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. 2022 Dec 5:4:1048702.
doi: 10.3389/frph.2022.1048702. eCollection 2022.

Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia

Gena Barnabee  1 , Gillian O'Bryan  1 , Lylie Ndeikemona  2 , Idel Billah  3 , Lukas Silas  3 , Karie L Morgan  4 , Katherine Shulock  5 , Susan Mawire  6 , Ellen MacLachlan  1 , Josua Nghipangelwa  7 , Elizabeth Muremi  8 , Alison Ensminger  1 , Norbert Forster  3 , Gabrielle O'Malley  1
Affiliations

Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia

Gena Barnabee et al. Front Reprod Health. .

Abstract

Introduction: Despite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services through community and hybrid models in Namibia to facility-based services. We subsequently identify potential mechanisms to explain how and why community and hybrid models achieved (or not) improved persistence to inform further service delivery innovation.

Methods: Data were collected from PrEP service delivery to AGYW over two-years in Namibia's Khomas Region. We used Kaplan-Meier analysis to estimate survival curves for PrEP persistence beyond three-months after initiation and report the cumulative probability of persistence at one- and three-months. Persistence was defined as any PrEP use within three months after initiation followed by a PrEP refill or previously prescribed supply of at least 30 days at the three-month visit. Interviews were conducted with 28 AGYW and 19 providers and analyzed using a deductive-inductive thematic approach.

Results: From October 2017 through September 2019, 372 (18.7%) AGYW received services through a facility model, 302 (15.1%) through a community model, and 1,320 (66.2%) through a hybrid model. PrEP persistence at one- and three-months was 41.2% and 34.9% in the community model and 6.2% and 4.8% in the hybrid model compared to 36.8% and 26.7% in the facility model. Within the community and hybrid models, we identified three potential mechanisms related to PrEP persistence. Individualized service delivery offered convenience and simplicity which enabled AGYW to overcome barriers to obtaining refills but did not work as well for highly mobile AGYW. Consistent interactions and shared experiences fostered social connectedness with providers and with peers, building social networks and support systems for PrEP use. PrEP and HIV-related stigma, however, was widely experienced outside of these networks. Community-to-facility referral for PrEP refill triggered apprehension towards unfamiliar PrEP services and providers in AGYW, which discouraged persistence.

Conclusion: Service delivery approaches that offer convenience and simplicity and foster social connectedness may reduce access barriers and increase social support enabling AGYW to self-manage their PrEP use and achieve improved PrEP persistence.

Keywords: HIV prevention; Namibia; adolescent girls and young women; delivery of health care; pre-exposure prophylaxis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PrEP persistence (interrupted or uninterrupted) beyond three months among AGYW who initiated PrEP by service delivery model. Kaplan–Meier survival curves were used to estimate the cumulative probability of PrEP persistence beyond three months after PrEP initiation by service delivery model. AGYW who initiated PrEP during the study period (N = 1994) are included in the analysis. The marks on the curve indicate censoring and curves drop down when PrEP non-persistence (“failure”) events, defined as discontinuation of PrEP with no subsequent refill within three months after PrEP initiation, occur.
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References

    1. Confronting Inequalities: Lessons for pandemic responses from 40 years of AIDS. UNAIDS Global update 2021. Geneva: Joint United Nations Programme on HIV/AIDS; (2021).
    1. Joint United National Programme on HIV/AIDS. In danger: Unaids global AIDS update 2022. Geneva: Joint United Nations Programme on HIV/AIDS; (2022). License: CC BY-NC-SA 3.0 IGO.
    1. Naicker N, Kharsany AB, Werner L, van Loggerenberg F, Mlisana K, Garrett N, et al. Risk factors for HIV acquisition in high risk women in a generalised epidemic setting. AIDS Behav. (2015) 19(7):1305–16. 10.1007/s10461-015-1002-5 - DOI - PMC - PubMed
    1. Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc. (2015) 18(2 Suppl 1):19408. 10.7448/IAS.18.2.19408 - DOI - PMC - PubMed
    1. Harrison A, Colvin CJ, Kuo C, Swartz A, Lurie M. Sustained high HIV incidence in young women in Southern Africa: social, behavioral, and structural factors and emerging intervention approaches. Curr HIV/AIDS Rep. (2015) 12(2):207–15. 10.1007/s11904-015-0261-0 - DOI - PMC - PubMed