Musheke Maurice, Pry Jake M, Sikazwe Izukanji, Muyunda Walusiku J, Chiyenu Kanema, Siame Charity M, Khondowe Winfred K, Mushiki Bwalya, Mwaba Martha M, Zulu Pelile, Mwape Flavia, Siamasuku Bridget, Shula Davies, Mweemba Mable B, Kanene Cuthbert, Phiri Arlene, Herce Michael E
Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
School of Medicine, University of California, Davis, California, USA.
J Int AIDS Soc. 2025 Jul;28 Suppl 3(Suppl 3):e26484. doi: 10.1002/jia2.26484.
Despite being at high risk of HIV acquisition, access to pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical settings. We describe the effects of community centres supported by the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative on PrEP outcomes in Zambia and examine factors associated with PrEP continuation.
We collected individual-level PrEP data for AGYW aged 15-24 years at risk of HIV acquisition and enrolled in DREAMS in seven districts of Zambia between August 2022 and August 2024. We used Pearson's Chi-squared test to examine differences in beneficiary characteristics between clients with a PrEP initiation visit and ≥ 2 PrEP visits (i.e. an initiation plus ≥ 1 return visit), and mixed effects Poisson regression modelling to estimate the association between DREAMS enrolment criteria and PrEP continuation (defined as ≥ 1 PrEP visit within 180 days of initiation). We also estimated the marginal probability of PrEP continuation by number of DREAMS enrolment criteria and used Kaplan-Meier methods to estimate the time to the first PrEP return visit by client age band.
Between 11 August 2022 and 23 August 2024, 15,502 AGYW aged 15-24 years were screened for PrEP eligibility, of whom 15,072 (97.2%) initiated PrEP per national guidelines. Of those initiating PrEP, 9807 (65.1%) had sufficient follow-up time to allow for observation of a PrEP return visit. The proportion of AGYW who had ≥ 1 PrEP return visit within 180 days of initiation was 59.0% (n/N = 5706/9675). Across age bands, the percent probability of having a PrEP return visit within 180 days of initiation was highest among clients who reported ≥ 4 DREAMS enrolment criteria at 91.7% (95% CI: 70.7, 112.7%) for clients aged 15-19 years and 83.6% (95% CI: 61.1, 106.2%) for clients aged 20-24 years. Overall, 41.5% of clients had a first PrEP return visit between 21 and 42 days of PrEP initiation.
The high number and proportion of AGYW initiated on PrEP suggests that decentralising PrEP services to DREAMS community centres has the potential to improve PrEP access among AGYW. Increasing HIV risk perception among AGYW may improve PrEP continuation.
尽管青春期女孩和年轻女性（AGYW）感染艾滋病毒的风险很高，但在赞比亚，她们获得暴露前预防（PrEP）的机会却很低，因为传统上PrEP是在临床环境中提供的。我们描述了由“坚定、坚韧、赋权、无艾滋病、受指导和安全”（DREAMS）倡议支持的社区中心对赞比亚PrEP结果的影响，并研究了与PrEP持续使用相关的因素。
我们收集了2022年8月至2024年8月期间在赞比亚七个地区有感染艾滋病毒风险且参加了DREAMS的15至24岁AGYW的个人层面PrEP数据。我们使用Pearson卡方检验来检查进行PrEP初次就诊的客户与进行≥2次PrEP就诊（即一次初次就诊加≥1次复诊）的客户之间的受益特征差异，并使用混合效应泊松回归模型来估计DREAMS登记标准与PrEP持续使用（定义为在初次就诊后180天内进行≥1次PrEP就诊）之间的关联。我们还按DREAMS登记标准的数量估计了PrEP持续使用的边际概率，并使用Kaplan-Meier方法按客户年龄组估计首次PrEP复诊的时间。
在2022年8月11日至2024年8月23日期间，对15502名15至24岁的AGYW进行了PrEP资格筛查，其中15072人（97.2%）按照国家指南开始使用PrEP。在开始使用PrEP的人中，9807人（65.1%）有足够的随访时间以观察到PrEP复诊。在开始使用PrEP后180天内进行≥1次PrEP复诊的AGYW比例为59.0%（n/N = 5706/9675）。在各个年龄组中，在开始使用PrEP后180天内进行PrEP复诊的概率在报告≥4条DREAMS登记标准的客户中最高，15至19岁的客户为91.7%（95%置信区间：70.7，112.7%），20至24岁的客户为83.6%（95%置信区间：61.1，106.2%）。总体而言，41.5%的客户在PrEP开始后的21至42天内进行了首次PrEP复诊。
开始使用PrEP的AGYW数量众多且比例较高，这表明将PrEP服务下放到DREAMS社区中心有可能改善AGYW获得PrEP的机会。提高AGYW对艾滋病毒风险的认知可能会改善PrEP的持续使用情况。
