Cargando…
Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia
The WHO guideline on the integration of family planning (FP) and pre-exposure HIV prophylaxis (PrEP) to enhance the health of women and adolescent girls is reflected in the Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection, 2020. There is however a dearth of data on the in...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580744/ https://www.ncbi.nlm.nih.gov/pubmed/36304051 http://dx.doi.org/10.3389/frph.2021.684717 |
_version_ | 1784812458759684096 |
---|---|
author | Kasaro, Margaret Phiri Sindano, Ntazana Chinyama, Manze Mudenda, Mayaba Chilaisha, Florence Price, Joan T. Chileshe, Modesta |
author_facet | Kasaro, Margaret Phiri Sindano, Ntazana Chinyama, Manze Mudenda, Mayaba Chilaisha, Florence Price, Joan T. Chileshe, Modesta |
author_sort | Kasaro, Margaret Phiri |
collection | PubMed |
description | The WHO guideline on the integration of family planning (FP) and pre-exposure HIV prophylaxis (PrEP) to enhance the health of women and adolescent girls is reflected in the Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection, 2020. There is however a dearth of data on the integration of PrEP and FP in Zambia. We describe the integration of oral PrEP in FP services using the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study experience at Kamwala District Health Center in Lusaka, Zambia. The provision of oral PrEP at Kamwala started in October 2017, lasting for ~11 months, and utilized the model where initial processes to offer PrEP were on-site followed by off-site referral to laboratory and PrEP provider services. The characteristics of 658 women who enrolled in ECHO at Kamwala are representative of women accessing FP services in Lusaka. About 644 of the enrollees were offered oral PrEP. The proportion of women accepting PrEP was low at 1.08% and the proportion of study visits at which PrEP was requested was also low at 0.57%. Those who accepted PrEP were above 20 years old, married, with at least primary education, sexual behavior, and risk comparable to decliners. The ECHO study experience indicates that the setup and integration of oral PrEP and FP services are feasible in the setting. However, uptake of PrEP was very low. Possible contributory factors were as follows: (1) timing of introduction of PrEP midway in the study, (2) PrEP being a new intervention, (3) challenges of autonomy of young women to include a daily pill into their lives and anticipated challenges to adherence because of fear of adverse events, (4) possible underdetermined risk due to use of an unvalidated risk assessment tool and assessment by health care provider vs. self-assessment, and (5) extra layer of challenges to negotiate due to needing for off-site referrals. Following these findings, we conclude that further research through demonstration projects of integration of oral PrEP and FP may provide solutions to low uptake. This information is critical for scaling up of integration HIV prevention services and sexual and reproductive health (SRH) services. |
format | Online Article Text |
id | pubmed-9580744 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-95807442022-10-26 Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia Kasaro, Margaret Phiri Sindano, Ntazana Chinyama, Manze Mudenda, Mayaba Chilaisha, Florence Price, Joan T. Chileshe, Modesta Front Reprod Health Reproductive Health The WHO guideline on the integration of family planning (FP) and pre-exposure HIV prophylaxis (PrEP) to enhance the health of women and adolescent girls is reflected in the Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection, 2020. There is however a dearth of data on the integration of PrEP and FP in Zambia. We describe the integration of oral PrEP in FP services using the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study experience at Kamwala District Health Center in Lusaka, Zambia. The provision of oral PrEP at Kamwala started in October 2017, lasting for ~11 months, and utilized the model where initial processes to offer PrEP were on-site followed by off-site referral to laboratory and PrEP provider services. The characteristics of 658 women who enrolled in ECHO at Kamwala are representative of women accessing FP services in Lusaka. About 644 of the enrollees