Moorhouse Louisa, Imai-Eaton Jeffrey W, Dadirai Tawanda, Maswera Rufurwokuda, Museka Tafadzwa, Mandizvidza Phyllis, Dzamatira Freedom, Tsenesa Blessing, Hallett Timothy B, Nyamukapa Constance, Gregson Simon
School of Public Health, Imperial College London, London, UK.
MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
BMJ Public Health. 2025 Aug 28;3(2):e002860. doi: 10.1136/bmjph-2025-002860. eCollection 2025.
HIV-negative adolescent girls and young women (AGYW), and men (ABYM), have disproportionately high HIV incidence in many African countries. We used a new HIV Prevention Cascade (HPC) approach to quantify levels of, and barriers to, prevention method use to guide interventions to increase effective uptake of primary HIV prevention.
Data from the Manicaland HPC pilot study (2018-19; n=9803) in Zimbabwe were used to measure levels of sexual risk behaviour and construct HPCs for male condom, pre-exposure prophylaxis (females), voluntary medical male circumcision (males) and combination prevention use by HIV-negative sexually active AGYW (15-24 years) and male partners (15-29 years).
19% of AGYW (n=1140) and 37% of ABYM (n=955) who had started sex reported one or more HIV risk behaviour and met the definition of the priority populations for HIV prevention. Of these, 63% of AGYW and 87% of ABYM were motivated to use an HIV prevention method, 28% and 63% had access to a method and 16% and 53% used a method. Male condoms were the most commonly used prevention method, accounting for 97% of use in AGYW and 55% in ABYM. Barriers to motivation, access and capacity to use were reported for all priority populations and methods. Some barriers were common across HPCs (eg, lack of risk perception, social unacceptability and lack of acceptable provision); others were specific to particular prevention methods or priority populations (eg, lack of availability).
HIV risk behaviours were commonly reported, but gaps in use of prevention methods exist among young people reporting these HIV risk behaviours in Manicaland. Population survey measurements of HPCs revealed large gaps in all steps in the cascade (lack of motivation, lack of access and lack of capacity to use prevention) and provided information on the reasons for these gaps that can aid in designing interventions that reduce new infections.
在许多非洲国家，艾滋病毒阴性的少女和年轻女性（AGYW）以及男性（ABYM）的艾滋病毒感染率高得不成比例。我们采用了一种新的艾滋病毒预防级联（HPC）方法来量化预防方法的使用水平及障碍，以指导干预措施，增加对艾滋病毒初级预防的有效采用。
来自津巴布韦马尼卡兰省HPC试点研究（2018 - 19年；n = 9803）的数据用于测量性风险行为水平，并为艾滋病毒阴性的性活跃AGYW（15 - 24岁）及其男性伴侣（15 - 29岁）构建男用避孕套、暴露前预防（女性）、自愿男性包皮环切术（男性）以及联合预防使用的HPC。
开始性行为的AGYW中有19%（n = 1140）以及ABYM中有37%（n = 955）报告了一种或多种艾滋病毒风险行为，符合艾滋病毒预防重点人群的定义。其中，63%的AGYW和87%的ABYM有使用艾滋病毒预防方法的动机，28%的AGYW和63%的ABYM能够获得预防方法，16%的AGYW和53%的ABYM使用了预防方法。男用避孕套是最常用的预防方法，在AGYW中占使用量的97%，在ABYM中占55%。所有重点人群和预防方法都存在动机、获取途径和使用能力方面的障碍。一些障碍在不同的HPC中是共有的（例如，缺乏风险认知、社会不可接受性以及缺乏可接受的供应）；其他障碍则特定于特定的预防方法或重点人群（例如，缺乏可获得性）。
在马尼卡兰省，报告艾滋病毒风险行为的年轻人中普遍存在艾滋病毒风险行为，但预防方法的使用存在差距。对HPC的人群调查测量显示，级联的所有步骤都存在很大差距（缺乏动机、缺乏获取途径以及缺乏使用预防方法的能力），并提供了这些差距的原因信息，有助于设计减少新感染的干预措施。
