Multi-level determinants of uptake and adherence to a novel women-empowered HIV prevention strategy

摘要 由于在生物、社会和经济方面的脆弱性，青春期女孩和年轻妇女(AGYW) 感染艾滋病毒的风险继续增加。我们提出了一项实施研究，以优化 AGYW妇女赋权艾滋病毒预防战略。优化艾滋病毒预防战略的关键是 增进对多层面决定因素(个人、家庭、关系和社区层面)的理解 接受和遵守针对AGYW的艾滋病毒预防战略。通过梦想创新获得资金 格兰特，威特科本健康和福利中心，南非约翰内斯堡的一家初级健康诊所，将注册 在一项实施研究中，艾滋病毒阴性的AGYW对其性伴侣(S)的艾滋病毒状况一无所知。 AGYW将为他们的男性伴侣提供免费的家庭艾滋病毒自我检测。感兴趣的AGYW将获得 HIV自检试剂盒和其伴侣检测HIV阳性的AGYW或AGYW仍未意识到其 性伴侣(S)艾滋病病毒感染状况将提供暴露前预防(PREP)。拟议的工作将建立在 如上所述的梦想创新研究。使用混合方法，我们将评估多水平的行列式 关于吸收和遵守由AGYW授权的新的艾滋病毒预防战略。收集的定量数据 通过梦想创新研究将得到R21的补充，对AGYW和 他们的男性伴侣在拟议的艾滋病毒预防级联的每一步：AGYW接受自我 伴侣检测试剂盒；AGYW向其男性伴侣交付自我检测试剂盒(S)；男性伴侣接受 艾滋病毒自我检测；向AGYW披露艾滋病毒检测结果；与照顾艾滋病毒阳性男性伴侣的联系；PrEP 符合条件的AGYW中的摄取量；以及PrEP遵守情况。我们的具体目标如下：目标1：了解 多层次(个人、关系和社区)的决定因素，包括对以下每一项的接受和坚持 通过混合方法采取新的AGYW授权的艾滋病毒预防战略的步骤。 结合来自梦想创新研究和社区地图研究的数据，我们将使用多层次 建模以评估艾滋病毒预防级联过程中每一步骤的干预吸收或依从性的预测因素。 在每一步，我们还将确定6-8名AGYW和未能完成 一步一步地进行定性访谈，以探索未完成HIV接触的原因 预防活动以及成功参与前几个步骤的促进者。目标2：比较 估计的艾滋病毒获取风险与感知的艾滋病毒风险对AGYW交付艾滋病毒自检的影响 合作伙伴和PrEP吸收。我们将估计干预参与度的比例，其解释如下 估计的艾滋病毒风险(根据基线风险评估)与感知的艾滋病毒风险之间的关系 估计和感知风险，并描述干预后风险感知的变化。

ABSTRACT Due to their biological, social and economic vulnerabilities, adolescent girls and young women (AGYW) continue to be at increased risk for HIV acquisition. We propose an implementation research study to optimize woman-empowered HIV prevention strategies for AGYW. Key to optimizing HIV prevention strategies is an improved understanding of the multilevel determinants (individual, familial, relationship and community-level) of uptake and adherence to HIV prevention strategies targeting AGYW. Funded through a DREAMS Innovation grant, Witkoppen Health and Welfare Centre, a primary health clinic in Johannesburg, South Africa, will enroll HIV-negative AGYW unaware of the HIV status of their sexual partner(s) in an implementation research study. AGYW will be offered free home-based HIV self-testing for their male partners. Interested AGYW will be given HIV self-test kits and AGYW whose partners test HIV-positive or AGYW who remain unaware of their partner(s) HIV status will be offered pre-exposure prophylaxis (PrEP). The proposed work will build upon the DREAMS Innovation study described above. Using mixed methods, we will evaluate multi-level determinants of uptake and adherence to the novel AGYW-empowered HIV prevention strategy. Quantitative data collected by the DREAMS Innovation study will be complemented by the R21 with qualitative interviews with AGYW and their male partners at each of the steps of the proposed HIV prevention cascade: AGYW acceptance of self- testing kits for partners; AGYW delivery of self-testing kits to their male partner(s); male partner acceptance of HIV self-testing; disclosure of HIV test results to AGYW; linkage to care of HIV positive male partners; PrEP uptake among eligible AGYW; and PrEP adherence. Our specific aims are as follows: Aim 1: Understand the multi-level (individual, relationship and community) determinants of uptake and adherence to each of the steps of the novel AGYW-empowered HIV prevention strategy via a mixed methods approach. Combining data from the DREAMS Innovations Study and a community mapping study, we will use multi-level modeling to assess predictors of intervention uptake or adherence at each step of the HIV prevention cascade. At each step, we will also identify 6-8 AGYW and male partners (if relevant) who failed to complete the cascade step and perform qualitative interviews to explore reasons for not completing engagement in HIV prevention activities as well as facilitators of successful engagement in previous steps. Aim 2: Compare the effects of estimated HIV acquisition risk vs. perceived HIV risk on AGYW delivery of HIV self-tests to partners and PrEP uptake. We will estimate the proportion of intervention engagement explained by estimated HIV risk (per baseline risk assessments) vs. perceived HIV risk, examine the relationship between estimated and perceived risk, and describe changes in risk perception post-intervention.