ARV-Based Prevention and Treatment in High-Risk Women in Durban, South Africa

南非德班高危妇女的抗逆转录病毒药物预防和治疗

• 批准号: 9344849
• 负责人: Joanne Ellen Mantell
• 金额: $ 21.68万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9344849
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Africa South of the Sahara; Anti-Retroviral Agents; Attention; Attitude; Awareness; Behavioral; Belief; CD4 Lymphocyte Count; Caring; Characteristics; Clinical Trials; Communities; Eligibility Determination; Evaluation; Face; Focus Groups; Funding; Future; General Population; Goals; Government; HIV; HIV Infections; HIV/STD; HIV/TB; Health Personnel; Health system; Healthcare; High Risk Woman; Hour; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Knowledge; Location; Modeling; Oral; Pharmaceutical Preparations; Prevalence; Prevention; Preventive Intervention; Process; Recommendation; Research; Sapphire; Services; Site; South Africa; South African; Testing; Training; Underserved Population; United States National Institutes of Health; Vagina; Woman; Work; Zimbabwe; base; condoms; design; evidence base; female sex worker; high risk; implementation research; interest; peer; pre-exposure prophylaxis; sex; social; success; uptake; web site

Female sex workers (FSW) who exchange sex for money in sub-Saharan Africa (SSA) have the highest global HIV burden among FSW, as high as 36.9%, yet are among the world's most underserved populations. In South Africa, it is estimated that there are up to 167,000 FSW who are at higher risk of HIV, TB and STIs than the general population. HIV prevalence among South African FSW is between 40% and 88%, significantly higher than the 14.6% HIV prevalence among women in the general population, and an estimated 20% of new HIV infections are attributed to sex work. Despite their substantial contribution to HIV incidence, insufficient attention has been given to FSW. Use of antiretroviral treatment (ART) among HIV+ FSW in South Africa is low, and FSW' interest in and demand for oral pre-exposure prophylaxis (PrEP) is unknown as real-world implementation studies are limited. Given the high HIV prevalence among FSW, and the high risk of acquiring HIV among the substantial numbers of HIV- FSW, attention to both treatment as prevention (TasP) and PrEP is warranted. FSW face myriad structural, social and individual-level barriers to HIV self-protection that contribute to high HIV prevalence and are underserved in receiving HIV prevention, care and treatment. However, little is known about how these factors influence FSW' uptake of and adherence to these drugs. Combination HIV prevention packages for FSW that augment TasP and PrEP with behavioral and structural adherence support interventions and work synergistically to maximize impact are imperative, but have not been sufficiently developed and tested. Formative research is needed to explore the acceptability of PrEP and reasons why HIV+ FSW are not initiating ART, and how best to implement and deliver ARV-based treatment and prevention to this underserved population. The Specific Aims of this R21 are to: (1) identify the structural, health system, interpersonal and individual-level barriers and facilitators that influence access to, use of and adherence to ARV-based prevention and treatment among brothel-based FSW via focus groups; (2) examine knowledge, beliefs and attitudes about ARV-based HIV prevention and treatment for FSW via in-depth qualitative interviews with health care providers, managers/owners and bouncers at brothels and hotels, and policymakers, and (3) elicit the views of FSW, health care providers and policymakers, and brothel and hotel managers/owners about approaches to increase brothel-and hotel-based FSW' access to and uptake of TasP and PrEP to guide the selection, design and evaluation of a future combination prevention. The study is closely aligned with NIH priorities, the recommendations of South Africa's National Sex Worker HIV Plan of PrEP, regular HIV testing for HIV-negative sex workers as part of combination HIV prevention and Universal Test and Treat for all FSW, the South African government's goal of initiating at least 80% of eligible people on ARVs, and UNAIDS 90-90- 90 goals.

在撒哈拉以南非洲（SSA），以性换取金钱的女性性工作者（FSW） FSW的全球艾滋病毒负担高达36.9%，但却是世界上最缺乏服务的人群之一。在 据估计，南非有多达167，000名女性性工作者，他们感染艾滋病毒、结核病和性传播感染的风险高于 普通民众。南非FSW的艾滋病毒感染率在40%至88%之间， 高于一般人口中妇女艾滋病毒感染率的14.6%， 艾滋病毒感染是由于性工作。尽管它们对艾滋病毒发病率有很大贡献， 对FSW给予了关注。在南非，艾滋病毒阳性的FSW中抗逆转录病毒治疗的使用率很低， 和FSW的兴趣和需求的口服暴露前预防（PrEP）是未知的，因为现实世界 实施研究有限。鉴于性工作者艾滋病毒感染率高， 在大量艾滋病毒感染者中，艾滋病毒- FSW，同时关注治疗即预防（TasP）和PrEP 有正当理由FSW在艾滋病毒自我保护方面面临无数结构性、社会和个人层面的障碍， 艾滋病毒感染率高，在接受艾滋病毒预防、护理和治疗方面服务不足。然而， 了解这些因素如何影响FSW对这些药物的吸收和坚持。联合艾滋病毒 针对FSW的预防包，通过行为和结构依从性支持来增强TasP和PrEP 必须采取干预措施，协同努力，最大限度地扩大影响，但这还不够， 开发和测试。需要形成性研究来探索PrEP的可接受性及其原因 HIV+ FSW没有启动抗逆转录病毒治疗，以及如何最好地实施和提供基于抗逆转录病毒的治疗和预防 给这些服务不足的人 R21的具体目标是：（1）确定结构、卫生系统、人际关系和 影响获得、使用和坚持抗逆转录病毒药物的个人层面的障碍和促进因素 通过焦点小组在妓院为基础的FSW中进行预防和治疗;（2）检查知识，信仰和 通过深入的定性访谈，了解FSW对基于ARV的艾滋病毒预防和治疗的态度， 卫生保健提供者、妓院和酒店的管理者/所有者和保镖以及政策制定者，以及（3） 家庭社会工作者、卫生保健提供者和决策者以及妓院和旅馆管理者/业主对以下问题的看法： 增加妓院和酒店的FSW获得和吸收TasP和PrEP的方法，以指导 选择、设计和评价未来的综合预防措施。该研究与NIH密切合作。 优先事项，南非国家性工作者艾滋病毒计划的建议，定期艾滋病毒检测 针对艾滋病毒阴性的性工作者，作为艾滋病毒预防和所有性工作者普遍检测和治疗的一部分， 南非政府的目标是启动至少80%的符合条件的人接受抗逆转录病毒药物治疗，联合国艾滋病规划署90-90- 90个进球