A Multilevel Comprehensive Response on Uptake and Adherence to HIV Prevention Among Adolescent Girls and Young Women

项目总结/摘要 我们提出了一项为期5年的整群随机试验，采用析因设计来评估多因素治疗的有效性。 一级干预，解决在获得医疗保健，社会支持和个人风险行为的耻辱 南非的青少年女孩和年轻妇女。我们将与政府部门合作， 卫生部门确保所有艾滋病毒阴性的青少年妇女在无安全套的情况下进行性行为时都能获得PrEP。下 由卫生和社会事务部支持的扩大公共工程计划（EPWP） 发展，女性受益人将帮助担任同行招聘人员和PrEP俱乐部领导人。我们会委聘 所有利益攸关方，并建立一个青年咨询委员会（YAB），以告知基于证据的 增强权能干预措施，妇女健康合作社-解决基于性别的暴力问题 (GBV)物质使用和性风险，以解决生殖健康和PrEP吸收和坚持。 采用类似的利益相关者参与方法，我们还将采用一种耻辱和歧视（S&D） 为诊所工作人员提供减少培训课程。将实施和评估多层次战略 通过两级随机化。首先，我们将地理区域（1：1）随机分配到健康诊所S&D 培训组或无培训组。位于卫生诊所培训区的诊所将参加讲习班 旨在减少医疗服务提供者的污名化和歧视性态度和行为。培训的目的 减少AGYW获得医疗保健的障碍，以提高PrEP的吸收。其次，我们将随机 受过训练和未经训练的诊所，以三个武器之一（1：1：1）：武器1：仅提供PrEP;武器2：提供 PrEP与PrEP俱乐部的社会支持，以增加依从性;和第3组：提供PrEP与PrEP 俱乐部以及WHC，以解决PrEP的吸收和遵守以及其他风险因素，如 个人代理、性别暴力和药物使用。主要结局将包括启动和遵守 PrEP预防HIV感染;次要结果将包括减少HIV风险行为。的 拟议的具体目标如下：目标1：让利益相关者参与，社区协作 董事会和青年局在适应WHC和S&D减少培训方面，建立PrEP俱乐部，并培训24 在比勒陀利亚地区的6个区，职业妇女扩展方案的受益者作为招募者，以确定从事高风险性行为的女青年 在形成阶段。目标二。评估医护人员S&D培训对 青年志愿者协会利用艾滋病毒和生殖健康服务的情况，包括PrEP，以及工作人员的态度和行为 在3个月、6个月和12个月的随访中，目标3。为了测试多层次策略的有效性， 解决结构（耻辱和歧视），人际（社会支持）和个人（个人 机构，物质使用和GBV）因素对PrEP吸收和依从性（主要结果）和避孕套 在3个月、6个月和12个月随访时， 脆弱的AGYW

PROJECT SUMMARY/ABSTRACT We propose a 5-year cluster randomized trial with a factorial design to evaluate the efficacy of a multi- level intervention that addresses stigma in accessing healthcare, social support, and individual risk behaviors of adolescent girls and young women (AGYW) in South Africa. We will collaborate with the Department of Health to ensure that PrEP is available for all HIV-negative AGYW who engage in condomless sex. Under the Expanded Public Works Program (EPWP), supported by the Department of Health and Social Development, female beneficiaries will help serve as peer recruiters and PrEP club leaders. We will engage all stakeholders and establish a Youth Advisory Board (YAB) to inform the adaptation of the evidence-based empowerment intervention, the Women's Health CoOp (WHC)—which addresses gender-based violence (GBV), substance use, and sexual risk—to address reproductive health and PrEP uptake and adherence. Using a similar stakeholder engagement approach, we will also adapt a stigma and discrimination (S&D) reduction training curriculum for clinic staff. The multilevel strategy will be implemented and evaluated through two levels of randomization. First, we will randomize geographic zones (1:1) to the health clinic S&D training arm or the no training arm. Clinics located in health clinic training zones will participate in workshops aimed to reduce health providers' stigmatizing and discriminatory attitudes and behaviors. The training aims to reduce AGYW's barriers to healthcare access to enhance PrEP uptake. Second, we will randomize trained and non-trained clinics to one of three arms (1:1:1): Arm 1: provision of PrEP only; Arm 2: provision of PrEP with a PrEP club for social support to increase adherence; and Arm 3: provision of PrEP with a PrEP club as well as the WHC to address PrEP uptake and adherence alongside other risk factors such as personal agency, GBV, and substance use. Primary outcomes will include initiation of and adherence to PrEP to prevent HIV infection; secondary outcomes will include reduction of HIV risk behaviors. The proposed Specific Aims are as follows: Aim 1: To engage stakeholders, the Community Collaborative Board, and the YAB in adapting the WHC and S&D reduction training, establish PrEP clubs, and train 24 EPWP beneficiaries as recruiters to identify AGYW engaging in high-risk sex in 6 zones in the Pretoria area during a formative stage. Aim 2. To evaluate the impact of training on S&D among healthcare staff on the use of HIV and reproductive health services by AGYW, including PrEP, and staff attitudes and behaviors toward AGYW at 3-, 6-, and 12-month follow-up. Aim 3. To test the efficacy of a multilevel strategy that addresses structural (stigma and discrimination), interpersonal (social support), and individual (personal agency, substance use, and GBV) factors on PrEP uptake and adherence (primary outcomes) and condom use, GBV, substance use, and HIV incidence (secondary) at 3-, 6-, and 12-month follow-up among vulnerable AGYW.