Stakeholder perspectives on integrating doxycycline postexposure prophylaxis into Kenyan HIV PrEP programmes.

IF 2.9 3区 医学 Q2 INFECTIOUS DISEASES
Felix Ong'era Mogaka, Benn Kwach, Alfred Odira, Gabrielle O'Malley, Mary Hearst, Elizabeth A Bukusi, Jenell Stewart
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引用次数: 0

Abstract

Objectives: Doxycycline postexposure prophylaxis (doxyPEP) is an efficacious sexually transmitted infection (STI) prevention strategy. Implementation guidelines recommend a focus on people with prior STIs and/or those taking HIV pre-exposure prophylaxis (PrEP), but trial results are insufficient for interventions to enter guidelines and clinical practice. The purpose of this paper is to describe potential barriers and facilitators for successful implementation strategies of doxyPEP in resource-limited settings.

Methods: This qualitative study explored the perceived acceptability, feasibility and sustainability of integrating doxyPEP for STI prevention into Kenyan HIV PrEP programmes. Semistructured interviews were conducted with policymakers, healthcare providers and HIV PrEP users. The interviews were recorded, transcribed and translated to English. Analysis was completed using Dedoose software using deductive reasoning based on the Consolidated Framework for Implementation Research.

Results: Forty interviews (7 policymakers, 16 HIV PrEP users, 17 healthcare providers) were conducted between August 2022 and April 2023. Collectively, study participants found doxyPEP to be an acceptable strategy and understood its potential use among HIV PrEP users. However, participants noted several considerations such as the relative advantage, quality and evidence strength, and tension for change alongside the needs, resources and knowledge of the recipient. Integrating doxyPEP into HIV PrEP programmes was deemed feasible, but there were concerns over long-term sustainability, antimicrobial resistance (AMR), surveillance, cost, pill burden and compatibility, and high workload for HIV PrEP providers. Establishing sustainable practice needs to consider costs, external policies, incentives to participate and engaging providers and recipients in the process.

Conclusion: Kenyan HIV/STI policymakers, healthcare providers and HIV PrEP users perceived doxyPEP for STI prevention to be acceptable and feasible when addressing local contextual factors. Potential for sustainability was recognised if programmes can address concerns, including AMR, pill burden and additional workload for health professionals, prior to the implementation of doxyPEP into HIV PrEP programmes.

利益相关者对将强力霉素暴露后预防纳入肯尼亚艾滋病毒预防规划的看法。
目的:多西环素暴露后预防(doxyPEP)是一种有效的性传播感染(STI)预防策略。实施指南建议重点关注既往性传播感染患者和/或采取艾滋病毒暴露前预防(PrEP)的人,但试验结果不足以使干预措施进入指南和临床实践。本文的目的是描述在资源有限的环境中成功实施doxyPEP策略的潜在障碍和促进因素。方法:本定性研究探讨了将doxyPEP用于性病预防纳入肯尼亚HIV PrEP规划的可接受性、可行性和可持续性。对政策制定者、卫生保健提供者和艾滋病毒PrEP使用者进行了半结构化访谈。这些采访被录音、转录并翻译成英文。采用Dedoose软件,基于统一实施研究框架,采用演绎推理方法完成分析。结果:在2022年8月至2023年4月期间进行了40次访谈(7名政策制定者,16名HIV PrEP使用者,17名卫生保健提供者)。总的来说,研究参与者发现doxyPEP是一种可接受的策略,并了解其在HIV PrEP使用者中的潜在用途。然而,与会者注意到一些考虑因素,如相对优势、质量和证据强度、以及变化的压力以及接受者的需求、资源和知识。将doxyPEP纳入HIV PrEP规划被认为是可行的,但存在长期可持续性、抗菌素耐药性(AMR)、监测、成本、药丸负担和兼容性以及HIV PrEP提供者的高工作量等问题。建立可持续的实践需要考虑成本、外部政策、参与和吸引提供者和接受者参与这一过程的激励措施。结论:肯尼亚HIV/STI政策制定者、卫生保健提供者和HIV PrEP使用者认为,在解决当地环境因素时,doxyPEP用于STI预防是可接受和可行的。如果方案能够在将doxyPEP纳入艾滋病毒预防方案之前解决一些问题,包括抗菌素耐药性、药丸负担和卫生专业人员的额外工作量,则认识到可持续性的潜力。
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
Sexually Transmitted Infections
Sexually Transmitted Infections 医学-传染病学
CiteScore
5.70
自引率
8.30%
发文量
96
审稿时长
4-8 weeks
期刊介绍: Sexually Transmitted Infections is the world’s longest running international journal on sexual health. It aims to keep practitioners, trainees and researchers up to date in the prevention, diagnosis and treatment of all STIs and HIV. The journal publishes original research, descriptive epidemiology, evidence-based reviews and comment on the clinical, public health, sociological and laboratory aspects of sexual health from around the world. We also publish educational articles, letters and other material of interest to readers, along with podcasts and other online material. STI provides a high quality editorial service from submission to publication.
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