PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia
<h4>Introduction</h4> Adolescent girls and young women (AGYW) face barriers in accessing clinic-based HIV pre-exposure prophylaxis (PrEP) services and community-based models are a proposed alternative. Evidence from such models, however, is limited. We evaluated PrEP service coverage, up...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10468070/?tool=EBI |
| _version_ | 1797692839395590144 |
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| author | Gena Barnabee Idel Billah Lylie Ndeikemona Lukas Silas Alison Ensminger Ellen MacLachlan Abigail K. Korn Susan Mawire Christa Fischer-Walker Laimi Ashipala Norbert Forster Gabrielle O’Malley Jennifer Velloza |
| author_facet | Gena Barnabee Idel Billah Lylie Ndeikemona Lukas Silas Alison Ensminger Ellen MacLachlan Abigail K. Korn Susan Mawire Christa Fischer-Walker Laimi Ashipala Norbert Forster Gabrielle O’Malley Jennifer Velloza |
| author_sort | Gena Barnabee |
| collection | DOAJ |
| description | <h4>Introduction</h4> Adolescent girls and young women (AGYW) face barriers in accessing clinic-based HIV pre-exposure prophylaxis (PrEP) services and community-based models are a proposed alternative. Evidence from such models, however, is limited. We evaluated PrEP service coverage, uptake, and early persistence among AGYW receiving services through community and hybrid models in Namibia. <h4>Methods</h4> We analyzed routine data for AGYW aged 15–24 who initiated PrEP within HIV prevention programming. PrEP was delivered via three models: community-concierge (fully community-based services with individually-tailored refill locations), community-fixed (community-based initiation and refills delivered by community providers on a set schedule at fixed sites), and hybrid community-clinic (community-based initiation and referral to clinics for refills delivered by clinic providers). We examined proportions of AGYW engaged in services along a programmatic PrEP cascade, overall and by model, and assessed factors associated with PrEP uptake and early persistence (refill within 15–44 days after initiation) using multivariable generalized estimating equations. <h4>Results</h4> Over 10-months, 7593 AGYW participated in HIV prevention programming. Of these, 7516 (99.0%) received PrEP education, 6105 (81.2%) received HIV testing services, 6035 (98.9%) tested HIV-negative, and 2225 (36.9%) initiated PrEP. Of the 2047 AGYW expected for PrEP refill during the study period, 254 (12.4%) persisted with PrEP one-month after initiation. Structural and behavioral HIV risk factors including early school dropout, food insecurity, inconsistent condom use, and transactional sex were associated with PrEP uptake. AGYW who delayed starting PrEP were 2.89 times more likely to persist (95% confidence interval (CI): 1.52–5.46) and those receiving services via the community-concierge model were 8.7 times (95% CI: 5.44–13.9) more likely to persist (compared to the hybrid model). <h4>Conclusion</h4> Community-based models of PrEP service delivery to AGYW can achieve high PrEP education and HIV testing coverage and moderate PrEP uptake. AGYW-centered approaches to delivering PrEP refills can promote higher persistence. |
| first_indexed | 2024-03-12T02:33:23Z |
| format | Article |
| id | doaj.art-fa60743556a441df9ec51f95ec2b34cd |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-12T02:33:23Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-fa60743556a441df9ec51f95ec2b34cd2023-09-05T05:31:42ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01188PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in NamibiaGena BarnabeeIdel BillahLylie NdeikemonaLukas SilasAlison EnsmingerEllen MacLachlanAbigail K. KornSusan MawireChrista Fischer-WalkerLaimi AshipalaNorbert ForsterGabrielle O’MalleyJennifer Velloza<h4>Introduction</h4> Adolescent girls and young women (AGYW) face barriers in accessing clinic-based HIV pre-exposure prophylaxis (PrEP) services and community-based models are a proposed alternative. Evidence from such models, however, is limited. We evaluated PrEP service coverage, uptake, and early persistence among AGYW receiving services through community and hybrid models in Namibia. <h4>Methods</h4> We analyzed routine data for AGYW aged 15–24 who initiated PrEP within HIV prevention programming. PrEP was delivered via three models: community-concierge (fully community-based services with individually-tailored refill locations), community-fixed (community-based initiation and refills delivered by community providers on a set schedule at fixed sites), and hybrid community-clinic (community-based initiation and referral to clinics for refills delivered by clinic providers). We examined proportions of AGYW engaged in services along a programmatic PrEP cascade, overall and by model, and assessed factors associated with PrEP uptake and early persistence (refill within 15–44 days after initiation) using multivariable generalized estimating equations. <h4>Results</h4> Over 10-months, 7593 AGYW participated in HIV prevention programming. Of these, 7516 (99.0%) received PrEP education, 6105 (81.2%) received HIV testing services, 6035 (98.9%) tested HIV-negative, and 2225 (36.9%) initiated PrEP. Of the 2047 AGYW expected for PrEP refill during the study period, 254 (12.4%) persisted with PrEP one-month after initiation. Structural and behavioral HIV risk factors including early school dropout, food insecurity, inconsistent condom use, and transactional sex were associated with PrEP uptake. AGYW who delayed starting PrEP were 2.89 times more likely to persist (95% confidence interval (CI): 1.52–5.46) and those receiving services via the community-concierge model were 8.7 times (95% CI: 5.44–13.9) more likely to persist (compared to the hybrid model). <h4>Conclusion</h4> Community-based models of PrEP service delivery to AGYW can achieve high PrEP education and HIV testing coverage and moderate PrEP uptake. AGYW-centered approaches to delivering PrEP refills can promote higher persistence.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10468070/?tool=EBI |
| spellingShingle | Gena Barnabee Idel Billah Lylie Ndeikemona Lukas Silas Alison Ensminger Ellen MacLachlan Abigail K. Korn Susan Mawire Christa Fischer-Walker Laimi Ashipala Norbert Forster Gabrielle O’Malley Jennifer Velloza PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia PLoS ONE |
| title | PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia |
| title_full | PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia |
| title_fullStr | PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia |
| title_full_unstemmed | PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia |
| title_short | PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia |
| title_sort | prep uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community clinic models in namibia |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10468070/?tool=EBI |
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