Expansion of HIV Preexposure Prophylaxis to 35 PEPFAR-Supported Early Program Adopters, October 2016–September 2018

Djomand, Gaston; Bingham, Trista; Benech, Irene; Muthui, Mercy; Savva, Helen; Alamo, Stella; Manopaiboon, Chomnad; Wheeler, Tisha; Mital, Sasha

doi:10.15585/mmwr.mm6908a3

Cited by 13 publications

(26 citation statements)

References 2 publications

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“…This study showed that multi-sectoral collaborations in addition to strengthening existing resources and policies promoted the rapid expansion of the DREAMS Initiative, contributing to PrEP uptake (12,16). The authors argue that the core tenants for successful adoption and early expansion of PrEP include key stakeholder consultations and engagement, favorable legal environment for key populations, existing PrEP treatment guidelines, HIV service provider training, existing drug procurement system, innovative demand creation activities, multiple service delivery models, and government's active ownership, which is consistent with our ndings (13,16).…”

Section: Discussionsupporting

confidence: 83%

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Facilitators and barriers to Pre-Exposure Prophylaxis (PrEP) uptake among adolescent girls and young women in Seme-Sub County, Kisumu, Kenya

Jackson-Gibson¹,

Ezema²,

Orero³

et al. 2020

Preprint

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Background: While the introduction of HIV pre-exposure prophylaxis (PrEP) as an HIV prevention strategy has allowed women to exercise more control over the reduction of HIV transmission rates, adolescent girls and young women (AGYW) in Sub-Saharan Africa continue to experience higher rates of HIV infections and bear the greatest disease burden. Understanding progress in PrEP uptake among AGYW would enhance risk reduction in this vulnerable population. The Determined, Resilient, AIDS-Free, Mentored and Safe women (DREAMS) Initiative plays a key role in this risk reduction strategy.Methods: We performed a retrospective qualitative study to explore facilitators and barriers to PrEP, specifically those effecting initiation and persistence, among AGYW enrolled in the DREAMS Initiative at Pamoja Community Based Organization (CBO) in Kisumu, Kenya. We conducted key informant interviews (n = 15) with Pamoja CBO staff, health care providers and community leaders. Additionally, we conducted focus group discussions with young women receiving PrEP (n = 40) and peer mentors (n = 12). We did thematic analysis using the Consolidated Framework for Implementation Research to identify emergent themes.Results: We found that the use of the safe space model, decentralization of PrEP support and delivery, peer mentors, proper linkage to local health care facilities, and the sensitization of parents and male sexual partners were among some of the facilitators to PrEP uptake. Barriers to initiation and persistence included stigma associated with the use of anti-retroviral dugs, distance to safe spaces, and limited testing and qualified health care workers for PrEP distribution and administration.Conclusions: Overall, community roll out of PrEP within the DREAMS Initiative was successful in part due to integration and layering of services (biological, behavioral and structural), increased self-efficacy among AGYW, enhanced inter-agency and multisectoral collaboration.

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Section: Discussionsupporting

confidence: 83%

“…Pamoja CBO is a grassroot, non-pro t organization based in Kisumu County, Kenya. It is a primary implementor of the DREAMS Initiative within the Seme Sub-County of Kisumu County, one of the regions prioritized for PrEP roll-out (13). Pamoja CBO has enrolled approximately 4,831 AGYW in its DREAMS program over the last three years.…”

Section: Introductionmentioning

confidence: 99%

Facilitators and barriers to Pre-Exposure Prophylaxis (PrEP) uptake among adolescent girls and young women in Seme-Sub County, Kisumu, Kenya

Jackson-Gibson¹,

Ezema²,

Orero³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Pre-exposure prophylaxis (PrEP), antiretroviral medication for the prevention of HIV acquisition among HIV negative individuals, is part of the comprehensive biomedical HIV prevention strategies recommended by the World Health Organisation (WHO) for people at risk of HIV infection ( World Health Organization, 2015 , 2016 , 2019 ). In Uganda PrEP was first introduced for key populations - people at high risk of HIV infection - in early 2017 ( Djomand et al, 2020 ; Government of the Republic of Uganda, 2016 ). Current guidance provides PrEP ‘for HIV negative people at substantial risk of acquiring HIV infection’ ( Government of the Republic of Uganda, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…A woman's perception of being at risk of HIV infection may be calibrated against other risks posed by engaging in sex work. Djomand et al (2020) in a review of 35 PEPFAR-supported PrEP programmes, observed that PrEP services were included in national treatment and prevention guidelines in five countries, including Uganda, ‘despite the lack of favourable legal environments to safeguard key populations from violence and discrimination’ (p. 213). It is illegal to sell sex or organise commercial sex in any place ( Interactions, 2020 ) in Uganda in accordance with the Penal Code Act.…”

