Randomized Trial of Dynamic Choice HIV Prevention at Antenatal and Postnatal Care Clinics in Rural Uganda and Kenya.
In: Journal of acquired immune deficiency syndromes (1999), Jg. 95 (2024-04-15), Heft 5, S. 447
academicJournal
Zugriff:
Background: Pregnant and postpartum women in Sub-Saharan Africa are at high risk of HIV acquisition. We evaluated a person-centered dynamic choice intervention for HIV prevention (DCP) among women attending antenatal and postnatal care.
Setting: Rural Kenya and Uganda.
Methods: Women (aged 15 years or older) at risk of HIV acquisition seen at antenatal and postnatal care clinics were individually randomized to DCP vs. standard of care (SEARCH; NCT04810650). The DCP intervention included structured client choice of product (daily oral pre-exposure prophylaxis or postexposure prophylaxis), service location (clinic or out of facility), and HIV testing modality (self-test or provider-administered), with option to switch over time and person-centered care (phone access to clinician, structured barrier assessment and counseling, and provider training). The primary outcome was biomedical prevention coverage-proportion of 48-week follow-up with self-reported pre-exposure prophylaxis or postexposure prophylaxis use, compared between arms using targeted maximum likelihood estimation.
Results: Between April and July 2021, we enrolled 400 women (203 intervention and 197 control); 38% were pregnant, 52% were aged 15-24 years, and 94% reported no pre-exposure prophylaxis or postexposure prophylaxis use for ≥6 months before baseline. Among 384/400 participants (96%) with outcome ascertained, DCP increased biomedical prevention coverage 40% (95% CI: 34% to 47%; P < 0.001); the coverage was 70% in intervention vs. 29% in control. DCP also increased coverage during months at risk of HIV (81% in intervention, 43% in control; 38% absolute increase; 95% CI: 31% to 45%; P < 0.001).
Conclusion: A person-centered dynamic choice intervention that provided flexibility in product, testing, and service location more than doubled biomedical HIV prevention coverage in a high-risk population already routinely offered access to biomedical prevention options.
Competing Interests: C.A.K. has received grant support paid to the University of California, San Francisco from Gilead Sciences. The remaining authors have no funding or conflicts of interest to disclose.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
| Titel: |
Randomized Trial of Dynamic Choice HIV Prevention at Antenatal and Postnatal Care Clinics in Rural Uganda and Kenya.
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| Autor/in / Beteiligte Person: | Kabami, J ; Koss, CA ; Sunday, H ; Biira, E ; Nyabuti, M ; Balzer, LB ; Gupta, S ; Chamie, G ; Ayieko, J ; Kakande, E ; Bacon, MC ; Havlir, D ; Kamya, MR ; Petersen, M |
| Zeitschrift: | Journal of acquired immune deficiency syndromes (1999), Jg. 95 (2024-04-15), Heft 5, S. 447 |
| Veröffentlichung: | Hagerstown, MD : Lippincott Williams & Wilkins, Inc., c1999-, 2024 |
| Medientyp: | academicJournal |
| ISSN: | 1944-7884 (electronic) |
| DOI: | 10.1097/QAI.0000000000003383 |
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