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

项目摘要/摘要 我们提出了一项为期5年的随机分组试验，采用析因设计来评估多药联用的疗效。 层级干预，解决在获得医疗保健、社会支持和个人危险行为方面的耻辱 南非青春期女孩和年轻妇女(AGYW)。我们将与美国国务院合作 健康，以确保所有艾滋病毒阴性的AGYW在无避孕套的性行为中都能获得PrEP。在……下面 扩大公共工程计划(EPWP)，由卫生和社会部提供支持 在发展方面，女性受益者将帮助担任同行招聘人员和PrEP俱乐部领导人。我们将与 所有利益攸关方并建立青年咨询委员会(YAB)，以循证的方式通报适应情况 赋权干预，妇女健康合作(WHC)--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摄取和坚持问题。 使用类似的利益相关者参与方法，我们还将改变污名和歧视(S和D) 减少诊所工作人员的培训课程。将实施和评估多层次战略 通过两个水平的随机化。首先，我们将随机地理区域(1：1)到卫生诊所S&D 训练臂或非训练臂。位于卫生诊所训练区的诊所将参加讲习班 旨在减少保健提供者的污名化和歧视性态度和行为。培训目标 减少AGYW在获得医疗保健方面的障碍，以提高PrEP的接受率。第二，我们将随机化 受过训练和未受过训练的诊所到三个部门之一(1：1：1)：第一部门：仅提供PrEP；第二部门：提供 建立PrEP俱乐部，以提高遵从率；ARM 3：为PrEP提供PrEP 俱乐部以及西隧，以解决PrEP的吸收和遵守以及其他风险因素，如 个人代理、GBV和物质使用。主要结果将包括发起和遵守 为预防艾滋病毒感染做好准备；次要成果将包括减少艾滋病毒危险行为。这个 拟议的具体目标如下：目标1：让利益攸关方、社区合作 董事会和YAB在适应西隧和S减量培训方面，建立PrEP俱乐部，并培训24名 EPWP受益者作为招募者，在比勒陀利亚地区的6个地区确定AGYW从事高危性行为 在形成阶段。目的2.评估医务人员S与发展培训对健康教育的影响。 AGYW利用艾滋病毒和生殖健康服务，包括预防艾滋病方案，以及工作人员的态度和行为 在3个月、6个月和12个月的随访中转向AGYW。目标3.测试多层次策略的有效性 解决结构性(污名和歧视)、人际(社会支持)和个人(个人)问题 机构、物质使用和GBV)因素对PrEP摄取和依从性(主要结果)和避孕套的影响 在3个月、6个月和12个月的随访中，使用情况、GBV、物质使用和艾滋病毒发病率(二次) 易受攻击的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.