Schluck Glenna, Romo Matthew L, Kosgei Josphat, Thigpen Michael C, Burns Natalie, Bor Rael, Langat Deborah, Akoth Christine, Yates Adam, Charles Curtisha, Qian Haoyu, Gayle Britt, Yacovone Margaret, Sawe Fredrick, Crowell Trevor A
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
U.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
J Int AIDS Soc. 2025 Jun;28 Suppl 1(Suppl 1):e26472. doi: 10.1002/jia2.26472.
INTRODUCTION: HIV post-exposure prophylaxis (PEP) can prevent HIV acquisition and facilitates linkage to pre-exposure prophylaxis (PrEP) for people with ongoing vulnerability. We assessed PEP awareness and use in Western Kenya. METHODS: We used cross-sectional screening/enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) study. Eligible participants had behavioural vulnerability to HIV and were ages 14-55 years. Participants completed questionnaires on demographics, sexual/behavioural history, and PEP/PrEP awareness and use. Depression was assessed using the Patient Health Questionnaire (PHQ-9) with none/minimal, mild and moderate/severe depression defined as PHQ-9 scores of 0-4, 5-9 and ≥10, respectively. We used multivariable robust Poisson regression with purposeful variable selection to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors associated with PEP awareness. RESULTS: From December 2021 to May 2023, 398 participants indicated whether they heard of PEP. The median age was 22 years (IQR 19-24), 316/399 (79.2%) were female and 315/389 (81.0%) reported sex work or transactional sex. One hundred fourteen (28.6%) participants had never heard of PEP, of whom 79 (69.3%) had also not heard of PrEP. Among 284 participants who had heard of PEP, 74 (26.1%) did not know where to access it. Seventy-one participants (17.8%) had taken PEP, of whom 17 (23.9%) encountered problems accessing PEP such as unavailability (n = 5) or prohibitive expense (n = 4). In the final model, only <12 years of education (aPR 1.65 [95% CI 1.16-2.34]) and not cohabitating (aPR 2.81 [95% CI = 1.11-7.08]) were associated with never having heard of PEP. Among participants who had heard of PEP, factors associated with not knowing where to access PEP were <12 years of education (aPR 2.20 [95% CI 1.37-3.54]) and depression (mild aPR 1.86 [95% CI 1.17-2.96]; moderate/severe aPR 1.84 [95% CI 1.09-3.09], compared to none/minimal). CONCLUSIONS: Despite enrolling a behaviourally vulnerable group potentially eligible for PEP, we identified substantial gaps in PEP awareness, access and use. Demand generation and improved access to PEP are needed to maximize the impact on reducing HIV incidence. Interventions to improve PEP awareness and access may be most impactful for people with lower education or when coupled with mental health services.
引言：HIV暴露后预防（PEP）可预防HIV感染，并有助于使持续面临感染风险的人群获得暴露前预防（PrEP）。我们评估了肯尼亚西部对PEP的知晓情况及使用情况。 方法：我们使用了来自HIV及其他感染多国观察队列（MOCHI）研究的横断面筛查/入组数据。符合条件的参与者存在HIV行为感染风险，年龄在14至55岁之间。参与者完成了关于人口统计学、性/行为史以及PEP/PrEP知晓情况和使用情况的问卷调查。使用患者健康问卷（PHQ-9）评估抑郁情况，PHQ-9得分0-4、5-9和≥10分别定义为无/轻微、轻度和中度/重度抑郁。我们使用多变量稳健泊松回归并进行有目的的变量选择，以估计与PEP知晓情况相关因素的调整患病率比（aPRs）和95%置信区间（CIs）。 结果：2021年12月至2023年5月，398名参与者表明他们是否听说过PEP。年龄中位数为22岁（四分位间距19-24），316/399（79.2%）为女性，315/389（81.0%）报告从事性工作或交易性行为。114名（28.6%）参与者从未听说过PEP，其中79名（69.3%）也从未听说过PrEP。在284名听说过PEP的参与者中，74名（26.1%）不知道在哪里可以获得PEP。71名（17.8%）参与者服用过PEP，其中17名（23.9%）在获取PEP时遇到问题，如无法获得（n = 5）或费用过高（n = 4）。在最终模型中，只有教育年限<12年（aPR 1.65 [95% CI 1.16-2.34]）和非同居（aPR 2.81 [95% CI = 1.11-7.08]）与从未听说过PEP相关。在听说过PEP的参与者中，与不知道在哪里可以获得PEP相关的因素是教育年限<12年（aPR 2.20 [95% CI 1.37-3.54]）和抑郁（轻度aPR 1.86 [95% CI 1.17-2.96]；中度/重度aPR 1.84 [95% CI 1.09-3.09]，与无/轻微相比）。 结论：尽管纳入了可能符合PEP条件的行为感染风险较高的人群，但我们发现PEP的知晓情况、获取途径和使用方面存在重大差距。需要开展需求宣传并改善PEP的获取途径，以最大程度地降低HIV发病率。提高PEP知晓情况和获取途径的干预措施可能对教育程度较低的人群最为有效，或者与心理健康服务相结合时效果更佳。
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