PLOS global public health最新文献

{"title":"Magnitude of ectopic pregnancy, management methods, and its associated factors among pregnant women attending Ambo University Referral Hospital in Oromia Regional State, Ethiopia: A seven years retrospective institutional based cross-sectional study.","authors":"Nigussie Tesfaye Gizaw, Mekbeb Afework K/Mariam, Motuma Gutu Fayera","doi":"10.1371/journal.pgph.0004611","DOIUrl":"10.1371/journal.pgph.0004611","url":null,"abstract":"<p><strong>Background: </strong>Ectopic pregnancy is the implantation of a blastocyst outside of the endometrial lining of the uterus. Ectopic pregnancy can take several forms, including ovarian, abdominal, and tubal. The most prevalent place for ectopic pregnancy is the fallopian tube, which accounts for over 97.7% of all ectopic gestations. The ampulla accounts for around 80% of tubal pregnancy, followed by the isthmus (12%), fimbria (5%). Ectopic pregnancy is diagnosed with the classic triad of amenorrhea, abdominal pain, vaginal bleeding, and a positive pregnancy test.</p><p><strong>Objective: </strong>This study aimed to assess the magnitude of ectopic pregnancy, its management outcome, and associated factors among pregnant women attending Ambo University Referral Hospital in the Oromia Region, Ethiopia, in 2024.</p><p><strong>Methods: </strong>A seven-year retrospective cross-sectional study, from February 2018 to April 2024, was conducted at the Ambo University Referral Hospital, which is located in Ambo town, Ethiopia. Data concerning all pregnant mothers who were admitted and managed for ectopic pregnancy were extracted from the medical records of patients and the operation book by a trained data collector through Kobo Toolbox electronic data collection software. The collected data was checked first for its completeness, and it was exported into SPSS version 26 software for data analysis. Then Descriptive statistics were employed for summarizing the data, and bivariate and multivariate logistic regression analyses were used to identify the independent effect of the predictor variable on the outcome variable.</p><p><strong>Results: </strong>From February 2018 to April 2024, there were 17,687 total pregnancies, 6,249 gynecologic admissions, and 182 cases of ectopic pregnancies at Ambo University Referral Hospital. A total of 173 patients with ectopic pregnancy were included in the data analysis. The magnitude of ectopic pregnancy was 0.98% among the total pregnancies and accounted for 2.77% of all gynecological admissions during the study period. Most of the patients, 81 (46.8%), were in the 25-29 years age group, with a mean age of 27.16 ± SD 4.77 years. Mothers who had a previous history of abortion, a history of pelvic inflammatory disease, a history of ectopic pregnancy, or a history of tubal surgery had a statistically significant association with ectopic pregnancy. The majority of the patients were married, 98 (56.6%), and urban residents, 121 (69.9%). The majority of ectopic pregnancies occurred on the right side of the fallopian tube 144 (83.24%). Among the majority of ectopic pregnancies, 159 (61.3%) were tubal ampullary ectopic pregnancies.</p><p><strong>Conclusion and recommendation: </strong>The major risk factors identified in this study were previous abortion, pelvic inflammatory disease, a previous history of ectopic pregnancy, and previous tubal surgery. The magnitude of the ectopic pregnancy in this study was 0.98%, which ","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004611"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and health system delays in the diagnosis and treatment of tuberculosis in Gandaki, Nepal.","authors":"Bikram Singh Dhami, Damaru Prasad Paneru, Sagar Parajuli, K C Aarati, Dhirendra Nath","doi":"10.1371/journal.pgph.0004676","DOIUrl":"10.1371/journal.pgph.0004676","url":null,"abstract":"<p><p>Delays in accessing healthcare worsen disease outcomes, increasing Tuberculosis (TB) transmission rates and mortality. Prolonged delays may contribute to drug-resistant TB strains in some cases, this study assessed delays in diagnosis and treatment among TB patients in Gandaki, Nepal. A cross-sectional study was conducted among a randomly selected sample of 194 TB patients enrolled in Direct Observed Treatment Short-course (DOTS) therapy. The data were collected through face-to-face interviews using a semi-structured interview schedule, which was developed through literature review and adaptation of the World Health Organization's multi-country study. Multivariate logistic regression was employed to identify factors associated with delays in diagnosis and treatment, considering a p value < 0.05 to indicate statistical significance. The median patient and health system delays were 35 (7-120) and 9 (2-98) days, respectively. Furthermore, 55.7% and 58.2% of patients experienced patient and health system delays, respectively. In the multivariable logistic regression analysis, factors associated with unacceptable patient delay included non enrollment in government health insurance programmes (AOR: 3.19; 95% CI: 1.29-7.98), seeking care from non-National Tuberculosis Program (non-NTP) providers (AOR: 3.19; 95% CI: 1.460-6.97), poor knowledge of TB (AOR: 3.74; 95% CI: 1.67-8.37), and high levels of perceived stigma (AOR: 3.15; 95% CI: 1.42-6.94). Furthermore, undergoing an initial diagnostic test other than GeneXpert (AOR: 3.25; 95% CI: 1.19-8.87) and visiting healthcare facilities multiple times before being diagnosed with TB (AOR: 5.62; 95% CI: 2.26-13.96) were significantly associated with unacceptable health system delay. Patient and health system delays were prevalent among TB patients. Reducing these delays is crucial for improving TB control. Therefore, urgent action is needed to implement education campaigns to improve TB literacy. Additionally, engaging private and informal healthcare providers and enhancing their capacity to deliver timely and effective TB care could potentially mitigate delays in diagnosis and treatment.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004676"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent boys' sociocultural beliefs and attitudes toward menstruation in selected high schools in Ghana: Mediation and moderation effect of knowledge.","authors":"Israel Wuresah, Priscilla Klutse, Sarah Odi Mantey, Isaiah Agorinya, Julie Hennegan, Sitsofe Gbogbo","doi":"10.1371/journal.pgph.0004354","DOIUrl":"10.1371/journal.pgph.0004354","url":null,"abstract":"<p><p>Adolescent boys can reinforce negative societal attitudes towards menstruation and make it difficult for adolescent girls to achieve optimal menstrual health and hygiene (MHH) which defeats Sustainable Development Goals 3, 5.1, 5.2 and 5.6. This study investigated how knowledge mediates/moderates the association between sociocultural beliefs (SB) and attitudes of adolescent boys regarding menstruation in senior high schools in Ghana. A cross-sectional study was conducted in five mix-sex public senior high schools (SHS) in Volta region, Ghana. Probability proportional to size was used to distribute 431 study subjects among the schools, and surveys were conducted using structured questionnaires. Structural equation modeling (SEM) and generalized least square (GLS) modeling were conducted. The mean age of the sample was 17.3 (±1.0). Majority (60.6%) were between 15-17 years old, and Christians (95.4%). Half of them had low knowledge; 38% had moderate, and 11% had high knowledge. Meanwhile, negative SB (55.2%) outweighed positive SB, which reflected in their attitudes towards menstruation with 52.7% exhibiting poor attitudes. The SEM revealed that knowledge had a significant negative effect on SB and attitudes, with coefficients of -0.06 (SE = 0.01, p < 0.001), and -0.28 (SE = 0.06, p < 0.001) respectively. The GLS model indicated that knowledge also moderates the relationship between SB and attitudes. Male students in Ghana have a tendency to stigmatize menstruation among their female counterparts because they have inadequate knowledge about it and this may affect the achievement of optimal MHH by their female colleagues. It is evident that effective menstrual education reduces negative attitudes.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004354"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-driven solutions to improve safety and health: Application of the REDECA framework for agricultural tractor drivers.","authors":"Negin Ashrafi, Sahar Yousefi, Guy Roger Aby, Salah F Issa, Houshang Darabi, Kamiar Alaei, Greg Placencia, Maryam Pishgar","doi":"10.1371/journal.pgph.0003543","DOIUrl":"10.1371/journal.pgph.0003543","url":null,"abstract":"<p><strong>Introduction: </strong>Despite tremendous efforts, including research, teaching, and extension, toward improving the safety of agricultural tractor drivers, the number of incidents related to agricultural tractor drivers has not declined. This evidence points out an urgent need to explore artificial intelligence (AI) solutions to improve the safety of tractor drivers.</p><p><strong>Methods: </strong>This paper uses 171 Fatality Assessment and Control Evaluation (FACE) reports related to tractor drivers and a new framework called Risk Evolution, Detection, Evaluation, and Control of Accidents (REDECA) to identify existing AI solutions, such as machine learning models for predictive maintenance, sensor-based monitoring, computer vision, and automated safety interventions, and specific areas where AI solutions are missed and can be developed to reduce incidents and recovery time. Fatality reports of tractor drivers were categorized into six main categories, including run over, pinned by/ Crushed and entanglement, fall, fire, roll over, and overturn. Each category was then subcategorized based on similarities of incident causes in the reports.</p><p><strong>Results: </strong>The application of the REDECA framework, which categorizes risk states into R1 (safe), R2 (hazard exposure), and R3 (incident), revealed potential AI solutions that could improve the safety of tractor drivers. In all categories, the REDECA framework lacks AI solutions for three elements, including the probability of reducing recovery time in R3, detecting changes between R2 and R3, and intervention to send workers to R2. Most of the categories were missing AI solutions for interventions to prevent entry to the R3 element of the REDECA. In addition, the fall, roll over, and overturn categories lacked AI intervention that minimized damage and recovery in R3.</p><p><strong>Conclusions: </strong>The outcome of this study shows an urgent need to develop AI solutions to improve tractor driver safety.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0003543"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building models, building capacity: A review of participatory machine learning for HIV prevention.","authors":"Mark Sendak, Meg Young, Jee Young Kim, Alifia Hasan, Clare Kelsey, Catherine O'Neal, Tonya Jagneaux, Wayne Wilbright, John Couk, Stephen Lim, Tamachia Davenport, Shirley Lolis, Jennifer Thomas, Shannon Widman, Suresh Balu, Meredith Clement, Lance Okeke","doi":"10.1371/journal.pgph.0003862","DOIUrl":"10.1371/journal.pgph.0003862","url":null,"abstract":"<p><p>A growing number of researchers and practitioners are embracing a \"participatory turn\" in machine learning (ML) to improve model development, prevent harm, and provide communities more influence over systems that impact them. In this paper, we explore the intersection of participatory practices in healthcare and the emerging focus on responsible AI with a focus on human immunodeficiency virus (HIV) care. We review the historical context of participation in HIV treatment and prevention, emphasizing how patient activism has shaped practices in this field. We then review participatory ML in HIV prevention and present a brief case study of a project designed to identify candidates for pre-exposure prophylaxis (PrEP) in Louisiana. The review highlights the essential steps in conducting participatory ML. Finally, we draw lessons for future participatory ML projects, underscoring the importance of long-term collaboration, responsiveness to partner feedback, and the crucial role of capacity-building for individuals and organizations. Effective participation requires substantial resources and investment, which supports overall project goals beyond mere improvements in model performance. We also draw lessons for advancing the participatory ML field, including (1) the impact of funding mandates on fostering effective engagement; (2) the need to scale participatory processes rather than just technologies; and (3) the need for genuine participation to allow flexibility in project plans, timelines, and shifts in institutional power dynamics.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0003862"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School and home-based educational intervention in urban Kenya: Sustained improvements in knowledge, attitudes, and practices for Aedes aegypti control.","authors":"Prathik Kalva, Jenna Forsyth, Francis Mutuku, Gladys Agola, Mwashee Lutt, Angelle Desiree LaBeaud","doi":"10.1371/journal.pgph.0004567","DOIUrl":"10.1371/journal.pgph.0004567","url":null,"abstract":"<p><p>Aedes aegypti mosquitoes are the primary vectors for important arboviral health threats including chikungunya (CHIKV) and dengue (DENV) viruses, primarily breeding in domestic plastic containers. Previous studies have highlighted a severe lack of knowledge about non-malarial mosquito-borne diseases in Kenya, so we proposed a household and school-based educational intervention in urban coastal Kenya to determine whether it could bring about long-term improvements in knowledge, attitudes, and practices related to the source reduction of arboviral disease vectors. In this cluster-randomized controlled trial, 249 households from 5 villages were placed in the intervention arm and 243 households from 5 other similar villages were placed in the control arm. From each household, one fourth grade child was enrolled. Data on the child participants' knowledge, attitudes, and practices (KAP) were collected at baseline and 3- and 12-months post-intervention, along with counts of immature mosquitoes in containers in the participants' households. At 3 months, the intervention group showed significantly greater improvement in attitude scores compared to the control group (p = 0.01), with no significant differences in knowledge or practices. However, by 12 months, the intervention group demonstrated significant improvements in knowledge (1.51 vs. 0.35, p < 0.001), attitude (0.268 vs. -0.263, p < 0.001), and practice (0.118 vs. -0.235, p < 0.001) scores compared to the control group. Additionally, the house index (houses with at least one productive container) increased in both the intervention (13.9% to 25.6%) and control (9.4% to 28.4%) households, signifying that although the intervention improved knowledge and some practices, a more targeted approach is needed to address challenges in vector control. This study demonstrates that long-term advances in knowledge, attitudes, and practices regarding arboviral diseases can be achieved through household and school-based educational interventions.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004567"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking through abrupt closure in humanitarian assistance: Key ethical considerations in seemingly impossible conditions.","authors":"Lisa Eckenwiler, Isabel Munoz-Beaulieu, Revka Perez, Mayfourth Luneta, Shelley Rose Hyppolite, Lisa Schwartz, Matthew Hunt","doi":"10.1371/journal.pgph.0004656","DOIUrl":"10.1371/journal.pgph.0004656","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004656"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting mobile health clinic utilization for COVID-19 vaccination in South Carolina: A statistical framework for strategic resource allocation.","authors":"Fatih Gezer, Kerry A Howard, Kevin J Bennett, Alain H Litwin, Kerry K Sease, Lior Rennert","doi":"10.1371/journal.pgph.0003837","DOIUrl":"10.1371/journal.pgph.0003837","url":null,"abstract":"<p><p>Mobile health clinics (MHCs) are effective tools for providing health services to disadvantaged populations, especially during health emergencies. However, patient utilization of MHC services varies substantially. Strategies to increase utilization are needed to maximize the effectiveness of MHC services by serving more patients in need. The purpose of this study is to develop a statistical framework to identify and prioritize high-risk communities for delivery of MHCs during health emergencies. Prisma Health MHCs delivered COVID-19 vaccines to communities throughout South Carolina between February 20, 2021, and February 17, 2022. In this retrospective study, we used generalized linear mixed effects models and ordinal logistic regression models to identify factors associated with, and predictive of, MHC utilization for COVID-19 vaccination by census tract. The MHCs conducted 260 visits to 149 sites and 107 census tracts. The site-level analysis showed that visits to schools (RR = 2.17, 95% CI = 1.47-3.21), weekend visits (RR = 1.38, 95% CI = 1.03-1.83), and visits when the resources were limited (term 1: 7.11, 95% CI = 4.43-11.43) and (term 2: 2.40, 95% CI = 1.76-3.26) were associated with greater MHC utilization for COVID-19 vaccination. MHC placement near existing vaccination centers (RR = 0.79, 95% CI = 0.68-0.93) and hospitals (RR = 0.83, 95% CI = 0.71-0.96) decreased utilization. Predictive models identified 1,227 (94.7%) census tracts with more than 250 individuals per MHC visit when vaccine resources were limited. Predictions showed satisfactory accuracy (72.6%). The census tracts with potential of high MHC demand had higher adolescent, 30-44 years old, and non-White populations; lower Primary Care Practitioners per 1,000 residents; fewer hospitals; and higher cumulative COVID-19 emergency department visits and deaths (compared to census tracts with low MHC demand). After the vaccines became widely available, the demand at MHCs declined. These study findings can improve MHC allocation by identifying and prioritizing medically underserved communities for strategic delivery of these limited resources, especially during health emergencies.