IPrEP: A Combination HIV Prevention Strategy for Young Women at Risk for HIV

 描述（由申请人提供）：撒哈拉以南非洲（SSA）普遍艾滋病毒流行的关键人群没有得到足够的关注，包括女性性工作者（FSW），这是一个艾滋病毒流行率大大高于一般人群的群体，也是肯尼亚艾滋病毒流行的主要原因。年轻的FSW（18-24岁）是一个弱势群体，在FSW中风险最高，需要量身定制的生物医学，行为和结构干预措施，以应对他们面临的流行病学和背景复杂性。我们提出了IPrEP研究项目，包括：1）形成性研究，包括定性研究，在年轻的FSW，男性客户（MC），以阐明生活挑战，动机和艾滋病毒风险的看法;风险行为;知识，艾滋病毒和艾滋病毒预防的态度，包括PrEP;坚持支持的偏好;和性伴侣关系。与卫生保健提供者（HCP）的访谈将评估有关艾滋病毒预防和PrEP的知识以及对FSW的态度; 2）在年轻的FSW中进行一项加强的口服暴露前预防（PrEP）研究，以确定PrEP（一种生物医学干预措施）组合策略的摄取、依从性、可行性和可接受性，通过行为和结构性的干预，（同伴支持与提醒和资源转移）和减少风险的咨询干预;（3）对社区管理员的招募和保留进行可行性研究，并评估降低风险咨询干预的可接受性; 4）与内罗毕大学（UoN）合作，对PrEP组合战略进行成本效益分析，为实施和扩大规模提供信息; 5）在PEPFAR护理教育伙伴关系倡议（NEPI）的经验和基础设施的基础上，为护士教师和学生进行实施研究的能力建设。 拟议的研究是由几个创新，包括重点放在年轻的FSW，人口在肯尼亚的地理艾滋病毒热点的高风险，以及对MC和HCP谁发挥关键作用的FSW获得预防服务和预防方法。该研究包括实施理论驱动的综合预防战略，包括生物医学、行为和结构干预措施以及旨在减少性风险补偿和风险行为的干预措施;评估HCP对艾滋病毒预防的知识和态度，包括PrEP和FSW;进行成本效益分析，为PEPFAR支持的项目的实施和扩大提供信息，并致力于建设设计能力，与护理伙伴一起实施和分析实施研究的结果。 我们研究的最终目标是确定如何有效地为这一年轻人群实施PrEP，降低他们感染艾滋病毒的风险，从而减少肯尼亚和类似环境中新感染艾滋病毒的总数。这项研究的结果也将为总统艾滋病紧急救援计划提供信息，因为该计划旨在通过有效利用循证干预措施来遏制艾滋病毒的传播。

 DESCRIPTION (provided by applicant): Key populations within the generalized HIV epidemic in sub-Saharan Africa (SSA) have received insufficient attention including female sex workers (FSWs), a group with HIV prevalence substantially higher than the general population and a major contributor to the HIV epidemic in Kenya. Young FSWs (18-24 years old), a vulnerable population, are at highest risk among FSWs and require tailored biomedical, behavioral and structural interventions to counter the epidemiological and contextual complexities they face. We propose the IPrEP Research Project which includes: 1) formative research, inclusive of qualitative research among young FSWs, male clients (MCs) to elucidate life challenges, motivations and perceptions of HIV risks; risk behaviors; knowledge, attitudes about HIV and HIV prevention, including PrEP; preferences for adherence support; and sex partner relations. Interviews with health care providers (HCPs) will assess knowledge regarding HIV prevention and PrEP and attitudes towards FSWs; 2) an enhanced oral pre-exposure prophylaxis (PrEP) study among young FSWs to determine the uptake, adherence, feasibility and acceptability of combination strategy of PrEP, a biomedical intervention, with behavioral and structural adherence interventions (peer support versus reminders and resource transfer) and risk-reduction counseling intervention; 3) feasibility study for recruitment and retention of MCs with assessment of acceptability of risk-reduction counseling intervention; 4) cost-effectiveness analysis in collaboration with University of Nairobi (UoN) of the combination PrEP strategies to inform implementation and scale-up and 5) capacity building in implementation research for nurse faculty and students at UoN building on PEPFAR Nursing Education Partnership Initiative (NEPI) experience and infrastructure. The proposed research is distinguished by several innovations, including focus on young FSW, a population a high risk in a geographic HIV hotspot in Kenya, as well as on MCs and HCPs who play key roles in access by FSWs to prevention services and to prevention methods. The research includes implementation of theoretically- driven combination prevention strategies inclusive of biomedical, behavioral and structural interventions and an intervention aimed to decrease sexual risk compensation and risk behaviors; the assessment of HCPs' knowledge and attitudes regarding HIV prevention, including PrEP, and FSWs; cost-effectiveness analysis to inform implementation and scale-up within PEPFAR-supported programs, as well as a commitment to building capacity to design, implement and analyze findings from implementation studies working with nursing partner. The ultimate goal of our research is to identify how PrEP can be effectively implemented for this young population at substantial risk for HIV decreasing their risk of HIV acquisition, consequently diminishing the overall number of new HIV infections in Kenya and similar settings. Findings from this research will also inform PEPFAR as it aims to stem the spread of HIV through the effective use of evidence-based interventions.