were offered oral PrEP. The proportion of women accepting PrEP was low at 1.08% and the proportion of study visits at which PrEP was requested was also low at 0.57%. Those who accepted PrEP were above 20 years old, married, with at least primary education, sexual behavior, and risk comparable to decliners. The ECHO study experience indicates that the setup and integration of oral PrEP and FP services are feasible in the setting. However, uptake of PrEP was very low. Possible contributory factors were as follows: (1) timing of introduction of PrEP midway in the study, (2) PrEP being a new intervention, (3) challenges of autonomy of young women to include a daily pill into their lives and anticipated challenges to adherence because of fear of adverse events, (4) possible underdetermined risk due to use of an unvalidated risk assessment tool and assessment by health care provider vs. self-assessment, and (5) extra layer of challenges to negotiate due to needing for off-site referrals. Following these findings, we conclude that further research through demonstration projects of integration of oral PrEP and FP may provide solutions to low uptake. This information is critical for scaling up of integration HIV prevention services and sexual and reproductive health (SRH) services. Frontiers Media S.A. 2021-07-13 /pmc/articles/PMC9580744/ /pubmed/36304051 http://dx.doi.org/10.3389/frph.2021.684717 Text en Copyright © 2021 Kasaro, Sindano, Chinyama, Mudenda, Chilaisha, Price and Chileshe. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Reproductive Health Kasaro, Margaret Phiri Sindano, Ntazana Chinyama, Manze Mudenda, Mayaba Chilaisha, Florence Price, Joan T. Chileshe, Modesta Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia |
title | Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia |
title_full | Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia |
title_fullStr | Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia |
title_full_unstemmed | Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia |
title_short | Integration of HIV Prevention With Sexual and Reproductive Health Services: Evidence for Contraceptive Options and HIV Outcomes Study Experience of Integrating Oral Pre-exposure HIV Prophylaxis in Family Planning Services in Lusaka, Zambia |
title_sort | integration of hiv prevention with sexual and reproductive health services: evidence for contraceptive options and hiv outcomes study experience of integrating oral pre-exposure hiv prophylaxis in family planning services in lusaka, zambia |
topic | Reproductive Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580744/ https://www.ncbi.nlm.nih.gov/pubmed/36304051 http://dx.doi.org/10.3389/frph.2021.684717 |
work_keys_str_mv | AT kasaromargaretphiri integrationofhivpreventionwithsexualandreproductivehealthservicesevidenceforcontraceptiveoptionsandhivoutcomesstudyexperienceofintegratingoralpreexposurehivprophylaxisinfamilyplanningservicesinlusakazambia AT sindanontazana integrationofhivpreventionwithsexualandreproductivehealthservicesevidenceforcontraceptiveoptionsandhivoutcomesstudyexperienceofintegratingoralpreexposurehivprophylaxisinfamilyplanningservicesinlusakazambia AT chinyamamanze integrationofhivpreventionwithsexualandreproductivehealthservicesevidenceforcontraceptiveoptionsandhivoutcomesstudyexperienceofintegratingoralpreexposurehivprophylaxisinfamilyplanningservicesinlusakazambia AT mudendamayaba integrationofhivpreventionwithsexualandreproductivehealthservicesevidenceforcontraceptiveoptionsandhivoutcomesstudyexperienceofintegratingoralpreexposurehivprophylaxisinfamilyplanningservicesinlusakazambia AT chilaishaflorence integrationofhivpreventionwithsexualandreproductivehealthservicesevidenceforcontraceptiveoptionsandhivoutcomesstudyexperienceofintegratingoralpreexposurehivprophylaxisinfamilyplanningservicesinlusakazambia AT pricejoant integrationofhivpreventionwithsexualandreproductivehealthservicesevidenceforcontraceptiveoptionsandhivoutcomesstudyexperienceofintegratingoralpreexposurehivprophylaxisinfamilyplanningservicesinlusakazambia AT chileshemodesta integrationofhivpreventionwithsexualandreproductivehealthservicesevidenceforcontraceptiveoptionsandhivoutcomesstudyexperienceofintegratingoralpreexposurehivprophylaxisinfamilyplanningservicesinlusakazambia |