Client experiences with "Dynamic Choice Prevention," a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa.

Autor: Camlin CS; University of California, San Francisco (UCSF), Obstetrics, Gynecology & Reproductive Sciences, San Francisco, California, USA., Arunga T; Kenya Medical Research Institute (KEMRI), Kisumu, Kenya., Johnson-Peretz J; University of California, San Francisco (UCSF), Obstetrics, Gynecology & Reproductive Sciences, San Francisco, California, USA., Akatukwasa C; Infectious Diseases Research Collaboration, Kampala, Uganda., Atwine F; Infectious Diseases Research Collaboration, Kampala, Uganda., Onyango A; Kenya Medical Research Institute (KEMRI), Kisumu, Kenya., Owino L; Kenya Medical Research Institute (KEMRI), Kisumu, Kenya., Kamya MR; Infectious Diseases Research Collaboration, Kampala, Uganda.; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda., Petersen ML; University of California, Berkeley, Biostatistics, Epidemiology, and Computational Precision Health, Berkeley, California, USA., Chamie G; University of California, San Francisco (UCSF), Medicine, San Francisco, California, USA., Kakande E; Infectious Diseases Research Collaboration, Kampala, Uganda., Kabami J; Infectious Diseases Research Collaboration, Kampala, Uganda., Balzer LB; University of California, Berkeley, Biostatistics, Epidemiology, and Computational Precision Health, Berkeley, California, USA., Havlir DV; University of California, San Francisco (UCSF), Medicine, San Francisco, California, USA., Ayieko J; Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2024 Jul; Vol. 27 (7), pp. e26336.
DOI: 10.1002/jia2.26336
Abstrakt: Introduction: Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models.
Methods: In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.
Results: Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.
Conclusions: Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.
(© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje