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Oral Pre-Exposure Prophylaxis Delivery Among HIV-Negative Pregnant and Postpartum Women in Antenatal Clinics of Cape Town, South Africa: Adolescent Girls and Young Women, Intimate Partner Violence, and Prevention-Effective Adherence- [electronic resource]
Oral Pre-Exposure Prophylaxis Delivery Among HIV-Negative Pregnant and Postpartum Women in Antenatal Clinics of Cape Town, South Africa: Adolescent Girls and Young Women, Intimate Partner Violence, and Prevention-Effective Adherence- [electronic resource]
상세정보
- 자료유형
- 학위논문파일 국외
- 최종처리일시
- 20240214101159
- ISBN
- 9798379597702
- DDC
- 614
- 저자명
- Khadka, Nehaa.
- 서명/저자
- Oral Pre-Exposure Prophylaxis Delivery Among HIV-Negative Pregnant and Postpartum Women in Antenatal Clinics of Cape Town, South Africa: Adolescent Girls and Young Women, Intimate Partner Violence, and Prevention-Effective Adherence - [electronic resource]
- 발행사항
- [S.l.]: : University of California, Los Angeles., 2023
- 발행사항
- Ann Arbor : : ProQuest Dissertations & Theses,, 2023
- 형태사항
- 1 online resource(131 p.)
- 주기사항
- Source: Dissertations Abstracts International, Volume: 84-12, Section: B.
- 주기사항
- Advisor: Gorbach, Pamina M.
- 학위논문주기
- Thesis (Ph.D.)--University of California, Los Angeles, 2023.
- 사용제한주기
- This item must not be sold to any third party vendors.
- 초록/해제
- 요약HIV acquisition risks remain high for pregnant and breastfeeding populations in South Africa. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) can be used daily during periods of sexual activity to prevent HIV infections for cisgender women. In 2021, oral PrEP became the standard of care for HIV prevention during pregnancy and breastfeeding periods. The objective of this dissertation was to evaluate trends in oral PrEP initiation, continuation, and adherence among adolescent girls and young women, women experiencing intimate partner violence, and by sexual behaviors throughout gestational periods and postpartum. We used data from the PrEP in Pregnancy and Postpartum (PrEP-PP) study, a prospective cohort in Cape Town of 1200 participants without HIV. The PrEP-PP study provided HIV prevention counselling and offered PrEP to pregnant and breastfeeding women.The first study evaluated the oral PrEP cascade framework among adolescent girls and young women (AGYW) in the PrEP-PP study. Approximately 83% of AGYW initiated PrEP at their first antenatal care (ANC) visit, 34% continued PrEP at 6 months, and 11% stopped and restarted. AGYW with a higher HIV risk had an increased adjusted likelihood of continuing PrEP through 6 months (adjusted odds ratio[aOR]:1.91 [95% CI, 1.15-3.16]). About 7% of AGYW had high adherence to PrEP at 6 months.The second study examined the relationship between recent and past-year intimate partner violence (IPV) experienced by pregnant and postpartum women and oral PrEP continuation and adherence. Women who experienced past-year IPV were less likely to discontinue PrEP(adjusted hazards ratio: 0.80 (95% CI: 0.61, 1.06) and had higher adherence(quantifiable tenofovir-diphosphate[TFV-DP] in dried blood spots; aOR=1.82 (95% CI: 1.02, 3.25) at 6-month follow-up visits.The third study evaluated prevention-effective adherence by gestational trimesters of pregnancy and postpartum. Prevention-effective adherence(initiation/quantifiable TFV-DP or reported use during follow-up among those engaging in condomless sex) was 65% overall, with the highest adherence in trimester 1(81%) and lowest at early postpartum(49%). There was a positive association between engaging in condomless sex and PrEP use(quantifiable TFV-DP or self-reported use; adjusted risk ratio:1.88; 95% CI: 1.67, 2.12).In conclusion, AGYW during pregnancy and postpartum had high oral uptake, but retention in PrEP by 6 months was low. Those with higher HIV risks are more likely to continue PrEP. Pregnant/postpartum women who experienced past-year IPV were more likely to stay in the study and had greater adherence. The findings suggest that pregnant and postpartum women align their PrEP use with their potential HIV risks. Implementing violence screening and oral PrEP counselling (with conversations about changing HIV risks) at ANC may improve HIV prevention for women during pregnancy and postpartum in South Africa and beyond.
- 일반주제명
- Public health.
- 일반주제명
- Health education.
- 일반주제명
- Epidemiology.
- 일반주제명
- Obstetrics.
- 키워드
- Adolescent girls
- 키워드
- Breastfeeding
- 키워드
- HIV
- 키워드
- Oral PrEP
- 키워드
- Pregnant
- 키워드
- South Africa
- 기타저자
- University of California, Los Angeles Epidemiology 0357
- 기본자료저록
- Dissertations Abstracts International. 84-12B.