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0003837"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing gender equality in global health: What can we learn from successful gender integration across five UN agencies?","authors":"Johanna Riha, T K Sundari Ravindran, George A Atiim, Renu Khanna, Michelle Remme","doi":"10.1371/journal.pgph.0004697","DOIUrl":"10.1371/journal.pgph.0004697","url":null,"abstract":"<p><p>The global nature of on-going crises - climate, economic, social, political - and their impact on health means more than ever a response supported via an effective multilateral system is needed. Not only have these crises worsened health inequities but they have also eroded strides advancing gender equality, with detrimental impacts in the health sector and beyond. Despite recent attacks against multilateralism, the United Nations (UN) and its agencies remain strategically well-placed to provide direction and lead the agenda of gender equality in health, drawing on lessons from the past. Through a collaborative practice-based multi-agency study, 14 case studies from across five UN agencies were documented and analysed to identify what has worked institutionally and programmatically to promote gender equality in health over the last 25 years. The outcomes observed reflected the different levels that UN agencies work at and showcased the capabilities and strengths of the UN system in promoting gender equality in health through its operational functions, global agenda-setting work, and institutional processes and structures. In addition, across the case studies five key factors - feminist civil society, robust evidence, leadership support and gender technical expertise, and institutional structures - consistently stood out as necessary elements to leverage opportunities and produce substantial and sustained advances in gender equality in health. These findings offer important lessons of what to foster more of in multilateral and bilateral health organisations as we seek to continue advancing gender equality in health.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004697"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the pill: Understanding barriers and enablers to oral and long-acting injectable PrEP among women in sex work in Zambia.","authors":"Ramya Kumar, Chisomo Mwale, Patricia Maritim, Jamia Phiri, Wendy Barrington, Ruth Zyambo, Martin Zimba, Kenneth Mugwanya, Michael Herce, Maurice Musheke, Deepa Rao, Anjali Sharma","doi":"10.1371/journal.pgph.0004461","DOIUrl":"10.1371/journal.pgph.0004461","url":null,"abstract":"<p><p>Women engaging in sex work (WESW) in low- and middle-income countries face a disproportionately high risk of HIV infection. This study explores enablers and barriers to the uptake and persistence of oral pre-exposure prophylaxis (PrEP) and long-acting injectable PrEP (LAI-PrEP) among WESW in Lusaka, Zambia. We evaluated Capability, Opportunity, and Motivation behavioral domains, using the COM-B model, which affectied behavioral engagement with PrEP services among newly-initiated WESW from community-based safe spaces. Participants were recruited from July-October 2023 and interviewed using a semi-structured guide to explore barriers and enablers to engagement with HIV prevention. We used a rapid analysis approach-a two-step qualitative method-to identify themes aligned with COM-B domains. Interviews were conducted in English, ChiNyanja, or IchiBemba, audio-recorded, translated into English when necessary, and transcribed verbatim. Among 18 participants with a median age of 28 years (IQR:23-33) and 5 years in sex work (IQR:2,7), education during outreach by peer navigators and program staff was crucial to building trust and demystifying PrEP. Persistent knowledge gaps and misconceptions, especially about daily adherence and alcohol use, were significant barriers. Trustworthy program staff and reliable service provision facilitated continued PrEP use, and women preferring that drugs be delivered to them. Social support systems were mixed, offering both aid and competition. Personal empowerment and health protection motivated PrEP use, with LAI-PrEP preferred for eliminating daily pill burdens and associated stigma. However, inconsistent supply and misconceptions about LAI-PrEP were potential barriers. This study underscores the importance of person-centered care in addressing the complex interplay of individual, community, and programmatic factors influencing PrEP engagement among WESW in Zambia. A holistic focus, and adaptive health service delivery approach are both crucial to ensure that advances in HIV prevention translate into tangible benefits for WESW. Reliable, respectful healthcare programs that provide accurate, and trusted information are essential for improving PrEP uptake and persistence.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 6","pages":"e0004461"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}