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) 的死亡率最高 全球 FSW 的艾滋病毒负担高达 36.9%，但属于世界上服务最匮乏的人群之一。在 据估计，南非有多达 167,000 名 FSW 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，显着 高于一般人群中女性 14.6% 的艾滋病毒感染率，估计新发艾滋病毒感染者的 20% 艾滋病毒感染归因于性工作。尽管它们对艾滋病毒发病率做出了重大贡献，但还不够 FSW 已受到关注。南非 HIV+ FSW 中抗逆转录病毒治疗 (ART) 的使用率较低， FSW 对口服暴露前预防 (PrEP) 的兴趣和需求在现实世界中并不为人所知 实施研究有限。鉴于 FSW 中艾滋病毒感染率较高，且感染艾滋病病毒的风险较高 在大量 HIV-FSW 患者中，对 HIV-FSW 的重视，同时关注治疗即预防 (TasP) 和 PrEP 保证。 FSW 在艾滋病毒自我保护方面面临着无数结构性、社会性和个人层面的障碍，这些障碍导致 艾滋病毒感染率高，并且在接受艾滋病毒预防、护理和治疗方面服务不足。然而，很少的是 了解这些因素如何影响 FSW 对这些药物的吸收和依从性。混合型艾滋病毒 FSW 预防包通过行为和结构依从性支持增强 TasP 和 PrEP 干预措施和协同工作以最大限度地发挥影响势在必行，但还不够充分 开发并测试。需要进行形成性研究来探索 PrEP 的可接受性及其原因 HIV+ FSW 未启动 ART，以及如何最好地实施和提供基于 ARV 的治疗和预防 对于这个服务不足的人群。 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、使用和坚持基于抗逆转录病毒药物的个人层面的障碍和促进因素 通过焦点小组预防和治疗以妓院为基础的 FSW； (2) 检验知识、信念和 通过深入定性访谈了解 FSW 对基于 ARV 的 HIV 预防和治疗的态度 医疗保健提供者、妓院和酒店的经理/业主和保镖以及政策制定者，以及 (3) 引出 FSW、医疗保健提供者和政策制定者以及妓院和酒店经理/业主的观点 增加以妓院和酒店为基础的 FSW 获取和采用 TasP 和 PrEP 的方法，以指导 未来组合预防的选择、设计和评估。该研究与 NIH 密切配合 优先事项、南非国家性工作者 HIV 预防前计划的建议、定期 HIV 检测 针对艾滋病毒呈阴性的性工作者，作为艾滋病毒预防和针对所有 FSW 的普遍检测和治疗相结合的一部分， 南非政府的目标是让至少 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。