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Abstract：
BACKGROUND: Optimizing uptake of pre-exposure prophylaxis (PrEP) for individuals at risk of HIV acquisition has been challenging despite clear scientific evidence and normative guidelines, particularly for key populations (KPs) such as men who have sex with men (MSM), female sex workers (FSWs), transgender (TG) people and persons who inject drugs (PWID). Applying an iterative Programme Science cycle, building on the effective programme coverage framework, we describe the approach used by the Centre for Infectious Disease Research in Zambia (CIDRZ) to scale up PrEP delivery and address inequities in PrEP access for KP in Lusaka, Zambia.
METHODS: In 2019, CIDRZ partnered with 10 local KP civil society organizations (CSOs) and the Ministry of Health (MOH) to offer HIV services within KP-designated community safe spaces. KP CSO partners led KP mobilization, managed safe spaces and delivered peer support; MOH organized clinicians and clinical commodities; and CIDRZ provided technical oversight. In December 2021, we introduced a community-based intervention focused on PrEP delivery in venues where KP socialize. We collected routine programme data from September 2019 to June 2023 using programme-specific tools and the national electronic health record. We estimated the before-after effects of our intervention on PrEP uptake, continuation and equity for KP using descriptive statistics and interrupted time series regression, and used mixed-effects regression to estimate marginal probabilities of PrEP continuity.
RESULTS: Most (25,658) of the 38,307 (67.0%) Key Population Investment Fund beneficiaries were reached with HIV prevention services at community-based venues. In total, 23,527 (61.4%) received HIV testing services, with 15,508 (65.9%) testing HIV negative and found PrEP eligible, and 15,241 (98.3%) initiating PrEP. Across all programme quarters and KP types, PrEP uptake was >90%. After introducing venue-based PrEP delivery, PrEP uptake (98.7% after vs. 96.5% before, p < 0.001) and the number of initiations (p = 0.014) increased significantly. The proportion of KP with ≥1 PrEP continuation visit within 6 months of initiation was unchanged post-intervention (46.7%, 95% confidence interval [CI]: 45.7%, 47.6%) versus pre-intervention (47.2%, 95% CI: 45.4%, 49.1%).
CONCLUSIONS: Applying Programme Science principles, we demonstrate how decentralizing HIV prevention services to KP venues and safe spaces in partnership with KP CSOs enabled successful community-based PrEP delivery beyond the reach of traditional facility-based services.
METHODS: In 2019, CIDRZ partnered with 10 local KP civil society organizations (CSOs) and the Ministry of Health (MOH) to offer HIV services within KP-designated community safe spaces. KP CSO partners led KP mobilization, managed safe spaces and delivered peer support; MOH organized clinicians and clinical commodities; and CIDRZ provided technical oversight. In December 2021, we introduced a community-based intervention focused on PrEP delivery in venues where KP socialize. We collected routine programme data from September 2019 to June 2023 using programme-specific tools and the national electronic health record. We estimated the before-after effects of our intervention on PrEP uptake, continuation and equity for KP using descriptive statistics and interrupted time series regression, and used mixed-effects regression to estimate marginal probabilities of PrEP continuity.
RESULTS: Most (25,658) of the 38,307 (67.0%) Key Population Investment Fund beneficiaries were reached with HIV prevention services at community-based venues. In total, 23,527 (61.4%) received HIV testing services, with 15,508 (65.9%) testing HIV negative and found PrEP eligible, and 15,241 (98.3%) initiating PrEP. Across all programme quarters and KP types, PrEP uptake was >90%. After introducing venue-based PrEP delivery, PrEP uptake (98.7% after vs. 96.5% before, p < 0.001) and the number of initiations (p = 0.014) increased significantly. The proportion of KP with ≥1 PrEP continuation visit within 6 months of initiation was unchanged post-intervention (46.7%, 95% confidence interval [CI]: 45.7%, 47.6%) versus pre-intervention (47.2%, 95% CI: 45.4%, 49.1%).
CONCLUSIONS: Applying Programme Science principles, we demonstrate how decentralizing HIV prevention services to KP venues and safe spaces in partnership with KP CSOs enabled successful community-based PrEP delivery beyond the reach of traditional facility-based services.
