Hoffman Susie, Hanass-Hancock Jill, Harrison Abigail D, Bhengu Nonhlonipho, Dolezal Curtis, Exner Theresa M, Miller Lori, Ready Tarylee, Han Jiying, Leu Cheng-Shiun
HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University, New York, NY, USA.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
AIDS Behav. 2025 Jun 13. doi: 10.1007/s10461-025-04747-2.
Oral pre-exposure prophylaxis (PrEP) has been available to adolescent girls and young women (AGYW) in the South African public sector since 2019, yet uptake has lagged below targets. In this pilot trial focused on early PrEP cascade steps, a WhatsApp-based small-group interactive intervention with a gender-empowerment component- "gender enhanced" (GE)-was compared to a control condition providing website links to PrEP information/motivation that women accessed individually ("individual access", IA). PrEP was not offered as part of the trial. Eligible participants were 18-25 years, heterosexually active in the past six months, but not pre-screened for PrEP eligibility. Primary outcome was undergoing individual PrEP counselling; secondary outcomes were HIV testing and self-reported PrEP initiation. Fifty women enrolled in each condition (N = 100). Retention, feasibility and acceptability were high. Fifty-six percent underwent PrEP counseling in each condition; PrEP was initiated by 8 women in GE and 5 in IA. Stage of change (readiness) for PrEP increased more in GE than IA women post-intervention (b = 0.68 [95%CI = 0.25, 1.11, p = 0.002]) and at 3-month follow-up (b = 0.73 [95%CI = 0.18, 1.27, p = 0.009]). GE women showed greater improvements in PrEP knowledge and positive PrEP beliefs, had less decline in perceived HIV risk, and greater reduction in perceived importance of family's opinions about sexuality/reproductive health. In a setting where women were not given immediate access to PrEP, a large proportion took a behavioral step for initiation. Especially as other forms of PrEP become available, both the GE intervention and the IA control conditions merit further refinement and testing in a larger trial.
自2019年以来，南非公共部门已向青春期女孩和年轻女性（AGYW）提供口服暴露前预防（PrEP），但其接受率一直低于目标。在这项专注于PrEP早期级联步骤的试点试验中，将一种基于WhatsApp的具有性别赋权成分的小组互动干预措施——“性别强化”（GE），与一种提供PrEP信息/激励的网站链接的对照条件进行了比较，女性可单独访问该网站链接（“个人访问”，IA）。PrEP不作为试验的一部分提供。符合条件的参与者年龄在18至25岁之间，在过去六个月中有异性性行为，但未进行PrEP资格预筛查。主要结局是接受个人PrEP咨询；次要结局是HIV检测和自我报告的PrEP启动。每种条件下招募了50名女性（N = 100）。保留率、可行性和可接受性都很高。每种条件下有56%的人接受了PrEP咨询；GE组有8名女性启动了PrEP，IA组有5名女性启动了PrEP。干预后，GE组女性PrEP的改变阶段（准备程度）比IA组女性增加得更多（b = 0.68 [95%CI = 0.25, 1.11, p = 0.002]），在3个月随访时也是如此（b = 0.73 [95%CI = 0.18, 1.27, p = 0.009]）。GE组女性在PrEP知识和积极的PrEP信念方面有更大改善，感知到的HIV风险下降较少，并且家庭对性/生殖健康意见的感知重要性降低幅度更大。在女性无法立即获得PrEP的环境中，很大一部分人采取了启动PrEP的行为步骤。特别是随着其他形式的PrEP出现，GE干预措施和IA对照条件都值得在更大规模的试验中进一步完善和测试。
