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.
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。