scholarly journals Ask the Way From Those Who Have Walked It Before – Grandmothers’ Roles in Health-related Decision Making and HIV Pre-exposure Prophylaxis (PrEP) Use Among Pregnant and Breastfeeding Women in Africa

2021 ◽  
Author(s):  
Krishnaveni Reddy ◽  
Doreen Kemigisha ◽  
Miria Chitukuta ◽  
Sufia Dadabhai ◽  
Florence Mathebula ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sub Saharan Africa ◽  
Sources Of Information ◽  
Maternal Experience ◽  
Biomedical Hiv Prevention ◽  
Health Related ◽  
Sub Saharan ◽  
Hiv Acquisition ◽  
The Right ◽  
Exposure Prophylaxis

Abstract Background: HIV acquisition among pregnant and breastfeeding women in sub-Saharan Africa (SSA) and vertical transmission rates remain high despite established strategies for HIV prevention. Methods: We explored grandmothers’ (mothers/mothers-in-law) influence on pregnant and breastfeeding women’s health-related decisions and their potential to support use of HIV prevention products utilizing qualitative data collected from grandmothers, HIV-uninfected, currently/recently pregnant or breastfeeding women and male partners of currently/recently pregnant or breastfeeding women during the MTN-041/MAMMA study. Results: Grandmothers were described as important sources of information, playing both supportive and influencer roles, due to personal maternal experience and generational knowledge. Grandmothers expressed willingness to support pre-exposure prophylaxis (PrEP) use and agreed with other groups that this decision should be made by women themselves and/or with partners. Conclusion: With the right framing and approach, grandmothers’ supportive roles can optimise uptake and adherence to biomedical HIV prevention and reduce HIV acquisition among pregnant and breastfeeding women in these communities.

scholarly journals Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Sexual Health ◽  
2014 ◽  
Vol 11 (2) ◽  
pp. 126 ◽  
Author(s):  
Ying-Ru Lo ◽  
Masaya Kato ◽  
Nittaya Phanuphak ◽  
Masami Fujita ◽  
Duong Bui Duc ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Sub Saharan Africa ◽  
Treatment As Prevention ◽  
The Pacific ◽  
Prep Implementation ◽  
Sub Saharan ◽  
Hiv Acquisition ◽  
Operational Issues ◽  
Exposure Prophylaxis ◽  
Firm Evidence

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

scholarly journals “I wish to remain HIV negative”: Pre-exposure prophylaxis adherence and persistence in transgender women and men who have sex with men in coastal Kenya

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244226
Author(s):  
Makobu Kimani ◽  
Elise M. van der Elst ◽  
Oscar Chirro ◽  
Elizabeth Wahome ◽  
Fauz Ibrahim ◽  
...  
Keyword(s):  
Risk Behaviour ◽  
Healthcare Services ◽  
Transgender Women ◽  
Situational Factors ◽  
Sub Saharan Africa ◽  
Sexual Risk Behaviour ◽  
Sub Saharan ◽  
Sex With Men ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis

Background Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. Methods Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700–1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. Results Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. Conclusion While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.

scholarly journals Biomedical prevention: what is the current status?

2010 ◽  
Vol 4 (5) ◽  
pp. 679-682
Author(s):  
David D. Celentano ◽  
Wendy W. Davis ◽  
Chris C. Beyrer
Keyword(s):  
Male Circumcision ◽  
Hiv Transmission ◽  
Sub Saharan Africa ◽  
Current Status ◽  
Post Exposure Prophylaxis ◽  
Biomedical Hiv Prevention ◽  
Hiv Prevention Strategies ◽  
Biomedical Prevention ◽  
Sub Saharan ◽  
Exposure Prophylaxis

Abstract Biomedical HIV prevention strategies for primary or secondary prevention of HIV transmission can be seen as an adjunct to behavioral prevention approaches. These interventions include vaccination, female controlled vaginal microbicides, male circumcision, treatment of sexually transmitted infections that cause genital ulceration, Pre-Exposure Prophylaxis (PREP) and Post-Exposure Prophylaxis (PEP). This article reviews results from recent randomized controlled trials of novel biomedical prevention approaches and discusses interpretation of the results. The only intervention consistently demonstrating reductions in HIV transmission was adult male circumcision in Sub-Saharan Africa. Results of PREP trials will be available in the next several years.

