Peer PrEP referral + HIV self-test for PrEP initiation among young Kenyan women

摘要 这个K99/R00奖项的总体目标是支持我的研究培训，使我能够发展成为一个 独立研究员，其工作重点是有效预防艾滋病毒干预措施的新交付模式 在医疗诊所之外运作。我的博士前，博士和博士后培训给了我 在全球艾滋病研究方面拥有十多年的经验，在定量方法、随机试验、 艾滋病毒自我检测、基于同伴的干预、实地工作和接触前预防（PrEP）以预防艾滋病毒。 本K99/R00建议书概述了一个有针对性的培训和职业发展计划， 我的研究技能和经验，使我能够成为一个有竞争力的申请终身教职的教师 在一所领先的研究型大学的跨学科部门（如全球健康）任职。 培训计划：为了完成我的研究工具包和过渡到独立，我已经组装了一个 来自美国和肯尼亚的多学科专家导师团队。我们一起设计了一个强大的培训 计划包括定期指导会议和相关的高级课程，研讨会，讲习班， 华盛顿大学的指导小组和国际科学会议。的具体培训 该奖项K99阶段的目标是：1）学习如何应用最常用的框架， 战略，以及实施和行为研究的理论; 2）发展新的和互补的技能， 成本计算方法和定性研究; 3）进行形成性研究和试点，以发展和完善同行 在肯尼亚年轻妇女中开始PrEP的PrEP转诊+艾滋病毒自我检测（HIVST）交付模式;以及4） 通过建立实施和行为科学的出版记录，过渡到科学独立。 研究计划：PrEP预防艾滋病毒非常有效。然而，在肯尼亚，政府提供 PrEP免费更改，很少有艾滋病毒高风险的年轻女性开始PrEP。我们建议开发，试点， 并测试一种创新模式，可能会克服肯尼亚年轻妇女开始PrEP的障碍： 同伴PrEP转诊+HIVST交付。拟议研究的具体目标是：1）开发一个同行的PrEP 转诊+HIVST交付模式，以促进肯尼亚年轻妇女使用深入的PrEP启动 采访了解实施框架和行为理论的年轻妇女（Y1）; 2）试点 拟议的交付模式，并通过与试点参与者进行焦点小组讨论来完善该模式， 实施框架（Y2）; 3）测试改进的PrEP交付模式的效果和实施情况 启动和其他结果（包括PrEP采用的其他指标，模型保真度和成本） 随机试验（Y3 - 5）。这个建议的K99/R00研究直接建立在我以前的研究经验， 使我能够获得新的技能，在实施和行为研究，解决了一个最大的 今天，PrEP规模扩大的挑战，并将为社区随机试验和预算提供R01提案 影响分析。

ABSTRACT The overall goal of this proposed K99/R00 award is to support my research training so that I can develop into an independent researcher whose work focuses on novel delivery models for effective HIV prevention interventions that operate outside of healthcare clinics. My pre-doctoral, doctoral, and post-doctoral training have given me over a decade of experience in global HIV research and expertise in quantitative methods, randomized trials, HIV self-testing, peer-based interventions, fieldwork, and pre-exposure prophylaxis (PrEP) for HIV prevention. This K99/R00 proposal outlines an intentional training and career development plan that builds on and expands my research skills and experiences so that I can become a competitive applicant for a tenured-track faculty position in an interdisciplinary department, such as global health, at a leading research university. Training plan: To complete my research toolkit and transition to independence, I have assembled a multidisciplinary team of expert mentors from the US and Kenya. Together, we have designed a robust training plan that includes regular mentored meetings and relevant advanced coursework, seminars, workshops, and mentoring groups at the University of Washington and international scientific conferences. The specific training goals for the K99 phase of this award are to: 1) learn how to apply the most commonly used frameworks, strategies, and theories in implementation and behavioral research; 2) develop new and complementary skills in costing methods and qualitative research; 3) conduct formative research and a pilot to develop and refine a peer PrEP referral + HIV self-test (HIVST) delivery model for PrEP initiation among young Kenyan women; and 4) transition to scientific independence by building a publication record in implementation and behavioral science. Research plan: PrEP for HIV prevention is highly effective. However, in Kenya, where the government offers PrEP free of change, few young women at high HIV risk are initiating PrEP. We propose developing, piloting, and testing an innovative model that might overcome barriers to PrEP initiation among young Kenyan women: peer PrEP referral + HIVST delivery. The specific aims of the proposed research are to: 1) develop a peer PrEP referral + HIVST delivery model to facilitate PrEP initiation among young Kenyan women using in-depth interviews with young women informed by implementation frameworks and behavioral theory (Y1); 2) pilot the proposed delivery model and refine the model using focus group discussions with pilot participants informed by implementation frameworks (Y2); 3) test the effect and implementation of the refined delivery model on PrEP initiation and other outcomes (including other metrics of PrEP adoption, model fidelity, and costs) using a hybrid randomized trial (Y3-5). This proposed K99/R00 research directly builds on my previous research experiences, enables me to gain new skills in implementation and behavioral research, addresses one of the greatest challenges to PrEP scale-up today, and will inform an R01 proposal for a community-randomized trial and budget impact analysis.