背景:双重预防丸(DPP)将口服暴露前预防(PrEP)与口服避孕药(OC)相结合,以预防HIV和怀孕。注意到私营部门在艾滋病毒高负担国家提供计划生育服务方面发挥的重要作用,私营部门OC的高水平吸收,以及最近以自我护理和技术为基础的私营部门渠道的增长,我们在肯尼亚进行了定性研究,南非和津巴布韦优先考虑私营部门提供服务的方法,以引入民进党。
方法:在2022年3月至2023年2月之间,我们对34个捐助者和实施伙伴进行了文献综述和关键线人访谈,19名政府代表,17个私营部门组织,13名药房和药店代表,和12家远程健康机构评估在私营部门渠道引入DPP的可行性。渠道根据政策进行了主题分析,与公共部门的协调程度,数据系统,供应链,需要补贴,可扩展性,可持续性和地理覆盖范围。
结果:地理范围广泛,肯尼亚和南非正在进行的药房管理的PrEP飞行员,津巴布韦的非处方OC可用性使药房成为DPP交付的优先事项,除了私人网络诊所,已经信任FP和HIV服务。在肯尼亚和南非,较新的,基于技术的渠道,如电子药房,远程医疗和远程医疗被优先考虑,因为它们由于全国范围的可及性而迅速普及,方便和隐私。调查结果受到限制,原因是缺乏关于新渠道服务吸收的标准化数据,以及关于所有渠道的商品价格和支付意愿的信息存在差距。
结论:在艾滋病毒负担较高的国家,私营部门提供了很大一部分FP服务,但仍是PrEP的未开发交付来源。在非传统渠道中为用户提供一系列DPP访问选项,最大限度地减少污名,增强自由裁量权和增加便利性可以增加吸收和延续。准备这些提供PrEP的渠道需要与卫生部和提供者接触,并进一步研究定价和支付意愿。使FP和PrEP的交付保持一致,以满足那些想要预防艾滋病毒和怀孕的人的需求,将有助于综合服务的提供和最终的DPP的推出,为私营部门引入多用途预防技术创造平台。
BACKGROUND: The Dual Prevention Pill (DPP) combines oral pre-exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self-care and technology-based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP.
METHODS: Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage.
RESULTS: Wide geographic reach, ongoing pharmacy-administered PrEP pilots in Kenya and South Africa, and over-the-counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology-based channels such as e-pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness-to-pay for all channels.
CONCLUSIONS: The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non-traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness-to-pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies.