Enhanced Oral Pre-exposure Prophylaxis (PrEP) Implementation for Ugandan Fisherfolk: Pilot Intervention Outcomes.

Autor: Bogart LM; RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA. lbogart@rand.org.; Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA. lbogart@rand.org., Musoke W; Mildmay Uganda, Kampala, Uganda., Mukama CS; Mildmay Uganda, Kampala, Uganda., Allupo S; Mildmay Uganda, Kampala, Uganda., Klein DJ; RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA., Sejjemba A; Mildmay Uganda, Kampala, Uganda., Mwima S; School of Social Work, University of Illinois at Urbana Champagne, Urbana, IL, USA., Kadama H; Ministry of Health, Republic of Uganda, Kampala, Uganda., Mulebeke R; Mildmay Uganda, Kampala, Uganda., Pandey R; RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA., Wagner Z; RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA., Mukasa B; Mildmay Uganda, Kampala, Uganda., Wanyenze RK; Makerere University School of Public Health, Kampala, Uganda.
Jazyk: angličtina
Zdroj: AIDS and behavior [AIDS Behav] 2024 Jul 19. Date of Electronic Publication: 2024 Jul 19.
DOI: 10.1007/s10461-024-04432-w
Abstrakt: Mobile populations such as fisherfolk show high HIV incidence and prevalence. We pilot-tested implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake and adherence in the context of healthcare outreach events in two mainland fisherfolk communities on Lake Victoria, Uganda from September 2021 to February 2022. The implementation strategies included PrEP adherence supporters (selected from PrEP users' social networks), community workshops (to address misconceptions and stigma, and empower PrEP advocacy), and check-in calls (including refill reminders). PrEP medical records data were collected from 6-months pre-intervention to 6-months post-intervention. Qualitative interviews with 20 PrEP users (10 who continued, 10 who discontinued), 9 adherence supporters, and 7 key partners (providers, community leaders) explored acceptability. Percentages of PrEP initiators (of those eligible) were significantly higher during the intervention (96.5%) than 6-months before the intervention (84.5%), p < 0.0001; percentages of PrEP users who persisted (i.e., possessed a refill) 6-months post-initiation (47.9% vs. 6.7%) and had at least 80% PrEP coverage (based on their medication possession ratio) from the initiation date to 6-months later (35.9% vs. 0%) were higher during versus pre-intervention, p < 0.0001. A comparison fisherfolk community with better healthcare access had lower uptake (78.3%; p < 0.0001) and persistence at 6-months (34.0%; p < 0.001), but higher coverage during the intervention period (70.4%; p < 0.0001). Qualitative data suggested the strategies promoted PrEP use through reduced stigma and misconceptions. The intervention bundle cost was $223.95, $172.98, and $94.66 for each additional person for PrEP initiation, persistence, and coverage, respectively. Enhanced community-based PrEP implementation that fosters a supportive community environment can improve PrEP use in mobile populations without easy access to healthcare. (NCT05084716).
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: