怀孕期间和产后感染艾滋病毒的风险很高,并且建议对围产期人群进行暴露前预防(PrEP)。将PrEP纳入母婴健康(MCH)诊所是可行且可接受的。了解诊所的服务可用性和准备情况对于有效扩大规模至关重要。
■怀孕期间的PrEP,AcceleratingReachandEfficiencystudy(PrEPARE;NCT04712994)envedPrEP-experiencedfacilitiespreviouslylinkedtoaprogrammalorresearchstudyinWestKenyatodocumentavailableservicesandcommodities(SARA)surveywith20Pr服务/设备,和药品/商品。设施先前的研究参与发生在2017年至2019年之间;SARA调查数据是在2020年4月至2021年6月之间收集的。描述性统计按先前的研究参与进行分层。ANOVA测试评估了设施特征和差距之间的关联。费希尔检验评估了商品可用性和缺货的差异。
■在调查的55个设施中,60%的人在过去两年接受过PrEP培训,95%的人提供了与MCH整合的PrEP,在PrEP和HIV检测服务(HTS)交付空间中,有64%和78%的人同时拥有听觉和视觉隐私,分别。监督频率是异质的,但82%的人在3个月内接受了监督访问。商品的可用性是可变的,最常见的不可用商品是MCH中的PrEP(71%可用)和风险评估筛选工具(RAST)和PrEP卡(60%和75%可用,分别)。每个设施的服务和商品缺口数量从零到八不等(中位数:3;IQR:2,5)。最常见的差距是:PrEP培训和风险评估卡(每个40%),PrEP(36%)和HIV检测服务(31%)空间缺乏隐私,MCH中的PrEP药(29%),和PrEP卡(25%)。各县的平均差距数没有差异,以前的研究参与,或公共vs.私人身份。4级设施的差距(平均2.2)少于2、3和5级设施(分别为平均5.7、4.5和5.3;p<0.001)。
■整个MCH设施的PrEP服务可用性和就绪性普遍较高。然而,有必要增加提供者培训的频率和以保真度为重点的支持性监督。为了解决诸如PrEP药丸之类的关键商品缺货问题,可能需要实施电子物流管理信息系统。瞄准这些差距对于有效扩大综合PrEP交付至关重要,尤其是在基础设施有限的设施中。
UNASSIGNED: Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics\' service availability and readiness is essential for effective scale up.
UNASSIGNED: The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged PrEP-experienced facilities previously linked to a programmatic or research study in Western Kenya to document available services and
commodities via a modified service availability and readiness assessment (SARA) survey with 20 PrEP tracer items covering: staffing/guidelines, services/equipment, and medicines/
commodities. Facilities\' prior study engagement occurred between 2017 and 2019; SARA survey data was collected between April 2020 and June 2021. Descriptive statistics were stratified by prior study engagement. ANOVA tests assessed associations between facility characteristics and gaps. Fisher\'s tests assessed differences in commodity availability and stockouts.
UNASSIGNED: Of the 55 facilities surveyed, 60% had received PrEP training in the last two years, 95% offered PrEP integrated into MCH, and 64% and 78% had both auditory and visual privacy in PrEP and HIV testing service (HTS) delivery spaces, respectively. Supervision frequency was heterogeneous, but 82% had received a supervision visit within 3 months. Availability of
commodities was variable and the most commonly unavailable
commodities were PrEP in MCH (71% available) and risk assessment screening tool (RAST) and PrEP cards (60% and 75% available, respectively). The number of service and commodity gaps per facility ranged from zero to eight (median: 3; IQR: 2, 5). The most frequent gaps were: PrEP training and risk assessment cards (40% each), lack of privacy in PrEP (36%) and HIV testing services (31%) spaces, PrEP pills in MCH (29%), and PrEP cards (25%). There were no differences in mean number of gaps by county, previous study engagement, or public vs. private status. Level 4 facilities had fewer gaps (mean 2.2) than level 2, 3, and 5 facilities (mean 5.7, 4.5, and 5.3 respectively; p < 0.001).
UNASSIGNED: PrEP service availability and readiness was generally high across MCH facilities. However, there is a need for increased frequency of provider training and supportive supervision focused on fidelity. To address key commodity stockouts such as PrEP pills, implementation of electronic logistics management information systems may be needed. Targeting these gaps is essential to effectively scale up integrated PrEP delivery, especially among facilities with limited infrastructure.