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My Way: development and preliminary evaluation of a novel delivery system for PrEP and other sexual health needs of young women in Western Kenya.
Haberer, Jessica E; Oware, Kevin; Juma, Lawrence; Nyerere, Bernard; Momanyi, Vincent; Odoyo, Josephine; Garrison, Lindsey; Bhagat, Julita; Musinguzi, Nicholas; Baeten, Jared M; Siegler, Aaron; Bukusi, Elizabeth A.
Afiliação
  • Haberer JE; Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Oware K; Harvard Medical School, Boston, Massachusetts, USA.
  • Juma L; Kenya Medical Research Institute, Kisumu, Kenya.
  • Nyerere B; Kenya Medical Research Institute, Kisumu, Kenya.
  • Momanyi V; Kenya Medical Research Institute, Kisumu, Kenya.
  • Odoyo J; Kenya Medical Research Institute, Kisumu, Kenya.
  • Garrison L; Kenya Medical Research Institute, Kisumu, Kenya.
  • Bhagat J; Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Musinguzi N; Ark Africa, Nairobi, Kenya.
  • Baeten JM; Global Health Collaborative, Mbarara, Uganda.
  • Siegler A; University of Washington, Seattle, Washington, USA.
  • Bukusi EA; Emory University, Atlanta, Georgia, USA.
J Int AIDS Soc ; 27(2): e26217, 2024 Feb.
Article em En | MEDLINE | ID: mdl-38379132
ABSTRACT

INTRODUCTION:

Young women in sub-Saharan Africa are a priority population for HIV prevention, yet challenges with adherence and persistence to HIV pre-exposure prophylaxis (PrEP) are common. This study involved the development and pilot testing of My Way-a novel delivery system for PrEP and co-packaged sexual health services.

METHODS:

My Way was developed in Kisumu, Kenya through a user-centred design process (2020). The intervention involves peer-delivery and support for HIV testing and PrEP use, self-collected vaginal swabs for sexually transmitted infection (STI) testing, pregnancy testing, oral contraceptive pills, self-injectable medroxyprogesterone and/or condoms. My Way was assessed among 16- to 24-year-old sexually active women in a randomized controlled trial versus standard of care (SoC; 2021-2022). Use of PrEP and other sexual health services were tracked at 1, 3 and 6 months for feasibility. Acceptability was determined by questionnaire. The effect of the intervention on tenofovir diphosphate (TFV-DP) levels was assessed by chi-square test (primary outcome); other predictors were explored with regression analysis.

RESULTS:

Among 150 women, the median age was 22 years and the median number of sexual partners was 2. Moderate/severe depression was common (60%). In the intervention arm, peers made 88% (198/225) of possible kit deliveries (177 with PrEP) and 49 STIs were diagnosed. In the SoC arm, 24% (55/225) of expected clinic visits occurred (53 with PrEP); no STI testing was performed. TVF-DP was detected in 16 participants at 6 months 16% (12/75) in the intervention arm versus 5% (4/75) in the SoC arm (p = 0.03). Persistence among those with ongoing HIV prevention needs (i.e. prevention-effective persistence) was 18% (12/67) versus 7% (4/56; p = 0.08). No women acquired HIV. The intervention was significantly associated with detectable TFV-DP (OR 3.5, 1.1-11.4; p = 0.04); moderate/severe depression trended towards an association with TFV-DP (OR 0.2, 0.03-1.6; p = 0.13).

CONCLUSIONS:

My Way is a promising delivery system for PrEP and other sexual health services among young women in Western Kenya. We found high feasibility and acceptability. PrEP use was modest, but higher with My Way compared to SoC. Long-acting PrEP formulations may overcome important barriers to PrEP use and should be explored in combination with the My Way delivery model.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Organofosfatos / Adenina / Infecções Sexualmente Transmissíveis / Infecções por HIV / Fármacos Anti-HIV / Saúde Sexual / Profilaxia Pré-Exposição Limite: Adolescent / Adult / Female / Humans País como assunto: Africa Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Organofosfatos / Adenina / Infecções Sexualmente Transmissíveis / Infecções por HIV / Fármacos Anti-HIV / Saúde Sexual / Profilaxia Pré-Exposição Limite: Adolescent / Adult / Female / Humans País como assunto: Africa Idioma: En Ano de publicação: 2024 Tipo de documento: Article