Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-10-08 DOI:10.1002/jia2.70032

Jacob Busang, Nqobile Ngoma, Thembelihle Zuma, Carina Herbst, Nonhlanhla Okesola, Natsayi Chimbindi, Jaco Dreyer, Theresa Smit, Kristien Bird, Lucky Mtolo, Osee Behuhuma, Willem Hanekom, Kobus Herbst, Limakatso Lebina, Janet Seeley, Andrew Copas, Kathy Baisley, Maryam Shahmanesh

{"title":"Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services","authors":"Jacob Busang, Nqobile Ngoma, Thembelihle Zuma, Carina Herbst, Nonhlanhla Okesola, Natsayi Chimbindi, Jaco Dreyer, Theresa Smit, Kristien Bird, Lucky Mtolo, Osee Behuhuma, Willem Hanekom, Kobus Herbst, Limakatso Lebina, Janet Seeley, Andrew Copas, Kathy Baisley, Maryam Shahmanesh","doi":"10.1002/jia2.70032","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p><i>Thetha Nami ngithethe nawe</i> is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; <i>p</i> < 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; <i>p</i> < 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Community-based and person-centred approaches delivered through trained peer-navigators can link AYA with SRH and HIV prevention/care needs with mobile SRH services.</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70032","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the International AIDS Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jia2.70032","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.

Methods

Thetha Nami ngithethe nawe is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).

Results

Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; p < 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; p < 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.

Conclusions

Community-based and person-centred approaches delivered through trained peer-navigators can link AYA with SRH and HIV prevention/care needs with mobile SRH services.

Abstract Image

查看原文本刊更多论文

南非农村青年以人为本的艾滋病毒护理和预防：来自Thetha Nami的初步实施结果，以及在流动性健康服务中动员同伴导航员的新分步试验

尽管以抗逆转录病毒疗法（ART）为基础的预防有效，但人口水平的影响仍然有限，因为传统服务无法覆盖艾滋病毒感染高风险人群。我们调查了在南非夸祖鲁-纳塔尔省，以社区为基础的同伴导航员与性健康和生殖健康（SRH）服务一起提供的以青年为中心和量身定制的艾滋病毒预防是否可以调动青少年和年轻人（AYA）对艾滋病毒暴露前预防（PrEP）和抗逆转录病毒治疗的需求。方法采用聚类随机楔形试验（SWT）对某农村卫生人口监测点的40个聚类进行研究。分组随机分为第一阶段（早期）或第二阶段（延迟）接受干预。经过培训的地区同伴导览员对15-30岁的青年进行了需求评估，以量身定制健康宣传、社会心理支持和转诊到护士领导的流动性健康和生殖健康诊所，这些诊所还提供艾滋病毒检测、身份中立的抗逆转录病毒治疗和口服PrEP。我们报告了在SWT （NCT05405582）的第一阶段，20个干预集群的性健康健康服务吸收情况。结果2022年6月至2023年9月，在目标人群13000名青少年中，同行导航员达到9742人（74.9%），其中男性46.8%。在9576名进行需求评估的个体中，同伴导航员确定141人（1.5%）有社会需求，4138人（43.5%）有中高健康需求。这些人被转介到流动诊所，就诊人数为2269人（54.8%），其中男性959人（42.3%）。艾滋病毒检测使用率高（92.7%;2103/2269），其中10.1%（212/2103）为艾滋病毒检测阳性，其中62人（29.2%）为首次开始抗逆转录病毒治疗。女性的HIV感染率高于男性（15.1% vs. 3.3%; p < 0.001）。在临床参与者中，96.8%的人接受了PrEP资格筛查，38.5%的人认为符合条件并提供了PrEP。在接受性传播感染（STI）检测的1433人中（63.2%），418人（29.2%）检测呈阳性，女性的STI患病率更高（37.2% vs. 17.9%; p < 0.001）。其中，385人（92.1%）接受了性传播感染治疗。在1310名女性中，769名（58.7%）报告首次就诊时未使用任何避孕措施，275/769名（35.8%）在试验期间开始避孕。结论：通过训练有素的同伴导航员提供的以社区为基础和以人为本的方法可以将AYA与性健康生殖健康和艾滋病毒预防/护理需求与流动性健康生殖健康服务联系起来。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

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.