Acceptability of PrEP for HIV Prevention among HIV-positive and HIV-negative Adolescents

HIV 阳性和 HIV 阴性青少年对 PrEP 预防 HIV 的接受程度

• 批准号: 8966647
• 负责人: Jacqueline Hoare
• 金额: $ 17.93万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-12-01 至 2018-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8966647
• 关键词: 18 year old; AIDS prevention; Accounting; Address; Adherence; Adolescence; Adolescent; Adult; Affect; Africa South of the Sahara; Anti-Retroviral Agents; Behavior; Behavior Control; Behavior Therapy; Behavioral; Characteristics; Child; Clinical; Collaborations; Country; Development; Disclosure; Disinhibition; Education; Effectiveness; Environment; Equilibrium; Evaluation; Fertility; Financial compensation; Focus Groups; Future; Generations; Goals; HIV; HIV Seropositivity; Health; Impulsivity; Individual; Infection; Interview; Knowledge; Learning; Life; Marketing; Modeling; Oral; Partner Communications; Perception; Pharmaceutical Preparations; Population; Prevention; Prevention strategy; Process; Prophylactic treatment; Public Health Practice; Research; Research Design; Resources; Risk; Risk Behaviors; Risk-Taking; Safety; Science; Scientist; Sex Behavior; South Africa; South African; Time; Translations; Work; Youth; base; behavior influence; design; efficacy trial; expectation; experience; improved; insight; medication compliance; novel; prevent; protective behavior; sex; sexual debut; social; social norm; social stigma; treatment adherence; uptake; willingness

 DESCRIPTION (provided by applicant): Oral antiretroviral (ARV) pre-exposure prophylaxis (PrEP) holds enormous potential for expanding prevention strategies for adolescents, who account for 39% of all new global infections. We urgently need to engage in exploratory research of PrEP as an adolescent prevention strategy given growing evidence on safety and partial efficacy of adult PrEP accompanied by the recent launch of initial adolescent safety trials We propose an exploratory R21 study to investigate adolescents' and clinicians' understandings of PrEP in South Africa, the country with the largest number of people living with HIV. This research can advance HIV prevention science by improving our understanding of the behavioral and social processes that may potentiate future implementation of adolescent PrEP trials, and to optimize the translation of clinical findings into public health practice through effective messaging about PrEP safety and efficacy. Adolescents undergo unique developmental milestones which are likely to influence PrEP acceptability, willingness to use or to support others' use of PrEP, understandings of messages about PrEP effectiveness, and behavioral decisions in different ways than adults. We focus on endemic settings to leverage lessons from adolescents navigating serodiscordant relationships and to capture PrEP relevant experiences of perinatally infected children who confront challenges relating to ARV adherence, balancing risk for infection of serodiscordant partners with decisions to initiate sex, and fertility desires We compare HIV-positive and HIV-negative adolescents' understandings of PrEP since acceptability, willingness to use or to support partner's use, and predicted behavioral impacts of PrEP may vary by HIV status. We explore how adolescents interpret messages of PrEP partial efficacy as derived from adult trials, and how expectations of PrEP efficacy might affect uptake, adherence, and risk compensation. We triangulate adolescent and clinician perspectives, and explore clinician's views on potential barriers and facilitators in PrEP implementation in resource-constrained endemic settings. Our immediate goals are to understand adolescent-specific factors that affect the design of safety, feasibility, and efficacy of PrEP trials for adolescents (d18 years) and to develop an initial empirical conceptual model to guide adolescent-tailored PrEP messaging to prevent behavioral disinhibition. We propose three aims: 1) to use focus groups (k = 6-10) with HIV-positive and HIV-negative adolescents to explore knowledge, acceptability, willingness to use PrEP or to support partner use, and how about PrEP education based on adult efficacy trials may influence uptake, adherence, and risk compensation; 2) to use in-depth interviews (n = 24- 32) with adolescents to explore Aim 1 topics in more depth and to probe for sensitive issues such as how stigma and disclosure might affect acceptability of PrEP; and 3) to use individual interviews (n = 20-30) with clinicians to understand opinions of PrEP, willingness to prescribe, barriers and facilitators for implementing PrEP, and how to support adherence and protective behaviors during future rollout of adolescent PrEP.

 描述（由申请人提供）：口服抗逆转录病毒 (ARV) 暴露前预防 (PrEP) 在扩大青少年预防策略方面具有巨大潜力，青少年占全球新增感染病例的 39%。鉴于越来越多的证据表明成人 PrEP 的安全性和部分有效性，以及最近启动的初步青少年安全性试验，我们迫切需要将 PrEP 作为青少年预防策略进行探索性研究。我们提出一项探索性 R21 研究，以调查艾滋病毒感染者人数最多的国家南非青少年和临床医生对 PrEP 的理解。这项研究可以通过提高我们对行为和社会过程的理解来推进艾滋病毒预防科学，这些过程可能会加强青少年 PrEP 试验的未来实施，并通过有关 PrEP 安全性和有效性的有效信息来优化临床发现到公共卫生实践的转化。青少年经历独特的发展里程碑，这些里程碑可能会影响 PrEP 的可接受性、使用或支持他人使用 PrEP 的意愿、对 PrEP 有效性信息的理解以及以与成人不同的方式做出的行为决策。我们重点关注流行环境，利用青少年处理血清不一致关系的经验教训，并获取围产期感染儿童的 PrEP 相关经验，这些儿童面临与抗逆转录病毒药物依从性、平衡血清不一致伴侣感染风险与开始性行为的决定以及生育愿望相关的挑战。 支持伴侣的使用，PrEP 的预测行为影响可能因 HIV 状况而异。我们探讨青少年如何解释来自成人试验的 PrEP 部分疗效信息，以及对 PrEP 疗效的期望如何影响吸收、依从性和风险补偿。我们对青少年和临床医生的观点进行了三角分析，并探讨了临床医生对在资源有限的流行病环境中实施 PrEP 的潜在障碍和促进因素的看法。我们的近期目标是了解影响青少年（18岁）PrEP试验的安全性、可行性和有效性设计的青少年特定因素，并开发一个初步的经验概念模型来指导青少年定制的PrEP信息传递，以防止行为去抑制。我们提出三个目标：1) 利用 HIV 阳性和 HIV 阴性青少年的焦点小组 (k = 6-10) 来探索使用 PrEP 或支持伴侣使用的知识、可接受性、意愿，以及基于成人功效试验的 PrEP 教育如何影响吸收、依从性和风险补偿； 2) 对青少年进行深度访谈（n = 24-32），更深入地探讨目标 1 主题，并探讨敏感问题，例如耻辱和披露如何影响 PrEP 的可接受性； 3) 通过与临床医生的个人访谈（n = 20-30）来了解对 PrEP 的看法、开药的意愿、实施 PrEP 的障碍和促进因素，以及在未来推出青少年 PrEP 期间如何支持依从性和保护行为。