Understanding and measuring the impact of stigma on PrEP adherence among adolescent girls and young women in Kenya: identifying targets for future interventions

项目总结/摘要 撒哈拉以南非洲的少女和青年妇女极易感染艾滋病毒。在肯尼亚， 15-24岁的年轻人占每年新感染人数的33%，AGYW的发病率是AGYW的两倍， 就是年轻人暴露前预防（PrEP）是减少艾滋病毒感染的有力工具，但 青少年妇女的遵守率很低，限制了其保护作用。PrEP污名-通常基于 使用者“滥交”或艾滋病毒呈阳性的定型观念正在成为坚持使用的一个主要障碍。然而，在这方面， 青年协会的证据有限。这项研究的目的是提高我们对耻辱感的理解- 肯尼亚AGYW坚持PrEP的相关障碍，并确定潜在的干预方法 和目标。这项研究将建立在我们最近的研究基础上， AGYW之间的PrEP耻辱框架，并将利用我们与Impact的成功伙伴关系 研究与发展组织，正在锡亚亚实施梦想倡议 县，肯尼亚，并已启动了3,900多AGYW的PrEP。 通过指导早期职业研究助理和培训当地AGYW青年研究人员，的 具体目标是（1）开发和验证一个衡量PrEP相关维度的缩放工具 使用PrEP的AGYW之间的耻辱，（2）评估耻辱和PrEP依从性之间的关系 确定干预目标。目标1将利用青年主导的参与性研究来完善PrEP污名 与AGYW框架，确定PrEP耻辱的关键组成部分，并了解相关类型的 污名（艾滋病毒，性别和性）与PrEP污名重叠。调查结果将为发展提供信息， 初始规模。认知测试后，该量表将与200 AGYW进行试点，以证实假设的 因素结构和评估信度和结构效度，包括它是否不同于其他类型的 耻辱目标2将采用混合方法。就目标2a而言，我们将进行一项定量调查， AGYW PrEP用户确定影响AGYW的各种类型和方面的耻辱的流行率， 用Aim 1量表测量PrEP污名。将使用DREAMS对参与者进行前瞻性随访 程序数据，以测试基线耻辱与PrEP依从性（持续性和 在接下来的6个月内执行。就目标2b而言，我们会与 AGYW及其关键影响者（家庭成员、同伴、合作伙伴和医疗保健提供者）了解 污名化的态度和行为，并评估候选干预措施的可接受性。定性 并将量化结果综合起来，以确定未来的干预目标和方法。这项研究的 肯尼亚AGYW对PrEP污名化的关注是创新的，填补了结束艾滋病毒工作的关键空白 疫情这些发现将为开发和测试一种适合不同文化、适合不同年龄的 减少耻辱干预，旨在增加这一弱势群体的PrEP依从性。

PROJECT SUMMARY/ABSTRACT Adolescent girls and young women (AGYW) in sub-Saharan Africa are highly vulnerable to HIV. In Kenya, youth ages 15–24 account for 33% of new infections annually, and incidence is twice as high in AGYW as it is in young men. Pre-exposure prophylaxis (PrEP) is a powerful tool to reduce HIV acquisition, but adherence has been low among AGYW, limiting its protective benefit. PrEP stigma—typically based on stereotypes of users as “promiscuous” or HIV-positive—is emerging as a key barrier to adherence. However, evidence among AGYW is limited. The goal of the proposed study is to improve our understanding of stigma- related barriers to PrEP adherence among AGYW in Kenya and identify potential intervention approaches and targets. The study will build on our recent research to adapt the Health Stigma and Discrimination Framework for PrEP stigma among AGYW and will leverage our successful partnership with Impact Research and Development Organization (IRDO), which is implementing the DREAMS Initiative in Siaya County, Kenya and has initiated more than 3,900 AGYW on PrEP. We will build stigma research capacity at IRDO by mentoring early-career Research Associates and training local AGYW youth researchers. The specific aims are to (1) develop and validate a scaled instrument to measure relevant dimensions of PrEP stigma among AGYW who use PrEP, and (2) assess the relationship between stigma and PrEP adherence and identify intervention targets. Aim 1 will use youth-led participatory research to refine the PrEP stigma framework with AGYW, identify key components of PrEP stigma, and understand how related types of stigma (HIV, gender, and sexuality) overlap with PrEP stigma. Findings will inform the development of the initial scale. After cognitive testing, the scale will be piloted with 200 AGYW to confirm the hypothesized factor structure and assess reliability and construct validity, including whether it is distinct from other types of stigma. Aim 2 will use a mixed methods approach. For Aim 2a, we will conduct a quantitative survey with 300 AGYW PrEP users to determine the prevalence of various types and dimensions of stigma impacting AGYW, measuring PrEP stigma with the Aim 1 scale. Participants will be prospectively followed using DREAMS program data to test the association of baseline stigma with PrEP adherence (both persistence and execution) over the next 6 months. For Aim 2b, we will conduct qualitative focus group discussions with AGYW and their key influencers (family members, peers, partners, and health care providers) to understand stigmatizing attitudes and behaviors and assess the acceptability of candidate interventions. The qualitative and quantitative findings will be integrated to identify future intervention targets and approaches. This study’s focus on PrEP stigma among Kenyan AGYW is innovative and fills a critical gap in efforts to end the HIV epidemic. The findings will lay the groundwork to develop and test a culturally tailored, age-appropriate stigma reduction intervention, which will aim to increase PrEP adherence in this vulnerable population.