Optimizing Pre-exposure Prophylaxis Use among Adolescent Girls and Young Women Seeking Reproductive Health Care in Kenya

项目摘要 该提案旨在调查影响肯尼亚少女和年轻妇女（AGYW） 艾滋病毒暴露前预防（PrEP）“PrEP级联”规定了可衡量的基准 从中可以评估PrEP计划的实施情况，以优化和确定计划 订婚PrEP级联结局包括PrEP启动频率，再填充和1，3， 和6个月，以及长期的PrEP计划保留在HIV阴性的HIV风险个体中。肯尼亚 年龄在15-24岁之间的青少年妇女面临着艾滋病毒和意外怀孕的平行流行， 艾滋病毒感染率比男性高出一倍。将PrEP纳入堕胎后护理（PAC） 艾滋病毒/艾滋病预防是成功加强青年志愿者预防艾滋病毒的关键一步，特别是考虑到 青少年妇女在社会和心理方面的脆弱性。将PrEP融入家庭的几个方案 规划或孕产妇和保健服务部门指出，预防性保健方案经常中断，特别是在青年女青年中。这 该项目将利用肯尼亚PAC诊所正在进行的PrEP扩大项目，以确定AGYW面临的挑战。 使用PrEP时的面部表情。这项研究旨在通过以下方式解决艾滋病毒预防研究和PrEP规模扩大的关键差距： 1)在个人、人际和环境的社会生态框架中评估PrEP级联结果 （2）用一种新的、经过调整的工具，衡量增强青少年性健康和生殖健康权能的情况， 与PrEP计划保留相关;以及3）评估对齐中的预防有效依从性 性行为和PrEP依从性之间的关系，通过护理点尿液分析测量。通过整合 基于行为科学和临床流行病学方法的研究，该研究将提供一个全面的 影响PrEP护理的青少年经历的观点，并提供PAC中AGYW的新证据 这些人仍然没有得到充分的研究，而且感染艾滋病毒的风险很高。

PROJECT ABSTRACT This proposal aims to investigate the factors that shape Kenyan adolescent girls and young women's (AGYW) experiences of HIV pre-exposure prophylaxis (PrEP). The “PrEP cascade” specifies measurable benchmarks from which the implementation of PrEP programs can be assessed to optimize and determine program engagement. PrEP cascade outcomes include the frequency of PrEP initiation, refills and adherence at 1-, 3-, and 6-months, and long-term PrEP program retention among HIV-negative individuals with HIV risk. Kenyan AGYW, between the ages of 15-24, face parallel epidemics of HIV and unintended pregnancy and have a ≥2- fold higher incidence of HIV than their male counterparts. Integration of PrEP within post-abortion care (PAC) settings is a crucial step in successfully strengthening the prevention of HIV among AGYW, especially in view of the age-specific social and psychological vulnerabilities of AGYW. Several programs integrating PrEP into family planning or maternal and health services cite frequent PrEP discontinuation, especially among AGYW. This project will leverage an ongoing PrEP scale-up project in PAC clinics in Kenya to identify challenges that AGYW face in PrEP use. This study seeks to address a critical gap in HIV prevention research and PrEP scale-up by: 1) assessing PrEP cascade outcomes in a socioecological framework of individual, interpersonal, and contextual factors; 2) measuring adolescent sexual and reproductive health empowerment, with a novel and adapted tool, in association with PrEP program retention; and 3) evaluating prevention-effective adherence in the alignment between sexual behaviors and PrEP adherence, measured through point-of-care urine assay. By integrating research grounded in behavioral science and clinical epidemiology methods, the research will provide a holistic perspective of adolescent experiences that influence PrEP care and provide new evidence of AGYW in PAC settings, who remain understudied and at high risk of HIV.