Enhancing PrEP outcomes among Kenyan adolescent girls and young women with a novel pharmacy-based PrEP delivery platform
通过基于药房的新型 PrEP 交付平台提高肯尼亚少女和年轻女性的 PrEP 效果
基本信息
- 批准号:10402054
- 负责人:
- 金额:$ 61.54万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-09-22 至 2026-08-31
- 项目状态:未结题
- 来源:
- 关键词:AIDS preventionAddressAdherenceAfricaClientClient satisfactionClimateClinicClinical effectivenessCollaborationsContraceptive UsageContraceptive methodsCounselingCountyDataFamily PlanningFemale AdolescentsFocus GroupsHIVHIV SeronegativityHairHealthHealth care facilityIncidenceIndividualInjectableInterventionKenyaMeasuresMental DepressionModelingMotionNursesOralOutcomeParticipantPathway interactionsPharmacistsPharmacy facilityPositioning AttributePrevalencePreventionProviderPublic FacilitiesQualitative EvaluationsQuality of CareRandomizedResearch DesignResearch InfrastructureRiskSouthern AfricaStandard ModelSystemTMC120-R147681TechnologyTenofovirTimeTranslationsVaginal RingWait TimeWomanarmbasecis-femalecofactorcostcost effectivecost effectivenesscost estimatecost outcomesdesigneconomic impacteffectiveness implementation studyeffectiveness testinghealth economicsimplementation outcomesimprovedmathematical modelmicrocostingnovelnovel strategiespillpre-exposure prophylaxisprimary outcomeprogramsprospectivereversible contraceptivesatisfactionscale upsecondary outcomesocial stigmasuccesstoolyoung woman
项目摘要
HIV incidence remains unacceptably high for adolescent girls and young women (AGYW). Pre-exposure
prophylaxis (PrEP) HIV prevention tools are promising, with tenofovir (TFV)-based daily oral PrEP and the
dapivirine vaginal ring (DPV-VR) recommended by WHO for cisgender women at-risk for HIV. Kenya is a leader
for PrEP delivery in Africa and efforts are ongoing to increase PrEP access with AGYW as a priority group. Our
team pioneered integrated PrEP delivery in family planning (FP) clinics in Kenya; yet, 40% of Kenyan women
access contraception without interfacing with facilities, including at retail pharmacies, and would be missed by
facility-based PrEP platforms. Retail pharmacies can increase options for reaching at-risk individuals with PrEP
and efforts are underway to define pathways for pharmacy-delivered PrEP in Kenya. We adapted our FP clinic-
based PrEP model and piloted PrEP delivery facilitated by nurse-navigators for AGYW seeking contraception at
pharmacies. AGYW offered daily oral PrEP frequently initiated, planned to continue use, and were willing to pay
for PrEP at pharmacies. Pill burden was a common reason for declining oral PrEP and could be addressed by
offering DPV-VR. Through close collaboration with the Kenya Ministry of Health both, national- and county-level,
we propose a cluster RCT at 20 pharmacies in Kisumu, Kenya–a region with an HIV prevalence of up to 28%
among women–to test the effectiveness of utilizing nurse-navigators at retail pharmacies to enhance AGYW
PrEP use. We will expand on our successful pilot to offer both daily oral PrEP and the DPV-VR and prospectively
ascertain PrEP outcomes (initiation, persistence, adherence) among AGYW. This effectiveness-implementation
hybrid RCT is designed to expedite translation into practice by evaluating clinical effectiveness alongside
implementation and cost outcomes. We hypothesize that combining nurse-navigators with pharmacy-based
PrEP will provide a cost-effective strategy for delivering novel HIV prevention tools to AGYW in HIV high-burden
settings. Aim 1 will determine the effect of nurse-navigators on PrEP initiation, persistence, and adherence
among AGYW seeking contraception within a pharmacy-based PrEP delivery model through a 2-arm cluster
RCT among HIV-negative AGYW at 20 retail pharmacies in Kisumu, Kenya. AGYW seeking contraception will
be offered PrEP and self-select daily oral PrEP or the DVR-VR. Primary outcomes will be proportion of AGYW
accessing contraception that initiate PrEP, persist with use at 10 mos., and adhere (quantified by TFV or DPV
hair levels). Secondary outcomes will include PrEP selection (PrEP pills vs. DPV-VR), STI incidence, and
adherence cofactors. Aim 2 will identify potential barriers and facilitators to acceptability, feasibility, and client
satisfaction of nurse-navigators and DPV-VR delivery for AGYW accessing PrEP at retail pharmacies through a
qualitative evaluation guided by Proctor et al. Aim 3 will estimate the cost-effectiveness of implementing
pharmacy-based PrEP delivery with nurse-navigators. This will be the first study aiming to improve PrEP access
for AGYW using a pharmacy-based model and will prime pharmacies to deliver novel PrEP agents in the pipeline.
