Facilitating engagement with PrEP and other HIV prevention technologies through practice‐based combination prevention

Abstract Background: Strengthening HIV combination prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential gamechanger because of its high clinical efficacy and the feasibility of making it available for different key populations.Experiences with different PrEP delivery models in a variety of settings and HIV epidemics will inform howits uptake and usage can be maximised.Methods: We conducted a scoping review using the five-step framework for conducting scoping studies provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing four components of a PrEP service delivery model in real-world: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set.Results: Following exclusion of ineligible records and removal of duplicates, 33 articles were retained for charting and analysing of the results. The target population of PrEP services was often described in terms of PrEP eligibility without targeting specific subgroups. If a specific target group was mentioned, PrEP was mainly offered to men who have sex with men (MSM). PrEP was often delivered centralisedin specialist clinics providing HIV, sexual health or STI care. Yet examples of de-centralised and community-based PrEP delivery have been reported. Health care providers delivering PrEP were mainly medical professionals, with task-shifting to non-traditional health professionals and lay providers identified in a minority of the studies. PrEP was mainly delivered through classic in-person visits. More innovative options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied.Conclusions: Within our scope for PrEP service delivery models, a range of possibilities was found for all components of such models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could respond to the needs of different profiles of PrEPuserswithin a combination prevention approach.

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Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review

BMJ Global Health ◽

10.1136/bmjgh-2019-001560 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001560

Author(s):

Carinne Brody ◽

Say Sok ◽

Sovannary Tuot ◽

Marija Pantelic ◽

Enrique Restoy ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Low Income ◽

Equal Rights ◽

Middle Income ◽

Policy Makers ◽

Combination Prevention ◽

Middle Income Countries ◽

Registration Number ◽

Prevention Programmes

IntroductionThis systematic review aims to determine if combination HIV prevention programmes include outcome measures for empowerment, inclusion and agency to demand equal rights and measure the relationship between empowerment and HIV prevention outcomes.MethodsAn electronic literature search of PubMed, POPLINE, Index Medicus and Google Scholar was conducted between August and October 2018. We included studies that evaluated combination prevention programmes that had all three types of intervention components and that specifically serve members of populations disproportionately affected by HIV published from 2008 to 2018. The selected studies were screened for inclusion, and relevant data abstracted, assessed for bias and synthesised.ResultsThis review included a total of 15 studies. Findings indicate that combination HIV prevention programmes for marginalised populations have delivered a variety of theory-based behavioural and structural interventions that support improvements in empowerment, inclusion and agency. However, empowerment, inclusion and least of all agency are not measured consistently or in a standardised way. In addition, analysis of their relationships with HIV prevention outcomes is rare. Out of our 15 included studies, only two measured a relationship between an empowerment, inclusion or agency outcome and an HIV prevention outcome.ConclusionThese findings suggest that policy-makers, programme planners and researchers might need to consider the intermediate steps on the pathway to increased condom use and HIV testing so as to explain the ‘how’ of their achievements and inform future investments in HIV prevention. This will support replication and expansion of programmes and ensure sustainability of the programmes.PROSPERO registration numberCRD42018106909

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Framework for Monitoring HIV/STI Services for Key Populations in Latin America and the Caribbean

10.37774/9789275121054 ◽

2021 ◽

Keyword(s):

Latin America ◽

Civil Society ◽

Hiv Prevention ◽

Civil Society Organizations ◽

Hiv Care ◽

Key Populations ◽

Combination Prevention ◽

Hiv Care Cascade ◽

The Caribbean ◽

The Impact

In Latin America and the Caribbean, between 50% and 65% of new HIV infections occur in key populations or their clients or sexual partners. Improving the availability and coverage of HIV/STI services for these populations requires the support of monitoring systems that are sustainable and adapt to the needs of the countries of the region. To respond to this need, the Pan American Health Organization, through an agreement with the Global Fund, has developed the Framework for Monitoring HIV/STI Services for Key Populations in Latin America and the Caribbean. It introduces a novel system in which the impact of HIV services on key populations is determined, not only by how HIV-positive people maintain an undetectable viral load but also by how HIV-negative people remain HIV-free. This document lists the essential HIV/STI services that, based on a combination prevention approach, should be offered to people from key populations. The monitoring framework establishes one or more indicators for each of the essential services together with the methodology for their measure. Likewise, a new HIV prevention cascade is introduced, which adds to the existing HIV care cascade. Countries are encouraged to disaggregate by key population group the HIV prevention and care cascades as well as the indicators. Finally, it is urgent to show the contribution of civil society organizations to the response to HIV infection and STIs to ensure their sustainability once external donors leave the region. To this end, the framework encourages breaking down the prevention and care cascades information by the service provider, to identify the contribution of health ministries, civil society organizations, and other actors.

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S09.2 Cascade of HIV prevention: a powerful tool to improve the implementation of DREAMS combination prevention in rural south africa

10.1136/sextrans-2019-sti.46 ◽

2019 ◽

Author(s):

Maryam Shahmanesh

Keyword(s):

South Africa ◽

Hiv Prevention ◽

Rural South ◽

Combination Prevention ◽

Rural South Africa

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Empowering Yoruba Women in Nigeria to Prevent HIV/AIDS: The Relative Significance of Behavioural and Social Determinant Models

Exchanges The Interdisciplinary Research Journal ◽

10.31273/eirj.v1i1.73 ◽

2013 ◽

Vol 1 (1) ◽

pp. 59-81

Author(s):

Oluwatosin Ige Alo ◽

Oluwatosin Ige Alo

Keyword(s):

Hiv Prevention ◽

Condom Use ◽

Social Determinant ◽

Basic Knowledge ◽

Limiting Factors ◽

Social Environments ◽

Heterosexual Relationships ◽

Relative Significance ◽

Combination Prevention ◽

Prevention Model

This article uncovers the relevance to practice of behavioural and social determinant models of HIV prevention among Yoruba women in Nigeria. Exploring what factors influence health behaviour in heterosexual relationships, the key question raised was whether the women’s experiences support the assumptions and prescriptions for action of these two dominant public health models. Eight focus group discussions and 39 in-depth interviews were conducted, which involved 121 women and men who were chosen purposefully and through self-nomination technique. This study revealed that the women were very much constrained by social environments in negotiating safe sex, despite having at least a basic knowledge of HIV prevention. Limiting factors included the fear of relationship breakup, economic dependence, violence, and the difficulties in justifying why they feel the need to insist on condom use, especially since initiating condom use is antithetical to trust. Furthermore, evidence suggested that improved access to income and education might be vital but it does not automatically constitute a direct means of empowering women to prevent HIV infection. The limitations of both behavioural and social determinants perspectives thus suggests the need for a combination prevention model, which focuses on how social, behavioural and biomedical factors overlap in shaping health outcomes.

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