Carol S. Camlin, Titus Arunga, Jason Johnson-Peretz, Cecilia Akatukwasa, Fredrick Atwine, Angeline Onyango, Lawrence Owino, Moses R. Kamya, Maya L. Petersen, Gabriel Chamie, Elijah Kakande, Jane Kabami, Laura B. Balzer, Diane V. Havlir, James Ayieko
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In this qualitative study, we sought to understand clients’ experiences of this “dynamic choice prevention model” (DCP) and highlight pathways of action to inform HIV prevention delivery models.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of <i>n</i> = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and <i>n</i> = 21 healthcare providers (total <i>n</i> = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners’ behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities—but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26336","citationCount":"0","resultStr":"{\"title\":\"Client experiences with “Dynamic Choice Prevention,” a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa\",\"authors\":\"Carol S. Camlin, Titus Arunga, Jason Johnson-Peretz, Cecilia Akatukwasa, Fredrick Atwine, Angeline Onyango, Lawrence Owino, Moses R. Kamya, Maya L. Petersen, Gabriel Chamie, Elijah Kakande, Jane Kabami, Laura B. Balzer, Diane V. 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引用次数: 0
摘要
导言:确定提供艾滋病预防服务的最佳方法以满足高危人群的需求是当务之急,特别是考虑到生物医学艾滋病预防方案的工具包在不断扩大。一项正在东非农村社区进行的研究通过以患者为中心的结构化艾滋病预防服务模式,评估了对产品、检测模式和护理服务地点选择的接受程度。在这项定性研究中,我们试图了解客户对这种 "动态选择预防模式"(DCP)的体验,并强调行动路径,为艾滋病预防服务模式提供信息:从 2021 年 11 月到 2022 年 3 月,我们有目的性地抽取了 n = 56 名 DCP 试验参与者(横跨门诊部、产前诊所和社区环境)和 n = 21 名医疗服务提供者(总人数 n = 77),对他们进行了深入的半结构式访谈。一个由七人组成的跨地区团队对记录誊本数据进行了翻译和归纳编码。我们采用框架分析法来确定新出现的主题:结果:接受艾滋病暴露前预防疗法(PrEP)的个人报告称,他们感到如释重负,从对感染艾滋病的恐惧中解脱出来,并对能够不顾伴侣的行为而采取行动感到满意。夫妻双方利用该研究提供的一系列方法说服伴侣接受检测并选择 PrEP。暴露后预防(PEP)的使用并不普遍,尽管妇女欢迎在受到性胁迫或性侵犯时使用这种方法。参与者讨论了在熟悉使用方法并确定持续风险后从 PEP 转为 PrEP 的问题。参与者认为自己受到了医疗服务提供者的尊重,信任他们,并对能够直接与他们联系以获得电话支持表示感谢。阻碍采取预防措施的因素包括:耻辱感、对预防方法的经验和知识有限、亲密伴侣关系和家庭中的性别和代际权力动态,以及产品本身导致的对预防方法的负面看法。参与者预计,长效注射 PrEP 可以解决他们在药片大小、每日药片负担和意外披露可能性方面的难题:不同的偏好和接受预防的障碍需要选择不同的艾滋病预防方案、地点和提供方式--但此外,灵活、称职和友好的护理服务对于促进接受也至关重要。帮助客户感受到自己的价值,解决他们的独特需求和挑战,使他们能够优先考虑自己的健康。
Client experiences with “Dynamic Choice Prevention,” a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa
Introduction
Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients’ experiences of this “dynamic choice prevention model” (DCP) and highlight pathways of action to inform HIV prevention delivery models.
Methods
In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.
Results
Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners’ behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.
Conclusions
Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities—but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.
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.