Applying the Effective Programme Coverage framework to assess gaps in HIV prevention programmes for female sex workers and men who have sex with men in Nairobi, Kenya: findings from an expanded Polling Booth Survey

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2024-07-10 DOI:10.1002/jia2.26240

Parinita Bhattacharjee, Leigh McClarty, Shajy Isac, Joshua Kimani, Faran Emmanuel, Rhoda Kabuti, Antony Kinyua, Bernadette Kina Kombo, Collins Owek, Helgar Musyoki, Anthony Kiplagat, Peter Arimi, Souradet Yuh-Nan Shaw, Monica Gandhi, Siobhan Malone, James Blanchard, Geoff Garnett, Marissa L. Becker

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引用次数: 0

Abstract

Introduction

Measuring the coverage of HIV prevention services for key populations (KPs) has consistently been a challenge for national HIV programmes. The current frameworks and measurement methods lack emphasis on effective coverage, occur infrequently, lack timeliness and limit the participation of KPs. The Effective Programme Coverage framework, which utilizes a programme science approach, provides an opportunity to assess gaps in various coverage domains and explore the underlying reasons for these gaps, in order to develop targeted solutions. We have demonstrated the application of this framework in partnership with the KP community in Nairobi, Kenya, using an expanded Polling Booth Survey (ePBS) method.

Methods

Data were collected between April and May 2023 among female sex workers (FSWs) and men who have sex with men (MSM) using (a) PBS, (b) bio-behavioural survey and (c) focus group discussions. Data collection and analysis involved both KP community and non-community researchers. Descriptive analysis was performed, and proportions were used to assess the programme coverage gaps. The data were weighted to account for the sampling design and unequal selection probabilities. Thematic analysis was conducted on the qualitative data.

Results

The condom programme for FSW and MSM had low availability (60.2% and 50.9%), contact (68.8% and 65.9%) and utilization (52.1% and 43.9%) coverages. The pre-exposure prophylaxis (PrEP) programme had very low utilization coverage for FSW and MSM (4.4% and 2.8%), while antiretroviral therapy utilization coverage was higher (86.6% and 87.7%). Reasons for coverage gaps included a low peer educator-to-peer ratio, longer distance to the clinics, shortage of free condoms supplied by the government, experienced and anticipated side effects related to PrEP, and stigma and discrimination experienced in the facilities.

Conclusions

The Effective Programme Coverage framework allows programmes to assess coverage gaps and develop solutions and a research agenda targeted at specific domains of coverage with large gaps. The ePBS method works well in collecting data to understand coverage gaps rapidly and allows for the engagement of the KP community.

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应用有效方案覆盖框架评估肯尼亚内罗毕女性性工作者和男男性行为者艾滋病毒预防方案的差距：扩大投票站调查的结果。

导言：衡量艾滋病毒预防服务对重点人群（KPs）的覆盖率一直是国家艾滋病毒计划面临的挑战。目前的框架和衡量方法缺乏对有效覆盖率的重视，不经常出现，缺乏及时性，并限制了关键人群的参与。有效计划覆盖率框架采用计划科学的方法，提供了一个机会来评估各个覆盖领域的差距，并探索造成这些差距的根本原因，从而制定有针对性的解决方案。我们与肯尼亚内罗毕的 KP 社区合作，采用扩大投票站调查 (ePBS) 方法展示了这一框架的应用：方法：2023 年 4 月至 5 月期间，我们使用（a）投票站调查（PBS）、（b）生物行为调查和（c）焦点小组讨论，在女性性工作者（FSWs）和男男性行为者（MSM）中收集了数据。金伯利进程社区和非社区研究人员参与了数据收集和分析工作。对数据进行了描述性分析，并使用比例来评估计划覆盖范围的差距。考虑到抽样设计和不平等的选择概率，对数据进行了加权处理。对定性数据进行了专题分析：针对性工作者和男男性行为者的安全套计划的可用率（60.2% 和 50.9%）、接触率（68.8% 和 65.9%）和使用率（52.1% 和 43.9%）均较低。暴露前预防（PrEP）计划在女性同性恋者和男男性行为者中的使用覆盖率很低（4.4% 和 2.8%），而抗逆转录病毒疗法的使用覆盖率较高（86.6% 和 87.7%）。造成覆盖率差距的原因包括同伴教育者与同伴的比例较低、距离诊所较远、政府提供的免费安全套短缺、与 PrEP 相关的经验和预期副作用，以及在医疗机构中遭受的羞辱和歧视：有效计划覆盖范围框架允许计划评估覆盖范围的差距，并针对差距较大的特定覆盖范围制定解决方案和研究议程。ePBS 方法能很好地收集数据，迅速了解覆盖面的差距，并让 KP 社区参与进来。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.