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

项目摘要 在撒哈拉以南非洲(SSA)，艾滋病毒发病率仍然高得令人无法接受，部分原因是机会不足， 吸收和保留生物医学艾滋病毒预防服务，包括暴露前和暴露后预防 (PREP/PEP)，在艾滋病毒风险增加的人中。饮酒是感染这两种病毒的共同风险因素 在SSA中获得和较差的艾滋病毒预防吸收和保留。促进生物医学艾滋病毒的干预措施 迫切需要在酗酒者及其性伴侣中进行预防。 提供酒精服务的饮酒场所是SSA艾滋病病毒传播的重要场所，是理想的场所 让艾滋病毒风险增加的妇女和男子参与生物医学预防服务。然而，尽管长时间以来- 认识到饮酒场所是传播的“热点”，几乎没有干预措施可以接触到和 在SSA的饮酒场所让参与PrEP和PEP的人员参与。接触和参与的主要障碍 来自社区环境的艾滋病毒高危人群，如在艾滋病毒检测中的饮酒场所--关键的第一步 获得生物医学艾滋病毒预防--包括与艾滋病毒相关的耻辱和对风险的不良认识。至 为了消除这些障碍，我们制定了一项动员战略，将艾滋病毒检测整合到多个 从肯尼亚和乌干达的饮酒场所招募2,000人进行疾病筛查，覆盖75%的人 招募成人进行艾滋病毒检测。我们现在需要确定多病种动员能否促进 在新的生物医学预防选择的背景下，成人在饮酒场所预防艾滋病毒的情况。 在采用生物医学预防艾滋病毒之后，酗酒者面临滞留的挑战 在护理和遵守PrEP/PEP方面。我们已经改编了一个简短的酒精咨询干预(健康生活) 减少酒精使用，促进遵守抗逆转录病毒疗法(ART)和抑制艾滋病毒 肯尼亚和乌干达的艾滋病毒携带者。我们现在需要确定这种干预是否可以促进 大量饮酒的成年人在生物医学预防中的保留和PrEP/PEP的依从性。 该项目将在肯尼亚和乌干达严格测试创新干预措施，以增加对 生物医学艾滋病毒预防，并评估这些方法的促进者、障碍和成本效益。 该项目将有以下目标：目标1：比较两种动员战略的有效性 在饮酒场所增加成年人对生物医学艾滋病毒预防的接受。目标2：确定疗效 减少重度酒精使用的健康生活干预(HLI)与标准护理(对照)之间的对比 在大量饮酒的成年人中进行的一项随机试验中的生物医学艾滋病毒预防。目标3：确定 增加生物医学艾滋病毒预防吸收(目标1)和保留(目标1)的干预措施的成本效益 2)去饮酒场所的艾滋病毒高危成年人。 拟议的研究将解决SSA中酒精使用和艾滋病毒风险的关键交集，通过促进 在生物医学艾滋病毒预防方面的覆盖、吸收和保留，并探索相关的促进者和障碍。

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.