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）中兑现性别的女性工作者（FSW）的最高 FSW中的全球艾滋病毒负担高达36.9％，但是世界上服务最低的人群之一。在 南非，据估计，艾滋病毒，结核病和性传播感染的风险高达167,000 fsw 普通人群。南非FSW中的HIV患病率在40％至88％之间，显着 高于一般人群中女性的14.6％的HIV患病率，估计有20％ 艾滋病毒感染归因于性工作。尽管它们对艾滋病毒的发病率做出了巨大贡献，但不足 注意FSW的关注。南非的HIV+ FSW中使用抗逆转录病毒治疗（ART）很低， FSW对口服预防预防（PREP）的兴趣和需求是现实世界中未知的 实施研究是有限的。鉴于FSW之间的艾滋病毒率高以及获得的高风险 艾滋病毒在大量的HIV-FSW中，注意治疗作为预防（TASP）和PREP是 有必要。 FSW面临着无数贡献艾滋病毒自我保护的无数结构，社会和个人级别的障碍 高艾滋病毒患病率，在接受HIV预防，护理和治疗方面得到了沮丧。但是，几乎没有 知道这些因素如何影响FSW对这些药物的吸收和依从性。组合艾滋病毒 FSW的预防软件包以行为和结构依从性支持增强和准备 干预措施和协同工作以最大程度地发挥影响是必要的，但还不够 开发和测试。需要形成性研究来探讨准备的可接受性和原因 HIV+ FSW不是发起艺术，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。 该R21的具体目的是：（1）确定结构，卫生系统，人际关系和 影响对基于ARV的访问，使用和遵守的个人级别障碍和促进者 通过焦点小组在基于妓院的FSW中进行预防和治疗； （2）检查知识，信念和 通过对基于ARV的HIV预防艾滋病毒预防和FSW治疗的态度，通过深入的定性访谈 妓院和酒店的医疗保健提供者，经理/所有者和弹跳者以及决策者，以及（3） FSW，医疗保健提供者和政策制定者以及妓院和酒店经理/所有者的观点 增加基于妓院和酒店的FSW访问和吸收TASP并进行准备的方法 对未来组合预防的选择，设计和评估。该研究与NIH紧密一致 优先事项，南非国家性工作者艾滋病毒艾滋病毒预备计划，常规艾滋病毒测试的建议 作为HIV阴性的性工作者，作为预防HIV组合和普遍测试的一部分，以及所有FSW的治疗 南非政府的目标是在ARV上启动至少80％的合格人士，而UNAIDS 90-90-- 90个进球。