Ivan Segawa, BPharm
Nominated From: University of Washington
Research Site: Global Health Uganda
Research Area: Infectious Disease, HIV
Primary Mentor: Andrew Mujugira
Nurse-Led PrEP Delivery for Young Women Attending Family Planning Clinics in Uganda
In Uganda, adolescent girls and young women (AGYW) aged 15 to 24 years account for 26% of new HIV infections and 270 new HIV infections every week. Moreover, Uganda ranks among the top 20 countries with the highest HIV incidence among AGYW. Compared to their male peers, AGYW globally are thrice as likely to acquire HIV because of behavioral, biological, cultural, and structural factors. Empowering AGYW with evidence-based self-controlled HIV prevention tools is an urgent Public Health priority. Oral pre-exposure prophylaxis (PrEP) is an effective, discreet, and user-controlled HIV prevention strategy, which could significantly decrease new HIV infections if delivered at scale. Improved access to PrEP is needed if meaningful reductions in new HIV infections are to be attained; we must integrate PrEP into existing healthcare systems and in ways that are acceptable to AGYW. In Uganda, PrEP is primarily delivered through HIV clinics, but these settings are not attractive to HIV-negative AGYW because of stigma. However, nearly 4 in 10 Ugandan women routinely access contraception services through family planning (FP) clinics at government health centers. These clinics have experienced sexual and reproductive health (SRH) nurse providers who already interact with these high-risk AGYW. Integrating PrEP delivery in FP clinics frequently visited by AGYW and where they already receive risk-reduction counseling and screening for sexual risk behaviors has the potential to efficiently reach this vulnerable population. However, little is known about the feasibility of nurse-delivered PrEP through public health FP clinics in Uganda or the effect of this ‘real-world’ delivery model on PrEP uptake and persistence among AGYW.
Adolescent girls and young women (AGYW) are disproportionately affected by HIV. PrEP is safe and efficacious, and could substantially reduce new HIV infections among AGYW if delivered with sufficient coverage and at scale. However, PrEP uptake and coverage among AGYW are low in this setting where PrEP is primarily delivered through HIV clinics alongside antiretroviral treatment. Innovative approaches that adapt PrEP delivery to the needs of AGYW at risk of HIV infection are needed. A nurse-led delivery model, which leverages existing platforms readily accessed by AGYW, such as FP clinics, could effectively deliver PrEP to this population. Risk behaviors for unintended pregnancy are similar to those for HIV and, in Uganda, FP clinics already provide HIV services such as risk reduction counseling and testing. Additionally, they have experienced and trained nurse providers who can extend AGYW’s interest in contraception to the prevention of HIV and other STIs. Thus, they are an ideal platform in which to integrate PrEP delivery into existing SHR services. Also, the young women attending FP clinics are already enthusiastic about the prevention of pregnancy and this prevention mindset can be extrapolated to STI and HIV prevention. Importantly, this integrated, and nurse-led, delivery model can easily be scaled up in resource-limited settings such as Uganda where primary care SHR services are well distributed nationally and are already delivered by nurses. Research is needed to evaluate the feasibility and acceptability of this nurse-led PrEP model. Our study aims to achieve this evaluation through high-quality and innovative research methods and execution of a pilot study integrating PrEP into FP clinics and using nurses to deliver PrEP.