Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia
IntroductionDespite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services t...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Reproductive Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/frph.2022.1048702/full |
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| author | Gena Barnabee Gillian O’Bryan Lylie Ndeikemona Idel Billah Lukas Silas Karie L. Morgan Katherine Shulock Susan Mawire Ellen MacLachlan Josua Nghipangelwa Elizabeth Muremi Alison Ensminger Norbert Forster Gabrielle O’Malley |
| author_facet | Gena Barnabee Gillian O’Bryan Lylie Ndeikemona Idel Billah Lukas Silas Karie L. Morgan Katherine Shulock Susan Mawire Ellen MacLachlan Josua Nghipangelwa Elizabeth Muremi Alison Ensminger Norbert Forster Gabrielle O’Malley |
| author_sort | Gena Barnabee |
| collection | DOAJ |
| description | IntroductionDespite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services through community and hybrid models in Namibia to facility-based services. We subsequently identify potential mechanisms to explain how and why community and hybrid models achieved (or not) improved persistence to inform further service delivery innovation.MethodsData were collected from PrEP service delivery to AGYW over two-years in Namibia's Khomas Region. We used Kaplan-Meier analysis to estimate survival curves for PrEP persistence beyond three-months after initiation and report the cumulative probability of persistence at one- and three-months. Persistence was defined as any PrEP use within three months after initiation followed by a PrEP refill or previously prescribed supply of at least 30 days at the three-month visit. Interviews were conducted with 28 AGYW and 19 providers and analyzed using a deductive-inductive thematic approach.ResultsFrom October 2017 through September 2019, 372 (18.7%) AGYW received services through a facility model, 302 (15.1%) through a community model, and 1,320 (66.2%) through a hybrid model. PrEP persistence at one- and three-months was 41.2% and 34.9% in the community model and 6.2% and 4.8% in the hybrid model compared to 36.8% and 26.7% in the facility model. Within the community and hybrid models, we identified three potential mechanisms related to PrEP persistence. Individualized service delivery offered convenience and simplicity which enabled AGYW to overcome barriers to obtaining refills but did not work as well for highly mobile AGYW. Consistent interactions and shared experiences fostered social connectedness with providers and with peers, building social networks and support systems for PrEP use. PrEP and HIV-related stigma, however, was widely experienced outside of these networks. Community-to-facility referral for PrEP refill triggered apprehension towards unfamiliar PrEP services and providers in AGYW, which discouraged persistence.ConclusionService delivery approaches that offer convenience and simplicity and foster social connectedness may reduce access barriers and increase social support enabling AGYW to self-manage their PrEP use and achieve improved PrEP persistence. |
| first_indexed | 2024-04-11T07:15:47Z |
| format | Article |
| id | doaj.art-a65cf2ba515549a4ab3e3c4d1229a0b6 |
| institution | Directory Open Access Journal |
| issn | 2673-3153 |
| language | English |
| last_indexed | 2024-04-11T07:15:47Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Reproductive Health |
| spelling | doaj.art-a65cf2ba515549a4ab3e3c4d1229a0b62022-12-22T04:38:00ZengFrontiers Media S.A.Frontiers in Reproductive Health2673-31532022-12-01410.3389/frph.2022.10487021048702Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in NamibiaGena Barnabee0Gillian O’Bryan1Lylie Ndeikemona2Idel Billah3Lukas Silas4Karie L. Morgan5Katherine Shulock6Susan Mawire7Ellen MacLachlan8Josua Nghipangelwa9Elizabeth Muremi10Alison Ensminger11Norbert Forster12Gabrielle O’Malley13International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United StatesInternational Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United StatesDirectorate of Special Programmes, Ministry of Health and Social Services, Windhoek, NamibiaInternational Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, NamibiaInternational Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, NamibiaCenter for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI, United StatesDisease Control and Health Statistics (DCHS), Washington State Department of Health, Seattle, WA, United StatesStar for Life, Windhoek, NamibiaInternational Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United StatesOshikoto Regional Directorate, Ministry of Health and Social Services, Omuthiya, NamibiaKhomas Regional Directorate, Ministry of Health and Social Services, Windhoek, NamibiaInternational Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United StatesInternational Training and Education Center for Health, Department of Global Health, University of Washington, Windhoek, NamibiaInternational Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United StatesIntroductionDespite the potential for community-based approaches to increase access to pre-exposure prophylaxis (PrEP) for adolescent girls and young women (AGYW), there is limited evidence of whether and how they improve PrEP persistence. We compared PrEP persistence among AGYW receiving services through community and hybrid models in Namibia to facility-based services. We subsequently identify potential mechanisms to explain how and why community and hybrid models achieved (or not) improved persistence to inform further service delivery innovation.MethodsData were collected from PrEP service delivery to AGYW over two-years in Namibia's Khomas Region. We used Kaplan-Meier analysis to estimate survival curves for PrEP persistence beyond three-months after initiation and report the cumulative probability of persistence at one- and three-months. Persistence was defined as any PrEP use within three months after initiation followed by a PrEP refill or previously prescribed supply of at least 30 days at the three-month visit. Interviews were conducted with 28 AGYW and 19 providers and analyzed using a deductive-inductive thematic approach.ResultsFrom October 2017 through September 2019, 372 (18.7%) AGYW received services through a facility model, 302 (15.1%) through a community model, and 1,320 (66.2%) through a hybrid model. PrEP persistence at one- and three-months was 41.2% and 34.9% in the community model and 6.2% and 4.8% in the hybrid model compared to 36.8% and 26.7% in the facility model. Within the community and hybrid models, we identified three potential mechanisms related to PrEP persistence. Individualized service delivery offered convenience and simplicity which enabled AGYW to overcome barriers to obtaining refills but did not work as well for highly mobile AGYW. Consistent interactions and shared experiences fostered social connectedness with providers and with peers, building social networks and support systems for PrEP use. PrEP and HIV-related stigma, however, was widely experienced outside of these networks. Community-to-facility referral for PrEP refill triggered apprehension towards unfamiliar PrEP services and providers in AGYW, which discouraged persistence.ConclusionService delivery approaches that offer convenience and simplicity and foster social connectedness may reduce access barriers and increase social support enabling AGYW to self-manage their PrEP use and achieve improved PrEP persistence.https://www.frontiersin.org/articles/10.3389/frph.2022.1048702/fulldelivery of health carepre-exposure prophylaxisHIV preventionadolescent girls and young womenNamibia |
| spellingShingle | Gena Barnabee Gillian O’Bryan Lylie Ndeikemona Idel Billah Lukas Silas Karie L. Morgan Katherine Shulock Susan Mawire Ellen MacLachlan Josua Nghipangelwa Elizabeth Muremi Alison Ensminger Norbert Forster Gabrielle O’Malley Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia Frontiers in Reproductive Health delivery of health care pre-exposure prophylaxis HIV prevention adolescent girls and young women Namibia |
| title | Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia |
| title_full | Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia |
| title_fullStr | Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia |
| title_full_unstemmed | Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia |
| title_short | Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: Insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia |
| title_sort | improving hiv pre exposure prophylaxis persistence among adolescent girls and young women insights from a mixed methods evaluation of community hybrid and facility service delivery models in namibia |
| topic | delivery of health care pre-exposure prophylaxis HIV prevention adolescent girls and young women Namibia |
| url | https://www.frontiersin.org/articles/10.3389/frph.2022.1048702/full |
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