Prison PrEP Values Adherence and Implementation in Lusaka (PrEVAIL)

卢萨卡监狱 PrEP 重视遵守和实施 (PrEVAIL)

• 批准号: 10401510
• 负责人: Cassidy W. Claassen
• 金额: $ 19.72万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-04 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10401510
• 关键词: AIDS prevention; Address; Adherence; Africa; Africa South of the Sahara; Communities; Country; Criminal Justice; Data; Development; Eligibility Determination; Enrollment; Epidemic; Funding; Future; Goals; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Human immunodeficiency virus test; Imprisonment; Incidence; Intervention; Interview; Justice; Knowledge; Left; Measures; Methods; Motivation; North America; Oral; Participant; Patient Self-Report; Pattern; Persons; Population; Prevalence; Prevention; Prevention strategy; Prisons; Qualitative Research; Questionnaires; Research; Research Methodology; Risk; Risk Behaviors; Risk Factors; Sampling; Seasons; Service delivery model; Social support; System; Tenofovir; Testing; Time; United States National Institutes of Health; Urine; Visit; Work; Zambia; cohort; emtricitabine; epidemic response; innovation; insight; interest; low and middle-income countries; meetings; member; men; novel; point of care; pre-exposure prophylaxis; preference; prevention service; primary outcome; prospective; response; risk perception; secondary outcome; service delivery; substance use; theories; uptake

PROJECT SUMMARY Incarcerated people are one of the key populations at the center of the HIV epidemic in Zambia and sub-Saharan Africa (SSA) in general. The periods during and after incarceration likely represent times of significant HIV risk, yet little is known about HIV infection vulnerability during these times or how best to provide incarcerated people with HIV prevention services such as pre-exposure prophylaxis (PrEP) to reduce HIV risk. To address these knowledge gaps, we propose the Prison PrEP Values, Adherence, and Implementation in Lusaka (PreVAIL) study. Our scientific premise is that providing effective combination prevention to incarcerated and justice- involved populations requires understanding both temporal changes in their HIV risk and patterns of their PrEP uptake, adherence, and persistence. The long-term goal of this work is to optimize the timing and delivery of PrEP, as part of combination prevention, for justice-involved persons in Zambia. The objective of this R21 is to characterize PrEP uptake, adherence, and persistence, as well as HIV risk perceptions and behaviors, among justice-involved persons during incarceration and transition to the community. PreVAIL builds on a robust platform for corrections-health research and service delivery in Zambia. The TasP study (Co-PI: Herce) was the first to assess universal test and treat for HIV for incarcerated people in SSA, the NIH-funded CONTINUUM study (PI: Herce) was one of the first studies to follow incarcerated people after release in SSA, and the CDC/PEPFAR-funded CIRKUITS project (PI: Claassen, Co-PI: Herce) is conducting one of the first demonstrations of PrEP for justice-involved people in SSA. In Aim 1 we will assess PrEP uptake, adherence, and persistence, as well as HIV risk factors and perception of HIV risk, among justice-involved people during incarceration and post-release. We will prospectively enroll a cohort of 800 HIV-negative and PrEP-eligible incarcerated people at prison entry and offer them oral PrEP. We will follow all cohort members for 12 months regardless of PrEP status, both during incarceration and following release. Primary outcomes include PrEP uptake, adherence, and persistence, as well as HIV status, HIV risk behaviors and risk perception. PrEP adherence will be assessed through self-report and a novel point-of-care urine tenofovir test. In Aim 2, we will use qualitative research methods to explore and understand barriers and facilitators of PrEP uptake, adherence, and persistence during incarceration and after release. We will purposively sample 40 participants from our cohort for theory-informed longitudinal in-depth interviews to understand multi- level barriers and facilitators to efficacious PrEP use, as well as PrEP method and service delivery preferences. This study will provide new insights into HIV risk for justice-involved people in Africa and quantify the magnitude of the gap in HIV prevention service continuity, leading to a future, efficacious PrEP differentiated service delivery model to support justice-involved people in Zambia during the period spanning incarceration and post-release.

项目总结 被监禁的人是赞比亚和撒哈拉以南地区艾滋病毒流行中心的关键人群之一 非洲(SSA)总体上。监禁期间和监禁后的时期很可能是艾滋病毒重大风险的时期， 然而，人们对这些时期艾滋病毒感染的脆弱性知之甚少，也不知道如何最好地为被监禁者提供 通过接触前预防(PrEP)等艾滋病毒预防服务来降低艾滋病毒风险。要解决这些问题 知识差距，我们提出了监狱PrEP的价值观、坚守和在卢萨卡的实施(盛行) 学习。我们的科学前提是为监禁和正义提供有效的组合预防- 相关人群需要了解其艾滋病毒风险的时间变化和PrEP的模式 吸收、坚持和坚持。这项工作的长期目标是优化时间和交付 作为联合预防的一部分，为赞比亚涉及司法的人员做好准备。这款R21的目标是 描述PrEP的吸收、坚持和持久性，以及艾滋病毒风险认知和行为，包括 在监禁和向社区过渡期间涉及司法的人员。 Prevail建立在赞比亚矫治--卫生研究和服务提供的强大平台上。TasP 研究(Co-PI：HERCE)是第一个评估SSA被监禁者艾滋病毒普遍检测和治疗的研究， 美国国立卫生研究院资助的连续研究(PI：HERCE)是第一批跟踪囚犯的研究之一 在SSA发布，CDC/PEPFAR资助的CIRKUITS项目(PI：Claassen，Co-PI：Herce)正在进行 为SSA涉及正义的人举行的第一批PrEP示威活动之一。 在目标1中，我们将评估PrEP的吸收、依从性和持久性，以及艾滋病毒风险因素和 参与司法的人在监禁和释放后对艾滋病毒风险的看法。我们会 前瞻性地招募800名艾滋病毒阴性和符合PrEP条件的囚犯进入监狱并提供 他们口述PrEP。我们将跟踪所有队列成员12个月，无论PrEP状态如何，都是在 监禁和随后的释放。主要结果包括PrEP的吸收、依从性和持久性，如 以及艾滋病毒状况、艾滋病毒危险行为和危险认知。准备工作遵守情况将通过自我报告进行评估 以及一种新的护理点尿替诺福韦测试。 在目标2中，我们将使用定性研究方法来探索和理解障碍和促进者 在监禁期间和释放后准备摄取、坚持和坚持。我们将有目的地 从我们的队列中抽取40名参与者进行理论知识的纵向深入访谈，以了解多个 有效使用PrEP的障碍和促进者，以及PrEP方法和服务交付偏好。 这项研究将对非洲涉及司法的人的艾滋病毒风险提供新的见解，并量化其规模 在艾滋病毒预防服务连续性方面的差距，导致未来有效的PrEP差异化服务提供 在监禁和释放后期间支持赞比亚涉及司法的人的模式。