摘要：
背景：尽管有明确的科学证据和规范的指导方针，但对有感染艾滋病毒风险的个体优化暴露前预防（PrEP）的摄取一直具有挑战性。特别是对于关键人群(KP)，如男男性行为者(MSM)，女性性工作者（FSW），变性人（TG）和注射毒品（PWID）的人。应用迭代的计划科学周期，在有效的方案覆盖框架的基础上，我们描述了赞比亚传染病研究中心（CIDRZ）用于扩大PrEP交付并解决卢萨卡KPPrEP访问中的不平等问题的方法，赞比亚。
方法：2019年，CIDRZ与10个地方KP民间社会组织（CSO）和卫生部（MOH）合作，在KP指定的社区安全空间内提供艾滋病毒服务。KPCSO合作伙伴领导了KP动员，管理安全空间并提供同行支持；卫生部组织临床医生和临床商品；和CIDRZ提供技术监督。2021年12月，我们引入了一项基于社区的干预措施，重点是在KP社交场所提供PrEP。我们使用特定计划工具和国家电子健康记录收集了2019年9月至2023年6月的常规计划数据。我们估计了我们的干预对PrEP摄取的前后影响，KP的连续性和公平性，使用描述性统计和中断时间序列回归，并使用混合效应回归来估计PrEP连续性的边际概率。
结果：38,307（67.0％）主要人口投资基金受益人中的大多数（25,658）在社区场所获得了艾滋病毒预防服务。总的来说,23,527人(61.4%)接受爱滋病毒检测服务,15,508（65.9％）的HIV检测呈阴性，并发现PrEP合格，15,241（98.3％）开始PrEP。在所有计划季度和KP类型中，PrEP摄取>90%。在引入基于场所的PrEP交付之后，PrEP摄取（与后98.7%96.5%之前，p<0.001）和初始化次数（p=0.014）显着增加。在开始的6个月内，具有≥1次PrEP延续访视的KP比例在干预后保持不变（46.7％，95%置信区间[CI]：45.7%，47.6%）与干预前（47.2%，95%CI：45.4%，49.1%）。
结论：应用计划科学原则，我们展示了如何与KP民间社会组织合作,将HIV预防服务分散到KP场所和安全空间,从而使基于社区的PrEP成功地交付了传统的基于设施的服务。
方法：2019年，CIDRZ与10个地方KP民间社会组织（CSO）和卫生部（MOH）合作，在KP指定的社区安全空间内提供艾滋病毒服务。KPCSO合作伙伴领导了KP动员，管理安全空间并提供同行支持；卫生部组织临床医生和临床商品；和CIDRZ提供技术监督。2021年12月，我们引入了一项基于社区的干预措施，重点是在KP社交场所提供PrEP。我们使用特定计划工具和国家电子健康记录收集了2019年9月至2023年6月的常规计划数据。我们估计了我们的干预对PrEP摄取的前后影响，KP的连续性和公平性，使用描述性统计和中断时间序列回归，并使用混合效应回归来估计PrEP连续性的边际概率。
结果：38,307（67.0％）主要人口投资基金受益人中的大多数（25,658）在社区场所获得了艾滋病毒预防服务。总的来说,23,527人(61.4%)接受爱滋病毒检测服务,15,508（65.9％）的HIV检测呈阴性，并发现PrEP合格，15,241（98.3％）开始PrEP。在所有计划季度和KP类型中，PrEP摄取>90%。在引入基于场所的PrEP交付之后，PrEP摄取（与后98.7%96.5%之前，p<0.001）和初始化次数（p=0.014）显着增加。在开始的6个月内，具有≥1次PrEP延续访视的KP比例在干预后保持不变（46.7％，95%置信区间[CI]：45.7%，47.6%）与干预前（47.2%，95%CI：45.4%，49.1%）。
结论：应用计划科学原则，我们展示了如何与KP民间社会组织合作,将HIV预防服务分散到KP场所和安全空间,从而使基于社区的PrEP成功地交付了传统的基于设施的服务。
