吧、旅馆），以解决获得卫生设施的障碍。同伴导师被视为可信赖的代理人，与临床医生合作，提高PrEP/PEP的知晓率，并为WESW提供以人为本的护理。参与者强调需要对同伴导师进行全面和持续的培训与监督。综合提供PrEP/PEP和HIVST也被描述为增强WESW权能和支持差异化服务提供的关键干预组成部分。由同伴主导的口服PrEP/PEP服务策略可以解决乌干达WESW在使用生物医学艾滋病毒预防措施方面的主要障碍。后续需要进行研究，以测试这种方法对WESW中PrEP/PEP使用情况的影响。
