Determinants of continuation on HIV pre-exposure propylaxis among female sex workers at a referral hospital in Uganda: a mixed methods study using COM-B model.

IF 3.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Samuel Kawuma, Rodgers Katwesigye, Happy Walusaga, Praise Akatukunda, Joan Nangendo, Charles Kabugo, Moses R Kamya, Fred C Semitala
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引用次数: 0

Abstract

Background: Female sex workers (FSWs) have the highest HIV prevalence in Uganda. Pre-exposure prophylaxis (PrEP) has been recommended as a key component of the HIV combination prevention strategy. Although patient initiation of PrEP has improved, continuation rates remain low. This study evaluated PrEP continuation among FSWs and explored potential determinants of PrEP adherence within a public referral hospital in urban Uganda.

Methods: We conducted an explanatory sequential mixed method study at Kiruddu National referral hospital in Uganda. Secondary data on socio demographic characteristics and follow up outcomes of at least one year was collected for all FSWs who were initiated PrEP between May 2020 and April 2021 and data analyzed on July 15,2023. We used Kaplan-Meier survival analysis to evaluate continuation on PrEP from time of initiation and follow-up period. The capability, opportunity, and motivation to change behaviour model was used to explore perspectives and practices of FSWs (n = 24) and health care providers (n = 8) on continuation on PrEP among FSWs, using semi structured interviews. The qualitative data was deductively coded and analyzed thematically, categorizing the themes related to PrEP continuation as facilitators and barriers.

Results: Of the 292 FSWs initiated on PrEP, median age was 26 years (interquartile range, 21-29), 101 (34.6) % were active on PrEP, 137 (46.9%) were lost to follow-up, 45 (15.4%) were no longer eligible to continue PrEP, eight (2.7%) were transferred out and one (0.3%) had died. Median survival time on PrEP was 15 months (Interquartile range IQR, 3-21). The continuation rates on PrEP at six (6) and 12 months were 61.1% and 53.1%, respectively. Facilitators of PrEP continuation included awareness of risk associated with sex work, integration of PrEP with other HIV prevention services, presence of PrEP Peer support and use of Drop-in centers. The barriers included low community awareness about PrEP, high mobility of sex workers, substance abuse, and the unfavorable daytime clinic schedules. However, the quantitative findings from the multivariable Cox Proportional Hazards Model did not align with the reported findings for the qualitative evaluation.

Conclusion: Continuation on PrEP remains low among FSWs. Interventions for PrEP continuation should address barriers such as low community awareness of PrEP, substance abuse and restrictive health facility policies for scale of the PrEP program among FSWs in Uganda. Integration of PrEP with other services and scale up of community PrEP delivery structures may improve its continuation.

乌干达一家转诊医院女性性工作者继续接受艾滋病毒暴露前丙基反应的决定因素:使用COM-B模型的混合方法研究
背景:在乌干达,女性性工作者(FSWs)的艾滋病毒感染率最高。暴露前预防(PrEP)已被推荐为艾滋病毒联合预防战略的一个关键组成部分。尽管患者开始使用PrEP的情况有所改善,但持续率仍然很低。本研究评估了在乌干达城市的一家公立转诊医院中,FSWs的PrEP持续情况,并探讨了PrEP依从性的潜在决定因素。方法:我们在乌干达Kiruddu国家转诊医院进行了一项解释性顺序混合方法研究。收集了2020年5月至2021年4月期间开始PrEP的所有FSWs至少一年的社会人口特征和随访结果的辅助数据,并于2023年7月15日对数据进行了分析。我们采用Kaplan-Meier生存分析从开始和随访时间评价PrEP的持续治疗。采用半结构化访谈,利用能力、机会和改变行为的动机模型,探讨女服务员(n = 24)和卫生保健提供者(n = 8)对女服务员继续服用PrEP的观点和做法。对定性数据进行演绎编码和主题分析,将与PrEP继续相关的主题分类为促进因素和障碍因素。结果:在292例开始使用PrEP的FSWs中,年龄中位数为26岁(四分位数范围21-29岁),101例(34.6%)%使用PrEP, 137例(46.9%)失去随访,45例(15.4%)不再符合继续使用PrEP的条件,8例(2.7%)转移,1例(0.3%)死亡。PrEP的中位生存时间为15个月(四分位数范围IQR, 3-21)。6个月和12个月的PrEP延续率分别为61.1%和53.1%。预防措施继续的促进因素包括:认识到与性工作有关的风险、将预防措施与其他艾滋病毒预防服务相结合、提供预防措施同伴支持和使用援助中心。这些障碍包括社区对PrEP的认知度低、性工作者流动性高、药物滥用以及不利的日间诊所安排。然而,多变量Cox比例风险模型的定量结果与定性评价的报告结果不一致。结论:FSWs患者继续服用PrEP的比例较低。预防措施继续实施的干预措施应解决诸如社区对预防措施认识不足、药物滥用以及卫生设施政策对乌干达家庭服务机构预防方案规模的限制等障碍。将预防措施与其他服务相结合,并扩大社区预防措施的提供结构,可改善其持续性。
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
BMC Public Health
BMC Public Health 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.50
自引率
4.40%
发文量
2108
审稿时长
1 months
期刊介绍: BMC Public Health is an open access, peer-reviewed journal that considers articles on the epidemiology of disease and the understanding of all aspects of public health. The journal has a special focus on the social determinants of health, the environmental, behavioral, and occupational correlates of health and disease, and the impact of health policies, practices and interventions on the community.
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