Feasibility and acceptability of peer-delivered HIV self-testing and PrEP for young women in Kampala, Uganda

Abstract

Background Adolescent girls and young women (AGYW) account for 29% of new HIV infections in Uganda despite representing just 10% of the population. Peer support improves AGYW linkage to HIV care and medication adherence. We evaluated the feasibility and acceptability of peer delivered HIV self-tests (HIVST) and oral pre-exposure prophylaxis (PrEP) to young women in Uganda. Methods Between March and September 2021, we conducted a pilot study of 30 randomly selected young women, aged 18–24 years, who had received oral PrEP for at least three months, but had suboptimal adherence as measured by urine tenofovir testing (< 1500 ng/ml). Participants were offered daily oral PrEP and attended clinic visits three and six months after enrollment. Between clinic visits, participants were visited monthly by trained peers who delivered HIVST and PrEP. Feasibility and acceptability of peer-delivered PrEP and HIVST (intervention) were measured by comparing actual versus planned intervention delivery and product use. We conducted two focus groups with young women, and five in-depth interviews with peers and health workers to explore their experiences with intervention delivery. Qualitative data were analyzed using thematic analysis. Results At baseline, all 30 enrolled young women (median age 20 years) accepted peer-delivered PrEP and HIVST. Peer delivery visit completion was 97% (29/30) and 93% (28/30) at three and six months, respectively. The proportion of participants with detectable tenofovir in urine was 93% (27/29) and 57% (16/28) at months three and six, respectively. Four broad themes emerged from the qualitative data: (1) Positive experiences of peer delivered HIVST and PrEP; (2) The motivating effect of peer support; (3) Perceptions of female controlled HIVST and PrEP; and (4) Multi-level barriers to HIVST and PrEP use. Overall, peer delivery motivated young women to use HIVST and PrEP and encouraged persistence on PrEP by providing non-judgmental client-friendly services and adherence support. Conclusion Peer delivery of HIVST and oral PrEP was feasible and acceptable to this sample of young women with suboptimal PrEP adherence in Uganda. Future larger controlled studies should evaluate its effectiveness among African AGWY.

Stakeholder-engaged development of a rapid test for detection of acute HIV infection

“…While participants expressed important bene ts and concerns for both end-user groups, the majority felt that CHW/peer-led testing would better meet the needs of high-risk populations, particularly regarding the need for counseling and navigation to care. These ndings supports a growing body of literature on the acceptability of both HIV community-based/peer-led and self-testing more broadly [37][38][39][40][41][42][43]. Several reviews have found that while interest in self-testing is high among vulnerable groups because of convenience and privacy, many are concerned about the reliability and accuracy of tests and post-test linkage to care and counseling [38][39][40].…”

The Transformative Power of Virtual Hospitals for Revolutionising Healthcare Delivery

“…These programs utilized “virtual safe spaces” for outreach and counseling, leveraging mediums like telephone, text messages, and WhatsApp. This approach was complemented by the home delivery of PrEP medications, HIV self-test kits, sanitary packs, and condoms, effectively ensuring the continuous provision of prevention services [ 49 ]. It is worth noting that PrEP home delivery was made available exclusively to individuals who did not require HIV testing (administered every 3 months), as HIV testing was still offered at healthcare facilities.…”

Feasibility, acceptability and preliminary effect of a community-led HIV self-testing model among adolescent girls and young women in Rural Northern Uganda: a quasi-experimental study protocol

“…In a Ugandan fishing community, peer leaders distributed 99.3% of HIVST kits to AGYW, and 98.2% used the kit [ 19 , 29 ]. In Kampala, all the 30 AGYW surveyed in a PrEP clinic embraced peer-delivered HIVST, citing its convenience, travel cost savings, reduced clinic waiting times, and stigma-free environment [ 30 ]. While CHW-led models have shown promise in delivering HIVST kits among AGYW in places like Malawi [ 25 , 31 , 32 ] and Zimbabwe [ 33 , 34 ], a significant research gap among AGYW exists in Uganda.…”