Abstract
IntroductionRecent years have witnessed a rapid expansion of efficacious biomedical HIV prevention technologies. Promising as they may be, they are largely delivered through standard, clinic‐based models, often in isolation from structural and behavioural interventions. This contributes to varied, and often poor, uptake and adherence. There is a critical need to develop analytical tools that can advance our understandings and responses to the combination of interventions that affect engagement with HIV prevention technologies. This commentary makes a call for practice‐based combination HIV prevention analysis and action, and presents a tool to facilitate this challenging but crucial endeavour.DiscussionModels and frameworks for combination HIV prevention already exist, but the process of identifying precisely what multi‐level factors that need to be considered as part of a combination of HIV interventions for particular populations and settings is unclear. Drawing on contemporary social practice theory, this paper develops a “table of questioning” to help interrogate the chain and combination of multi‐level factors that shape engagement with HIV prevention technologies. The tool also supports an examination of other shared social practices, which at different levels, and in different ways, affect engagement with HIV prevention technologies. It facilitates an analysis of the range of factors and social practices that need to be synchronized in order to establish engagement with HIV prevention technologies as a possible and desirable thing to do. Such analysis can help uncover local hitherto un‐identified issues and provide a platform for novel synergistic approaches for action that are not otherwise obvious. The tool is discussed in relation to PrEP among adolescent girls and young women in sub‐Saharan Africa.ConclusionsBy treating engagement with HIV prevention technologies as a social practice and site of analysis and public health action, HIV prevention service planners and evaluators can identify and respond to the combination of factors and social practices that interact to form the context that supports or prohibits engagement with HIV prevention technologies for particular populations.
Highlights
Recent years have witnessed a rapid expansion of efficacious biomedical HIV prevention technologies
This, coupled with a so-called “youth bulge” in sub-Saharan Africa [3], has contributed to a sense of urgency to harness recent biomedical and health service successes in HIV treatment and rapidly expand the availability of biomedical HIV prevention technologies. Promising as these innovations may be, biomedical HIV prevention technologies are largely implemented in isolation from structural and behavioural interventions, with little recognition of their synergies [4]
The DREAMS programme is not exhaustive, and it is likely that local material, symbolic, competence, relational and motivational factors, and associated social practices that affect AGYW motivation and capacity to engage with pre-exposure prophylaxis (PrEP) have not been considered
Summary
Despite some successes in HIV prevention, 1.8 million people were infected with HIV in 2017, and rates of infection grew in more than 50 countries [1]. This, coupled with a so-called “youth bulge” in sub-Saharan Africa [3], has contributed to a sense of urgency to harness recent biomedical and health service successes in HIV treatment and rapidly expand the availability of biomedical HIV prevention technologies. Promising as these innovations may be, biomedical HIV prevention technologies are largely implemented in isolation from structural and behavioural interventions, with little recognition of their synergies [4].
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