HIV Self Testing to Empower Prevention Choices in Sex Workers

项目摘要/摘要 拟议的K43新兴全球领导者奖的总体目标是支持安德鲁·穆朱吉拉博士的 研究培训，以发展为独立的全球卫生艾滋病毒研究人员。穆朱吉拉博士目前是一名 乌干达坎帕拉传染病研究所博士后。在香港进行拟议的研究 这一应用将有助于他的培训目标：1)在行为科学方面奠定坚实的基础；2)获得 行为监测和干预的移动技术方面的专业知识；以及3)获取定性数据 具有收集、分析和写作能力。这项提议建立在他已经在临床试验中拥有的独特技能之上， 流行病学和医学，同时利用多学科导师团队最终成为 富有成效和影响力的独立调查员专注于在关键人群中预防艾滋病毒。这项研究 该提案的目标是进行严格的概念验证评估，以测试艾滋病毒自我检测(与 以临床为基础的测试)激发PrEP的吸收和依从性，并使有效的预防决策成为可能 在性工作者身上。变性人、男性和女性性工作者感染艾滋病毒的可能性分别是前者的49倍、21倍和14倍 与普通人群中的其他成年人一样。在乌干达，性工作者的艾滋病毒血清阳性率很高(35-37%)， 占新增艾滋病毒感染者的10%。两个强大的、以证据为基础的自我控制的艾滋病毒预防工具是 可用的--艾滋病毒自我检测(HIVST)和抗逆转录病毒暴露前预防(PrEP)--但这些不是 目前在性工作者中得到了很好的利用。HIVST和PrEP是互补的工具，可以组合在一起 建立自我效能感和赋权能力，提高PrEP依从性，减少性危险行为。然而， 需要研究来证明联合使用HIVST和PrEP可能会对摄取和 每项预防干预措施的使用。为了解决这些问题，穆朱吉拉博士将进行一项随机试验 在乌干达启动PrEP的性工作者中，测试HIV自我检测是否增加了HIV-HIV-的PrEP依从性 未感染的性工作者(目标1)，减少服用PrEP的性工作者的性危险行为(目标2)，以及 影响性工作者及其伴侣的预防选择(目标3)。他将使用新技术 (使用Wisepill技术和手机调查进行实时电子监测)以表征模式 准备遵守，并评估HIVST和PrEP的使用如何与性危险行为相一致。此外，他还将 进行深入的定性访谈，探索HIVST和PrEP结合的机制 交付可能是协同的和赋权的。这项研究将是第一次联合评估HIVST和PrEP 性工作者。穆朱吉拉博士的研究目标与他的培训目标相一致，通过完成这一 获奖后，他将处于一个极好的地位，可以提交一份R01申请，进一步推动艾滋病毒的研究议程 预防。

PROJECT SUMMARY/ABSTRACT The overall goal of the proposed K43 Emerging Global Leader Award is to support Dr. Andrew Mujugira’s research training to develop as an independent global health HIV researcher. Dr. Mujugira is currently a postdoctoral fellow at the Infectious Disease Institute in Kampala, Uganda. Conducting the proposed studies in this application will facilitate his training goals to: 1) develop a solid foundation in behavioral science; 2) gain expertise in mobile technologies for behavior monitoring and intervention; and 3) acquire qualitative data collection, analysis and writing skills. This proposal builds on the unique skills he already has in clinical trials, epidemiology and medicine while leveraging a multidisciplinary team of mentors to ultimately become a productive and influential independent investigator focused on HIV prevention in key populations. The research goal of this proposal is to conduct a rigorous proof-of-concept evaluation to test if HIV self-testing (compared to clinic-based testing) motivates PrEP uptake and adherence, and empowers effective prevention decision making in sex workers. Transgender, male, and female sex workers are 49, 21 and 14 times as likely to be HIV-infected as other adults in the general population. In Uganda, sex workers have high HIV seroprevalence (35-37%) and account for 10% of new HIV infections. Two robust, evidence-based, self-controlled HIV prevention tools are available -- HIV self-testing (HIVST) and antiretroviral pre-exposure prophylaxis (PrEP) -- but these are not currently well utilized among sex workers. HIVST and PrEP are complementary tools that could be combined to build self-efficacy and empowerment, increase PrEP adherence and reduce sexual risk behaviors. However, research is needed to show how combination HIVST and PrEP may have a synergistic impact on uptake and use of each prevention intervention. To address these questions, Dr. Mujugira will conduct a randomized trial among sex workers initiating PrEP in Uganda to test if HIV self-testing increases PrEP adherence among HIV- uninfected sex workers (Aim 1), decreases sexual risk behavior in sex workers taking PrEP (Aim 2), and influences prevention choices among sex workers and their partners (Aim 3). He will use novel technologies (real-time electronic monitoring with Wisepill technology and mobile phone surveys) to characterize patterns of PrEP adherence, and assess how use of HIVST and PrEP aligns with sexual risk behaviors. Additionally, he will conduct in-depth qualitative interviews to explore the mechanisms through which combined HIVST and PrEP delivery may be synergistic and empowering. This study will be the first to jointly evaluate HIVST and PrEP in sex workers. Dr. Mujugira’s research goals correspond with his training goals, and by the completion of this award, he will be in an excellent position to submit an R01 application that furthers the research agenda in HIV prevention.