scholarly journals Stigma and Confidentiality Indiscretions: Intersecting Obstacles to the Delivery of Pre-Exposure Prophylaxis to Adolescent Girls and Young Women in East Zimbabwe

2021 ◽  
pp. 237-248
Author(s):  
Morten Skovdal ◽  
Phyllis Magoge-Mandizvidza ◽  
Rufurwokuda Maswera ◽  
Melinda Moyo ◽  
Constance Nyamukapa ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Adolescent Girls ◽  
Young Women ◽  
Scale Up ◽  
Healthcare Providers ◽  
Local Health ◽  
Individual Interviews ◽  
Biomedical Hiv Prevention ◽  
Sub Saharan ◽  
Exposure Prophylaxis

AbstractDespite efforts to scale-up biomedical HIV prevention technologies, such as oral pre-exposure prophylaxis (PrEP), many countries and regions of the world are far off–track in reaching global HIV prevention targets. Uptake of, and adherence to PrEP amongst adolescent girls and young women (AGYW) in sub-Saharan Africa has proved particularly challenging. Drawing on qualitative individual interviews and focus group discussions with thirty AGYW in east Zimbabwe, as well as interviews with healthcare providers, we investigate some of the root causes of this challenge, namely the social risks involved with accessing PrEP. We find that stigma and the worry of AGYW that privacy and confidentiality cannot be maintained in local health clinics and by local healthcare providers, presents a major barrier to the uptake of PrEP. We call for interventions that recognise the need to tackle the range of socio-cultural norms and social practices that interact and in synergy make engagement with PrEP an (im)possible and (un)desirable thing to do for AGYW.

scholarly journals Pregnant and breastfeeding women’s prospective acceptability of two biomedical HIV prevention approaches in Sub Saharan Africa: A multisite qualitative analysis using the Theoretical Framework of Acceptability

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259779
Author(s):  
Mandeep Sekhon ◽  
Ariane van der Straten ◽  
Keyword(s):  
Qualitative Analysis ◽  
Theoretical Framework ◽  
Sub Saharan Africa ◽  
Group Discussions ◽  
Biomedical Hiv Prevention ◽  
Affective Attitude ◽  
Positive Attitudes ◽  
Vaginal Rings ◽  
Sub Saharan ◽  
Exposure Prophylaxis

HIV infection during pregnancy and breastfeeding has implications for maternal health. Between May- November 2018, we explored prospective acceptability of two novel HIV Pre-exposure Prophylaxis (PrEP) products, oral pills and vaginal rings, through focus group discussions with 65 pregnant and breastfeeding women in Malawi, South Africa, Uganda, Zimbabwe. Qualitative analysis was completed, guided by the Theoretical Framework of Acceptability (TFA). First, a deductive thematic analysis was applied to relevant coded data, into the seven TFA constructs (Affective Attitude; Burden; Ethicality, Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Next, an iterative analysis was completed to generate themes within each of the TFA constructs. Women’s positive attitudes towards daily oral PrEP highlighted the familiarity of taking pills, understanding the purpose of taking pills, and the perception that it is an effective method to protect mothers and babies from HIV during pregnancy and breastfeeding. Women emphasized the ease of using the ring given its monthly duration that lowers burden on the user, its discreetness and invisibility once in place. The TFA analysis highlighted how acceptability of both methods could be enhanced by focusing on perceptions of the end users (i.e. the women) and not just the products themselves. This approach provided insights into how to refine the intervention materials and plans for implementation.

scholarly journals From trials to the public health: pre-exposure prophylaxis for HIV prevention

2013 ◽  
pp. 64-65
Author(s):  
Esper Kallas ◽  
Luiz Miraglia João
Keyword(s):  
Hiv Prevention ◽  
Sub Saharan Africa ◽  
Heterosexual Couples ◽  
Men And Women ◽  
Hiv Positive Women ◽  
Discordant Couples ◽  
Different Populations ◽  
Sub Saharan ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Two million two hundred thousand adults were newly HIV-infected in 2011, underscoring the urgent need for new, effective ways to prevent incident infections. Recently, the field of HIV prevention has gathered positive results from different strategies, among different populations, and with varying effect sizes, including the treatment of HIV-positive women and men in discordant couples, male circumcision of HIV-negative men in sub-Saharan Africa, a HIV vaccine evaluated in a community-based trial among HIV-negative men and women in Thailand, the use of vaginal gel formulation of TDF for HIV prevention in women in South Africa, pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) or emtricitabine and TDF (TDF-FTC) among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda, and PrEP with TDF-FTC among heterosexual men and women in Africa. Of these interventions, PrEP is an attractive policy because it does not directly interferes with the sexual intercourse, providing people a choice on HIV prevention regardless of cultural, religious, or social harnesses.

