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，艾滋病毒的发病率仍然高得令人无法接受，部分原因是缺乏足够的机会， 艾滋病毒生物医学预防服务，包括接触前和接触后预防服务的接受和保留情况 (PrEP/PEP）。饮酒是艾滋病毒和艾滋病的共同危险因素 艾滋病毒感染和艾滋病毒预防的吸收和保留率低。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。 提供酒精饮料的场所在SSA中作为HIV传播场所起着重要作用，是理想的场所 让感染艾滋病毒风险增加的男女参与生物医学预防服务。然而，尽管长- 由于人们长期认识到饮酒场所是传播“热点”，几乎没有干预措施可以触及， 让人们从SSA的饮酒场所参与PrEP和PEP。接触和参与的主要障碍 在艾滋病毒检测中，将艾滋病毒高危人群从饮酒场所等社区环境中隔离-关键的第一步 艾滋病毒的生物医学预防--包括与艾滋病毒有关的耻辱和对风险的不良认识。到 为了克服这些障碍，我们制定了一项动员战略，将艾滋病毒检测纳入多个 在肯尼亚和乌干达的饮酒场所招募2,000多人进行疾病筛查， 招募成年人进行艾滋病毒检测。我们现在需要确定多疾病动员是否能促进 在新的生物医学预防选择的背景下，在饮酒场所对成年人进行艾滋病毒预防。 在接受生物医学艾滋病毒预防后，重度饮酒者面临保留的挑战 在护理和坚持PrEP/PEP。我们已经适应了一个简短的酒精咨询干预（健康生活） 减少酒精使用，促进抗逆转录病毒疗法（ART）的坚持和艾滋病毒抑制， 肯尼亚和乌干达的艾滋病毒感染者。我们现在需要确定这种干预是否能促进 保留在生物医学预防和PrEP/PEP坚持与重度酒精使用的成年人。 该项目将在肯尼亚和乌干达严格测试创新干预措施， 生物医学艾滋病毒预防，并评估促进者，障碍，和这些方法的成本效益。 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艾滋病毒生物医学预防的了解。目的2：确定疗效 健康生活干预（HLI）与标准护理（对照）相比， 在大量饮酒的成年人中进行的一项随机试验的生物医学HIV预防。目标3：确定 提高艾滋病毒生物医学预防的接受率（目标1）和保留率（目标2）的干预措施的成本效益 2)在那些去饮酒场所的艾滋病毒高危成年人中。 拟议的研究将解决撒哈拉以南非洲地区酒精使用和艾滋病毒风险的关键交叉点， 在生物医学艾滋病毒预防方面的普及、吸收和保留，并探讨相关的促进因素和障碍。

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.