背景:暴露前预防(PrEP)是一种HIV预防策略,如果持续服用,可以将HIV感染的风险降低90%以上。尽管南非自2016年以来一直在实施PrEP,但最初是针对选定的人口群体,然后再扩大与更多人的接触,缺乏针对青春期男孩和年轻人(ABYM)的PrEP的研究,尽管他们经历了高艾滋病毒感染率。为了解决这个差距,我们比较了夸祖鲁-纳塔尔省ABYM按服务交付点(SDP)划分的PrEP启动率,南非。
方法:我们于2021年7月至2022年7月在夸祖鲁-纳塔尔省对22个SDP进行了一项基于人群的前瞻性研究。南非。在有目的地选择的PrEPSDP中招募了15-35岁的HIV检测呈阴性的性活跃ABYM(即,医疗保健设施,中学和技术职业教育与培训(TVET)学院,和基于社区的青年区)。我们使用REDCap内置的自我管理电子问卷从每个参与者收集基线定量数据,包括人口统计信息,如年龄,性别,就业状况和教育水平,以及PrEP启动结果。我们从REDCap中提取数据,并将其导出到Stata17.0版本进行分析,然后消除差异并删除重复项。我们使用汇总和描述性统计数据描述了基线特征(中位数,四分位数间距[IQR]和比例)以及报告的PrEP起始比例总体和SDP。
结果:该研究包括1104ABYM,年龄中位数为24岁(四分位数间距(IQR):21-28)。几乎所有参与者都是非洲黑人(n=1090,99%),超过一半的年龄为15-24岁(n=603,55%)和45%(n=501)的年龄为25-35岁。大多数(n=963;87%)达到了中等教育水平。青春期男孩和年轻男性的总体PREP启动率很低:在1078名符合PrEP资格的参与者中,13%(n=141)开始使用PrEP。在参与PrEP的参与者中,超过四分之三(78%,n=58)是从高中开始的,与社区青年区相比(40%,n=37),TVET学院(26%,n=16)和医疗保健设施(4%,n=30)。
结论:这项研究提供的证据表明,将PrEP服务扩展到非传统环境,比如高中,TVET学院,和社区组织,可能有可能增加南非ABYM中的PrEP访问。
BACKGROUND: Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that can reduce the risk of HIV acquisition by more than 90% if taken consistently. Although South Africa has been implementing PrEP since 2016, initially for selected population groups before expanding access to more people, there is a dearth of research focused on PrEP among adolescent boys and young men (ABYM), despite them experiencing high rates of HIV infection. To address this gap, we compared PrEP initiation rates by service delivery points (SDPs) among ABYM in KwaZulu-Natal, South Africa.
METHODS: We conducted a population-based prospective study in 22 SDPs from July 2021 to July 2022 in KwaZulu-Natal, South Africa. Sexually active ABYM aged 15-35 years who tested HIV negative were recruited at purposively selected PrEP SDPs (i.e., healthcare facilities, secondary schools and Technical Vocational Education and Training (TVET) colleges, and community-based youth zones). We collected baseline quantitative data from each participant using self-administered electronic questionnaires built into REDCap, including demographic information such as age, sex, employment status and level of education, as well as PrEP initiation outcomes. We extracted data from REDCap and exported it to Stata version 17.0 for analysis, and then eliminated discrepancies and removed duplicates. We described baseline characteristics using summary and descriptive statistics (median, interquartile range [IQR] and proportions) and reported PrEP initiation proportions overall and by SDPs.
RESULTS: The study included 1104 ABYM, with a median age of 24 years (interquartile range (IQR): 21-28)). Almost all participants were black African (n = 1090, 99%), with more than half aged 15-24 years (n = 603, 55%) and 45% (n = 501) aged 25-35 years. The majority (n = 963; 87%) had attained a secondary level of education. Overall PREP initiation rate among adolescent boys and young men was low: among 1078 participants who were eligible for PrEP, 13% (n = 141) were started on PrEP. Among the participants who were initiated on PrEP, over three quarters (78%, n = 58) were initiated from high schools, compared with community-based youth zones (40%, n = 37), TVET colleges (26%, n = 16) and healthcare facilities (4%, n = 30).
CONCLUSIONS: This study provided evidence suggesting that expanding PrEP services to non-traditional settings, such as high schools, TVET colleges, and community-based organizations, may have a potential to increase PrEP access among ABYM in South Africa.