scholarly journals Maternal PrEP use in HIV-uninfected pregnant women in South Africa: Role of Stigma in PrEP initiation, retention and adherence

2020 ◽  
Author(s):  
Alexander Moran ◽  
Nyiko Mashele ◽  
Rufaro Mvududu ◽  
Pamina Gorbach ◽  
Linda-Gail Bekker ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Sub Saharan Africa ◽  
Antenatal Visit ◽  
Sub Saharan ◽  
Anticipated Stigma ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
The Relationship

AbstractPregnant women in sub-Saharan Africa are at high risk of HIV acquisition and require effective methods to prevent HIV. In a cohort of pregnant women offered pre-exposure prophylaxis (PrEP), we evaluate the relationship between internalized and anticipated stigma and PrEP initiation at first antenatal visit, 3-month continuation and adherence using multivariable logistic regression. High internalized and anticipated PrEP stigma are associated with lower PrEP initiation at first antenatal visit (aOR internalized stigma=0.06; 95%CI=0.03-0.12 & aOR anticipated stigma=0.53; 95%CI=0.29-0.97) compared to women with low reported stigma, after controlling for covariates. Women whose partners have not been tested for HIV or whose serostatus remains unknown have 1.6-times odds of PrEP retention at 3-months compared to women whose partners have been tested (aOR=1.60; 95%CI=1.02-2.52) after adjusting for covariates. PrEP counseling and maternal PrEP interventions must consider individual- and relational-level interventions to overcome anticipated PrEP stigma and other barriers to PrEP initiation and adherence.

scholarly journals PrEP as a Lifestyle and Investment for Adolescent Girls and Young Women in Sub-Saharan Africa

2019 ◽  
Vol 18 ◽  
pp. 232595821983101 ◽  
Author(s):  
Jessica E. Haberer ◽  
Nelly Mugo ◽  
Jared M. Baeten ◽  
Maria Pyra ◽  
Elizabeth Bukusi ◽  
...  
Keyword(s):  
Adolescent Girls ◽  
Young Women ◽  
Sub Saharan Africa ◽  
Lifestyle Choice ◽  
Hiv Epidemic ◽  
Sub Saharan ◽  
The Many ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis

Adolescent girls and young women (AGYW) are highly affected by the HIV epidemic, yet standard approaches to pre-exposure prophylaxis (PrEP) delivery will not meet their needs. This commentary highlights key characteristics of AGYW related to PrEP use and delivery, including typical neurocognitive development, lack of experience with sustained medication use, and the social and connected nature of AGYW’s lives. We then suggest ways for programs to embrace these characteristics, such as presenting PrEP as a lifestyle choice and not a biomedical tool, making access to PrEP simple and easy, and recognizing the many influences AGYW face in taking PrEP. We also suggest ways for programs to identify AGYW at the highest risk of HIV acquisition. Adolescent girls and young women have an important role to play in ending the HIV epidemic and they deserve considerable, tailored investment.

scholarly journals HIV prevention is not all about HIV – using a discrete choice experiment among women to model how the uptake and effectiveness of HIV prevention products may also rely on pregnancy and STI protection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Peter Vickerman ◽  
Matthew Quaife ◽  
Maggie Kilbourne-Brook ◽  
Mercy Mvundura ◽  
Robyn Eakle ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Household Survey ◽  
Sub Saharan Africa ◽  
Adult Women ◽  
Adolescent Women ◽  
Sub Saharan ◽  
Hiv Acquisition

Abstract Introduction In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI). Methods A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women’s HIV acquisition risk. Results In adolescent women, there will be limited uptake (< 6% for any product) and impact (< 4% decrease in HIV acquisition risk) of new products unless they provide pregnancy protection, which could quadruple use and impact. Adult women have weaker preference for pregnancy protection, with moderate use (< 17% for each) and impact (< 14 percentage point decrease) if they only provide HIV protection. All women had highest preference for injectable ARVs, with oral PrEP having high preference if injectable ARVs are not available. Adult women will use the ring, but adolescent women will not. Importantly, even with three additional prevention products, all providing pregnancy and STI protection, > 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain. Conclusions Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women.

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