在不断扩大的艾滋病毒预防工作中,利用私营部门的计划生育战略来提供双重预防药丸,这是第一种具有接触前预防功能的多用途预防技术。

IF 4.6 1区 医学 Q2 IMMUNOLOGY Journal of the International AIDS Society Pub Date : 2024-08-15 DOI:10.1002/jia2.26346
Catherine Verde Hashim, Emma Llewellyn, Rob Wood, Tracey Brett, Tinashe Chinyanga, Karen Webb, Kate Segal
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引用次数: 0

摘要

简介:双重预防药丸(DPP)结合了口服暴露前预防(PrEP)和口服避孕药(OC),以预防艾滋病毒和怀孕。我们注意到在艾滋病负担较重的国家,私营部门在提供计划生育(FP)服务方面发挥着重要作用,私营部门对口服避孕药的吸收率较高,而且最近以自我保健和技术为基础的私营部门渠道也在增长,因此我们在肯尼亚、南非和津巴布韦开展了定性研究,以优先考虑私营部门为引入 DPP 而提供服务的方法:在 2022 年 3 月至 2023 年 2 月期间,我们进行了文献综述和关键信息提供者访谈,访谈对象包括 34 名捐赠者和实施合作伙伴、19 名政府代表、17 家私营部门组织、13 家药房和药店代表以及 12 家远程保健机构,以评估在私营部门渠道引入 DPP 的可行性。根据政策、与公共部门的协调程度、数据系统、供应链、补贴需求、可扩展性、可持续性和地理覆盖范围对渠道进行了专题分析:广泛的地理覆盖范围、肯尼亚和南非正在进行的由药房管理的 PrEP 试点,以及津巴布韦的非处方 OC 供应,使药房成为提供 DPP 的优先场所,此外还有在 FP 和 HIV 服务方面已经得到信任的私人网络诊所。在肯尼亚和南非,电子药房、远程保健和远程医疗等以技术为基础的新渠道被优先考虑,因为它们在全国范围内的可及性、便利性和私密性使其迅速普及。由于缺乏有关较新渠道服务吸收情况的标准化数据,以及有关所有渠道的商品定价和支付意愿的信息空白,研究结果受到了限制:在艾滋病负担较重的国家,私营部门提供的 FP 服务占很大比例,但 PrEP 的提供渠道尚未开发。在非传统渠道中为用户提供一系列的 DPP 获取选择,最大限度地减少耻辱感、提高自由裁量权并增加便利性,可以提高用户的使用率和持续性。要使这些渠道为 PrEP 的提供做好准备,需要卫生部和提供者的参与,以及对定价和支付意愿的进一步研究。调整 FP 和 PrEP 的提供,以满足那些既想预防艾滋病毒又想预防怀孕的人的需求,将促进综合服务的提供和最终 DPP 的推广,为私营部门引进多用途预防技术创造一个平台。
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Harnessing private sector strategies for family planning to deliver the Dual Prevention Pill, the first multipurpose prevention technology with pre-exposure prophylaxis, in an expanding HIV prevention landscape

Introduction

The Dual Prevention Pill (DPP) combines oral pre-exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self-care and technology-based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP.

Methods

Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage.

Results

Wide geographic reach, ongoing pharmacy-administered PrEP pilots in Kenya and South Africa, and over-the-counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology-based channels such as e-pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness-to-pay for all channels.

Conclusions

The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non-traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness-to-pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies.

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来源期刊
Journal of the International AIDS Society
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.
期刊最新文献
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