Peer-Delivered HIV Self-Testing, STI Self-Sampling and PrEP for Transgender Women in Uganda

乌干达变性女性同伴提供的艾滋病毒自我检测、性传播感染自我采样和暴露前预防

• 批准号: 10170433
• 负责人: Andrew Mujugira
• 金额: $ 15.9万
• 依托单位: INFECTIOUS DISEASES INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10170433
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Africa South of the Sahara; African; Anti-Retroviral Agents; Caring; Cellular Phone; Characteristics; Chlamydia trachomatis; Clinic; Clinic Visits; Clinical Trials; Cluster randomized trial; Collaborations; Collection; Communities; Data; Decentralization; Decision Making; Diagnostic Reagent Kits; Disclosure; Discrimination; Effectiveness; Enrollment; Epidemic; Ethics; Evaluation; Female; Foundations; General Population; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Health Personnel; Healthcare; High Risk Woman; Human immunodeficiency virus test; Incidence; Instruction; Intervention; Interview; Joints; Knowledge; Low Prevalence; Methodology; Neisseria gonorrhoeae; Oral; Participant; Partner Notification; Peer Group; Perception; Persons; Policies; Population; Population Research; Positioning Attribute; Prevalence; Prevention; Process; Randomized; Research; Research Design; Respondent; Risk; Role; Sampling; Services; Sexual Partners; Sexually Transmitted Diseases; Specimen; Stigmatization; Testing; Time; Training; Treatment Efficacy; Uganda; Underserved Population; Urine; Vulnerable Populations; World Health Organization; acceptability and feasibility; aged; arm; base; behavior change; beneficiary; civil society; effective intervention; effectiveness testing; efficacy testing; experience; health care service; high risk; improved; innovation; insight; male; marginalized population; member; men who have sex with men; novel; peer; peer networks; pilot trial; pre-exposure prophylaxis; prevent; prevention service; preventive intervention; primary outcome; programs; randomized trial; recruit; rectal; screening; self testing; service delivery; sex; sexual HIV transmission; sexual risk behavior; social; social stigma; testing services; testing uptake; tool; transgender; transgender women; transmission process; treatment arm; uptake

PROJECT SUMMARY/ABSTRACT Transgender women (TGW) are at high risk for HIV infection, and are an important, under-researched population in sub-Saharan Africa. Globally, HIV acquisition risk among TGW is 13 times higher than other adults aged 15- 49 years. In Uganda, HIV prevalence among TGW is 22% compared to 5.9% in the general population. Encouraging use of self-controlled HIV prevention tools – specifically, HIV self-testing (HIVST), STI self-sampling (STISS) and antiretroviral pre-exposure prophylaxis (PrEP) - to those testing HIV negative could decrease HIV incidence among African TGW. This R34 application proposes formative research and a pilot trial to develop an HIV prevention intervention for African transgender women (TGW). We will evaluate whether peer-delivered combination HIV prevention increases testing uptake and empowers effective prevention decision making in TGW. Peer-led interventions are effective in increasing HIV and STI testing among other hard-to-reach vulnerable populations with high HIV prevalence but low testing coverage, and are recommended by the World Health Organization. Exploring peer-delivery approaches to increase coverage of combination HIV prevention interventions is key to addressing research gaps in HIV epidemic control. However, little is known about the effectiveness of peer-delivered combination HIV prevention (HIVST, STISS and PrEP) for African TGW, or the best way to deliver care to this population. Key knowledge gaps include: 1) whether peer delivery increases testing rates and status knowledge, 2) the role of peers in creating demand for repeat testing and PrEP, and 3) how to optimize peer delivery of combination HIV prevention (HIVST, STISS and PrEP). To address these questions, this proposal seeks to conduct formative research to inform implementation of peer-delivered combination HIV prevention for African TGW (Aim 1), implement a pilot cluster randomized trial to evaluate the feasibility, acceptability and preliminary effectiveness of peer delivered combination HIV prevention (Aim 2), and conduct in-depth interviews to explore how peer-delivery of HIVST, STISS and PrEP influences prevention choices among TGW and sexual partners (Aim 3). This will be the first clinical trial, to our knowledge, to evaluate HIV self-testing and STI self-sampling in HIV-uninfected TGW. Pilot data from TGW and their partners will provide unique perspectives to inform HIV prevention delivery. The proposed proof-of-concept evaluation is uniquely positioned to improve prevention uptake for African TGW - a high-risk, marginalized, and underserved population. Rigorous application of mixed methodologies will generate actionable data for policy and programs, and provide a strong foundation for scalable implementation of cutting edge combination HIV prevention interventions for African TGW. The local transgender community is involved in study design, planning and implementation. This project is supported by the Ugandan Ministry of Health.

项目总结/摘要 跨性别妇女（TGW）是艾滋病毒感染的高危人群，是一个重要的、研究不足的人群。 于撒哈拉以南非洲的在全球范围内，TGW感染艾滋病毒的风险比其他15岁至20岁的成年人高13倍。 49年了在乌干达，过渡期妇女中的艾滋病毒感染率为22%，而一般人口中的感染率为5.9%。 鼓励使用自我控制的艾滋病毒预防工具-特别是艾滋病毒自我检测、性传播感染自我采样 （STISS）和抗逆转录病毒暴露前预防（PrEP）-对那些测试艾滋病毒阴性的人可以减少艾滋病毒 非洲TGW的发病率。该R34应用程序提出了形成性研究和试点试验，以开发一种 非洲变性妇女艾滋病毒预防干预。我们将评估同行是否提供 联合艾滋病毒预防增加了检测的接受率，并使有效的预防决策成为可能， TGW同行领导的干预措施在增加艾滋病毒和性传播感染检测以及其他难以接触的检测方面是有效的。 艾滋病毒感染率高但检测覆盖率低的弱势群体， 卫生组织。探索同伴提供服务的办法，以扩大艾滋病毒综合预防的覆盖面 干预措施是填补艾滋病毒流行病控制研究空白的关键。然而，人们对此知之甚少。 为非洲TGW提供同伴提供的艾滋病毒预防组合（艾滋病毒/艾滋病防治、性传播感染和艾滋病防治和预防前预防）的有效性， 最好的方式来照顾这个群体。关键的知识差距包括：1）同行交付是否增加 检测率和状态知识，2）同行在创造重复检测和PrEP需求方面的作用，以及3） 如何优化艾滋病毒预防组合（艾滋病毒预防、性传播感染和支持服务以及PrEP）的同伴交付。解决这些 问题，该提案旨在进行形成性研究，以告知同行交付的实施情况 非洲TGW的艾滋病毒预防组合（目标1），实施一项试点随机分组试验，以评估 同伴提供艾滋病毒预防组合的可行性、可接受性和初步效果（目标2），以及 进行深入访谈，探讨艾滋病毒/艾滋病防治、性传播感染支持服务和PrEP的同行传递如何影响预防 TGW和性伴侣之间的选择（目标3）。据我们所知，这将是第一个临床试验， 在未感染艾滋病毒的TGW中进行艾滋病毒自我检测和性传播感染自我采样。TGW及其合作伙伴的试点数据将 提供独特的视角，为艾滋病毒预防工作提供信息。拟议的概念验证评估是 具有独特的地位，以提高非洲TGW的预防吸收-高风险，边缘化，服务不足 人口严格应用混合方法将为政策和方案产生可采取行动的数据， 并为可扩展地实施最先进的艾滋病毒预防组合提供坚实的基础 非洲TGW的干预措施。当地的跨性别社区参与了研究设计、规划和 实施.该项目得到乌干达卫生部的支持。

项目成果

"I felt special!": a qualitative study of peer-delivered HIV self-tests, STI self-sampling kits and PrEP for transgender women in Uganda.

• DOI: 10.1002/jia2.26201
• 发表时间: 2023-12
• 期刊: Journal of the International AIDS Society
• 影响因子: 6
• 作者: Mujugira A;Karungi B;Mugisha J;Nakyanzi A;Bagaya M;Kamusiime B;Nalumansi A;Nalukwago GK;Kasiita V;Twesigye CC;Nampewo O;Nsubuga R;Nyanzi KR;Muwonge T;Wyatt MA;Ware NC;Haberer JE
• 通讯作者: Haberer JE