少女和年轻妇女的艾滋病毒感染率仍然高得令人无法接受(青年妇女协会)。暴露前
预防(PrEP)艾滋病毒预防工具是有希望的,基于替诺福韦(TFV)的每日口服PrEP和
达匹韦林阴道环(DPV-VR)是世卫组织推荐用于有艾滋病毒感染风险的顺性别妇女的。肯尼亚是一个领导者
在非洲提供PrEP服务,目前正在努力增加PrEP服务,AGYW是一个优先群体。我们
团队率先在肯尼亚计划生育(FP)诊所提供综合PrEP服务;然而,40%的肯尼亚妇女
在没有与设施接触的情况下获得避孕药具,包括在零售药店,
基于设施的PrEP平台。零售药店可以增加PrEP接触高危人群的选择
目前正在努力确定肯尼亚药房提供PrEP的途径。我们改造了我们的FP诊所-
基于PrEP模型和试点PrEP交付由护士导航员为寻求避孕的AGYW提供便利,
药店AGYW提供每日口服PrEP频繁启动,计划继续使用,并愿意支付
在药房进行PrEP。药丸负担是减少口服PrEP的常见原因,可以通过以下方式解决
提供DPV-VR。通过与肯尼亚卫生部在国家和县级的密切合作,
我们建议在肯尼亚基苏穆的20家药店开展一项随机对照试验,该地区的艾滋病流行率高达28
在妇女中-测试在零售药店利用护士导航员提高AGYW的有效性
PrEP使用。我们将扩大我们成功的试点,提供每日口服PrEP和DPV-VR,
确定AGYW之间的PrEP结果(启动,持续性,依从性)。这种有效性-实施
混合RCT旨在通过评估临床有效性以及
实施和成本结果。我们假设,结合护士导航与药房为基础的
PrEP将为艾滋病毒高负担地区的AGYW提供一种具有成本效益的艾滋病毒预防工具
设置.目标1将确定护士导航员对PrEP启动,持续和坚持的影响
在通过双臂集群在基于药店的PrEP提供模式中寻求避孕的AGYW中
在肯尼亚基苏穆的20家零售药店对艾滋病毒阴性的青少年妇女进行随机对照试验。AGYW寻求避孕将
提供PrEP和自我选择每日口服PrEP或DVR-VR。主要结局将是AGYW的比例
获得启动PrEP的避孕措施,持续使用10个月,和粘附(通过TFV或DPV定量
毛发水平)。次要结局将包括PrEP选择(PrEP药丸与DPV-VR)、STI发生率和
粘附辅助因子目标2将确定潜在的障碍和促进因素,以实现可接受性、可行性和客户
护士导航员的满意度和AGYW通过零售药店访问PrEP的DPV-VR交付
由普罗克特等人指导的定性评价。目标3将估计实施的成本效益
基于药房的PrEP输送与护士导航。这将是第一项旨在改善PrEP获取的研究
AGYW使用基于药房的模式,并将主要药房提供新的PrEP制剂。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Elizabeth Anne BUKUSI其他文献
Elizabeth Anne BUKUSI的其他文献
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{{ truncateString('Elizabeth Anne BUKUSI', 18)}}的其他基金
Sustainable Development for Improved HIV Health and Prevention in Kenya (SD4H-Kenya)
肯尼亚改善艾滋病毒健康和预防的可持续发展(SD4H-肯尼亚)
- 批准号:
10872887 - 财政年份:2023
- 资助金额:
$ 61.54万 - 项目类别:
Simplifying PrEP delivery: One-stop service pathway to improve PrEP care efficiency and continuation in Kenya
简化 PrEP 交付:提高肯尼亚 PrEP 护理效率和持续性的一站式服务途径
- 批准号:
10547902 - 财政年份:2022
- 资助金额:
$ 61.54万 - 项目类别:
Development and Validation of an Artificial-Intelligence-enabled Portable Colposcopy Device for Optimizing Triage Alternatives for HPV-based Cervical Cancer Screening
开发和验证人工智能便携式阴道镜设备,用于优化基于 HPV 的宫颈癌筛查的分诊方案
- 批准号:
10416639 - 财政年份:2022
- 资助金额:
$ 61.54万 - 项目类别:
Simplifying PrEP delivery: One-stop service pathway to improve PrEP care efficiency and continuation in Kenya
简化 PrEP 交付:提高肯尼亚 PrEP 护理效率和持续性的一站式服务途径
- 批准号:
10688130 - 财政年份:2022
- 资助金额:
$ 61.54万 - 项目类别:
Evaluating sexually transmitted infections among adolescent girls and young women within a pharmacy-based PrEP delivery model in Kenya.
在肯尼亚基于药房的 PrEP 交付模式中评估青春期女孩和年轻女性的性传播感染情况。
- 批准号:
10878139 - 财政年份:2021
- 资助金额:
$ 61.54万 - 项目类别:
SD4H Training Grant Supplement to Promote Diversity, Equity and Inclusion
SD4H 培训补助金补充,以促进多元化、公平和包容性
- 批准号:
10874195 - 财政年份:2020
- 资助金额:
$ 61.54万 - 项目类别:
Sustainable Development for Improved HIV Health and Prevention in Kenya (SD4H-Kenya)
肯尼亚改善艾滋病毒健康和预防的可持续发展(SD4H-肯尼亚)
- 批准号:
10348189 - 财政年份:2020
- 资助金额:
$ 61.54万 - 项目类别:
Sustainable Development for Improved HIV Health and Prevention in Kenya (SD4H-Kenya)
肯尼亚改善艾滋病毒健康和预防的可持续发展(SD4H-肯尼亚)
- 批准号:
10544044 - 财政年份:2020
- 资助金额:
$ 61.54万 - 项目类别:
Sustainable Development for Improved HIV Health and Prevention in Kenya (SD4H-Kenya)
肯尼亚改善艾滋病毒健康和预防的可持续发展(SD4H-肯尼亚)
- 批准号:
10254375 - 财政年份:2020
- 资助金额:
$ 61.54万 - 项目类别:
PrEP and dPEP: Doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections among Kenyan women using HIV pre-exposure prophylaxis
PrEP 和 dPEP:强力霉素暴露后预防,用于使用 HIV 暴露前预防来预防肯尼亚妇女的性传播感染
- 批准号:
10223161 - 财政年份:2019
- 资助金额:
$ 61.54万 - 项目类别:
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