Section: Introductionmentioning

confidence: 99%

Women at high risk of HIV-infection in Kampala, Uganda, and their candidacy for PrEP

Kawuma

Ssemata

Bernays

et al. 2021

SSM - Population Health

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Pre-exposure prophylaxis (PrEP), antiretroviral medication for prevention of HIV-acquisition, is part of biomedical HIV prevention strategies recommended for people at risk of HIV-infection. A decision to take PrEP depends on an assessment of ‘being at risk’ either by an individual, or healthcare provider. In this paper, we draw on the concept of ‘candidacy’ to examine the different ways in which women attending a dedicated clinic in Kampala, Uganda, for women at risk of HIV infection (including sex workers), assessed their suitability for PrEP. We conducted in-depth interviews with 30 HIV negative women up to four different times, to gather information on the motives for taking PrEP, and their life history and daily life. All the women described the relevance of PrEP to mitigate their risk of HIV infection. However, there were challenges to adherence because of alcohol use, irregular working hours and a fear of being seen taking pills that others might assume to be HIV treatment. The ways in which the different women used PrEP and interpreted the place of PrEP in their lives were not solely based on their assessment of protecting themselves during sex work. They also used PrEP to guard against infection from their regular partners, and as a tool to allow them to make more money safely, by having sex without a condom with clients. While eligibility to access PrEP was predicated on the women's being in an ‘at risk’ population group, an incentive to use PrEP was to protect themselves from HIV acquisition from a long-term partner and preserve the ‘trust’ in their intimate relationship by having condom-less sex. Applying a candidacy lens we highlight the complexity in how women experience and present as being ‘at risk’ and query the criteria on which categories of risk and PrEP eligibility are determined.

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“…To prepare for this rollout, we surveyed potential PrEP users among four key MARPs in Uganda (SDC, MSM, FSW, and fisher folk) before and after HCW training that followed routine MoH guidelines [ 13 , 16 , 17 ]. The government of Uganda had not yet endorsed PrEP use among adolescent girls and young women at the time of data collection and AGYW were therefore not included in the study.…”

Section: Introductionmentioning

confidence: 99%

Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda

et al. 2020

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Background Scale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Uganda began with serodiscordant couples (SDC) and has expanded to other most at-risk populations (MARPs). We explored knowledge, acceptability, barriers and facilitators of PrEP use among potential PrEP users in four MARPs (SDC; men who have sex with men [MSM]; female sex workers [FSW], and fisher folk). Methods We administered quantitative surveys to potential PrEP users in multiple settings in Central Uganda at baseline and approximately 9 months after healthcare worker (HCW) training on PrEP. Results The survey was completed by 250 potential PrEP users at baseline and 125 after HCW training; 55 completed both surveys. For these 250 participants, mean age was 28.5 years (SD 6.9), 47% were male and 6% were transgender women, with approximately even distribution across MARPs and recruitment locations (urban, peri-urban, and rural). Most (65%) had not heard about PrEP. After HCW training, 24% of those sampled were aware of PrEP, and the proportion of those who accurately described PrEP as “antiretrovirals to be used before HIV exposure” increased from 54% in the baseline survey to 74% in the second survey (p<0.001). The proportion of participants who reported HCW as a source of PrEP information increased after training (59% vs 91%, p<0.001). In both surveys, nearly all participants indicated they were willing to take PrEP if offered. The most common anticipated barriers to PrEP were stigma, transportation, accessibility, busy schedules, and forgetfulness. Closeness to home was a common facilitator for all participant categories. Conclusions Initial awareness of PrEP was low, but PrEP knowledge and interest increased among diverse MARPs after HCW training. Demand creation and HCW training will be critical for increasing PrEP awareness among key populations, with support to overcome barriers to PrEP use. These findings should encourage the acceleration of PrEP rollout in Uganda.

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Expansion of HIV Preexposure Prophylaxis to 35 PEPFAR-Supported Early Program Adopters, October 2016–September 2018

Cited by 13 publications

References 2 publications

Facilitators and barriers to Pre-Exposure Prophylaxis (PrEP) uptake among adolescent girls and young women in Seme-Sub County, Kisumu, Kenya

Facilitators and barriers to Pre-Exposure Prophylaxis (PrEP) uptake among adolescent girls and young women in Seme-Sub County, Kisumu, Kenya

Women at high risk of HIV-infection in Kampala, Uganda, and their candidacy for PrEP

Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda

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