Innovative strategies to promote biomedical HIV prevention uptake and retention among high-risk adults at drinking venues in Kenya and Uganda

促进肯尼亚和乌干达饮酒场所高危成年人接受和保留生物医学艾滋病毒预防的创新战略

• 批准号: 10541747
• 负责人: Gabriel Chamie
• 金额: $ 66.32万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10541747
• 关键词: AIDS prevention; Address; Adherence; Adult; Africa South of the Sahara; Alcohol consumption; Alcohols; Anti-Retroviral Agents; Awareness; Caring; Communities; Consumption; Counseling; Country; Data; Disease; Effectiveness of Interventions; Face; HIV; HIV Seropositivity; HIV risk; HIV therapy; Health; Heavy Drinking; Hot Spot; Human immunodeficiency virus test; Incidence; Injectable; Intervention; Interview; Kenya; Oral; Participant; Perception; Persons; Play; Prevalence; Prevention; Prophylactic treatment; Research; Risk; Risk Factors; Role; Rural; Sampling; Sexual Partners; Site; Testing; Time; Uganda; Unsafe Sex; Viral; Woman; antiretroviral therapy; arm; base; community setting; compare effectiveness; cost effectiveness; cost estimate; drinking; effectiveness measure; effectiveness trial; high risk; innovation; insight; men; phosphatidylethanol; pre-exposure prophylaxis; prevention service; primary outcome; randomized trial; recruit; reduced alcohol use; risk perception; screening; secondary outcome; social stigma; standard care; testing uptake; therapy adherence; transmission process; uptake

Project Summary HIV incidence remains unacceptably high in sub-Saharan Africa (SSA) due in part to inadequate access, uptake, and retention in biomedical HIV prevention services, including pre- and post-exposure prophylaxis (PrEP/PEP), among persons at increased HIV risk. Alcohol use is a common risk factor for both HIV acquisition and poor HIV prevention uptake and retention in SSA. Interventions that promote biomedical HIV prevention among persons with heavy alcohol use and their sexual partners are urgently needed. Alcohol-serving drinking venues play an important role as sites of HIV transmission in SSA and are ideal sites to engage women and men at increased risk of HIV in biomedical prevention services. However, despite long- standing awareness of drinking venues as transmission “hot spots”, few interventions exist to reach and engage persons in PrEP and PEP from drinking venues in SSA. Major barriers to reaching and engaging persons at high risk of HIV from community settings such as drinking venues in HIV testing – a critical first step to accessing biomedical HIV prevention – include HIV-associated stigma and poor perceptions of risk. To address these barriers, we have developed a mobilization strategy of integrating HIV testing within multi- disease screening to recruit >2,000 people from drinking venues in Kenya and Uganda, reaching >75% of adults recruited for HIV testing. We now need to determine whether multi-disease mobilization can promote uptake of HIV prevention for adults at drinking venues in the context of new biomedical prevention options. Following uptake of biomedical HIV prevention, persons with heavy alcohol use face challenges with retention in care and adherence to PrEP/PEP. We have adapted a brief alcohol counseling intervention (Health Living) to reduce alcohol use and promote antiretroviral therapy (ART) adherence and HIV viral suppression among persons with HIV in Kenya and Uganda. We now need to determine whether this intervention can promote retention in biomedical prevention and PrEP/PEP adherence among adults with heavy alcohol use. The project will rigorously test innovative interventions in Kenya and Uganda to increase uptake and use of biomedical HIV prevention, and assess facilitators, barriers, and cost-effectiveness of these approaches. The project will have the following aims: Aim 1: Compare the effectiveness of two mobilization strategies to increase uptake of biomedical HIV prevention among adults at drinking venues. Aim 2: Determine the efficacy of the Healthy Living Intervention (HLI) to reduce heavy alcohol use vs. standard care (control) on retention in biomedical HIV prevention in a randomized trial among adults with heavy alcohol use. Aim 3: Determine the cost-effectiveness of interventions that increase biomedical HIV prevention uptake (Aim 1) and retention (Aim 2) among adults at high-risk for HIV who attend drinking venues. The proposed research will address the critical intersection of alcohol use and HIV risk in SSA, by promoting reach, uptake and retention in biomedical HIV prevention and exploring associated facilitators and barriers.

项目总结