- 기본자료저록
- Dissertation Abstract International
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
008240612s2023 us |||||||||||||||c||eng d■001000016933066
■00520240214101159
■006m o d
■007cr#unu||||||||
■020 ▼a9798379597702
■035 ▼a(MiAaPQ)AAI30524404
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a614
■1001 ▼aKhadka, Nehaa.
■24510▼aOral Pre-Exposure Prophylaxis Delivery Among HIV-Negative Pregnant and Postpartum Women in Antenatal Clinics of Cape Town, South Africa: Adolescent Girls and Young Women, Intimate Partner Violence, and Prevention-Effective Adherence▼h[electronic resource]
■260 ▼a[S.l.]:▼bUniversity of California, Los Angeles. ▼c2023
■260 1▼aAnn Arbor :▼bProQuest Dissertations & Theses, ▼c2023
■300 ▼a1 online resource(131 p.)
■500 ▼aSource: Dissertations Abstracts International, Volume: 84-12, Section: B.
■500 ▼aAdvisor: Gorbach, Pamina M.
■5021 ▼aThesis (Ph.D.)--University of California, Los Angeles, 2023.
■506 ▼aThis item must not be sold to any third party vendors.
■520 ▼aHIV acquisition risks remain high for pregnant and breastfeeding populations in South Africa. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) can be used daily during periods of sexual activity to prevent HIV infections for cisgender women. In 2021, oral PrEP became the standard of care for HIV prevention during pregnancy and breastfeeding periods. The objective of this dissertation was to evaluate trends in oral PrEP initiation, continuation, and adherence among adolescent girls and young women, women experiencing intimate partner violence, and by sexual behaviors throughout gestational periods and postpartum. We used data from the PrEP in Pregnancy and Postpartum (PrEP-PP) study, a prospective cohort in Cape Town of 1200 participants without HIV. The PrEP-PP study provided HIV prevention counselling and offered PrEP to pregnant and breastfeeding women.The first study evaluated the oral PrEP cascade framework among adolescent girls and young women (AGYW) in the PrEP-PP study. Approximately 83% of AGYW initiated PrEP at their first antenatal care (ANC) visit, 34% continued PrEP at 6 months, and 11% stopped and restarted. AGYW with a higher HIV risk had an increased adjusted likelihood of continuing PrEP through 6 months (adjusted odds ratio[aOR]:1.91 [95% CI, 1.15-3.16]). About 7% of AGYW had high adherence to PrEP at 6 months.The second study examined the relationship between recent and past-year intimate partner violence (IPV) experienced by pregnant and postpartum women and oral PrEP continuation and adherence. Women who experienced past-year IPV were less likely to discontinue PrEP(adjusted hazards ratio: 0.80 (95% CI: 0.61, 1.06) and had higher adherence(quantifiable tenofovir-diphosphate[TFV-DP] in dried blood spots; aOR=1.82 (95% CI: 1.02, 3.25) at 6-month follow-up visits.The third study evaluated prevention-effective adherence by gestational trimesters of pregnancy and postpartum. Prevention-effective adherence(initiation/quantifiable TFV-DP or reported use during follow-up among those engaging in condomless sex) was 65% overall, with the highest adherence in trimester 1(81%) and lowest at early postpartum(49%). There was a positive association between engaging in condomless sex and PrEP use(quantifiable TFV-DP or self-reported use; adjusted risk ratio:1.88; 95% CI: 1.67, 2.12).In conclusion, AGYW during pregnancy and postpartum had high oral uptake, but retention in PrEP by 6 months was low. Those with higher HIV risks are more likely to continue PrEP. Pregnant/postpartum women who experienced past-year IPV were more likely to stay in the study and had greater adherence. The findings suggest that pregnant and postpartum women align their PrEP use with their potential HIV risks. Implementing violence screening and oral PrEP counselling (with conversations about changing HIV risks) at ANC may improve HIV prevention for women during pregnancy and postpartum in South Africa and beyond.
■590 ▼aSchool code: 0031.
■650 4▼aPublic health.
■650 4▼aHealth education.
■650 4▼aEpidemiology.
■650 4▼aObstetrics.
■653 ▼aAdolescent girls
■653 ▼aBreastfeeding
■653 ▼aHIV
■653 ▼aOral PrEP
■653 ▼aPregnant
■653 ▼aSouth Africa
■690 ▼a0573
■690 ▼a0680
■690 ▼a0766
■690 ▼a0380
■71020▼aUniversity of California, Los Angeles▼bEpidemiology 0357.
■7730 ▼tDissertations Abstracts International▼g84-12B.
■773 ▼tDissertation Abstract International
■790 ▼a0031
■791 ▼aPh.D.
■792 ▼a2023
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T16933066▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
■980 ▼a202402▼f2024
