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.

Manze Chinyama,Modesta Chileshe,Mayaba Mudenda,Florence Chilaisha,Joan T. Price,Margaret Phiri Kasaro,Ntazana Sindano

doi:10.3389/frph.2021.684717

Manze Chinyama, Modesta Chileshe + Show 5 more

Open Access

https://doi.org/10.3389/frph.2021.684717

Copy DOI

Abstract

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.

Highlights

African women are disproportionately affected by HIV infection
The Evidence for Contraceptive Options and HIV Outcomes (ECHO) study experience at Kamwala Health Center (KHC) has shown that with available internal resources and creating linkages with external resources, integration of oral pre-exposure prophylaxis (PrEP) and Family planning (FP) is feasible in our setting
The demographic characteristics and sexual behavior of women who were offered oral PrEP in ECHO at KHC were young, married, with at least primary education, and reported sexual behavior and risk included having one current sexual partner and inconsistent use of condoms. This profile of women who participated in ECHO is similar to that of women who participated in the Zambian Demographic and Health Survey, 2018 [18]

Summary

Introduction

African women are disproportionately affected by HIV infection. Sub-Saharan Africa carries more than 70% of the global burden of infection with women bearing the brunt of this burden. Adolescent girls and young women aged 15–24 years have up to eight-fold higher incidence of HIV infection compared to their male peers [1]. In Zambia, the 2,018 numbers indicate that 11.3% of adults were living with HIV out of which 14.3% are women compared to 8.8% men. Adolescent girls and young women are four times at higher risk with the prevalence of 5.7% compared to their male peers at 1.8% [2]. The need for contraception is likely to be underestimated as this information excludes unmarried women. Efforts to both increase provision of contraception and reduce HIV transmission among women can be delivered in one stop. Planning (FP) clinics provide services to women at risk for acquiring HIV and could be a vehicle for providing both contraceptive and HIV prevention services [4, 5]

Methods

Results

Conclusion