Picture me HIV Free: Using Photovoice to Identify Factors Shaping PrEP Adherence

项目总结 撒哈拉以南非洲的少女和年轻妇女不成比例地受到艾滋病毒的影响 流行病。暴露前预防(PrEP)，如果每天使用，可以减少新感染艾滋病毒的人数 AGYW。然而，影响AGYW中PrEP坚持和持久性的多层次因素包括 未得到充分研究。拟议中的研究--描绘没有艾滋病病毒的我：使用光声识别影响因素 准备坚持-将使用PhotoVoice，这是一种基于社区的成熟的参与式研究方法，以 确定影响AGYW对PrEP的坚持和持久性的显著多层次因素。我们会 与PEPFAR赞助的DREAM倡议计划合作，该计划为AGYW提供在 肯尼亚基苏木。这项拟议研究的参与者将拍摄照片并写下说明文字来描述 照片中图像的上下文。使用这种方法，参与者可以记录、反思和讨论 围绕艾滋病毒预防的个人和共同现实，在其社区内突出并形成 他们的日常生活。在目标1中，我们将确定和描述影响遵守PrEP的多层次因素 在AGYW通过使用PhotoVoice与AGYW注册了DREAM并发起PrEP的人中，AGYW 尚未发起PrEP(同伴)、男性伴侣和男性同伴、家庭成员和社区 成员，包括医疗保健提供者。参与者将参与队列内的讨论(其中单个 研究人群，例如发起PrEP的AGYW，开会分享和讨论他们的照片和 观点)和队列间讨论(其中两个研究群体，例如，AGYW和社区 会员，分享和讨论他们的照片和观点)。对AGYW的深入采访，他们已经 随后将启动PrEP，以确定在 PhotoVoice讨论会影响个人行为。使用类似的过程，我们将进行同样的 目标2中的人群组确定和描述影响PrEP持久性的多水平因素， 包括《危险季节》，在AGYW。通过从AGYW的多个层面识别和描述因素 影响AGYW坚持和坚持PrEP的社会生态，我们将有能力识别 并将未来干预措施的组成部分定位在支持遵守和 AGYW对PrEP的坚持。然后，我们将制定和评估干预措施，作为未来的一部分 研究。

PROJECT SUMMARY Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionally affected by the HIV epidemic. Pre-exposure prophylaxis (PrEP), if used daily, can reduce the number of new HIV infections among AGYW. The multi-level factors that influence PrEP adherence and persistence among AGYW, however, are understudied. The proposed research—Picture Me HIV Free: Using Photovoice to Identify Factors Shaping PrEP Adherence—will use Photovoice, an established community-based participatory research method, to identify salient multi-level factors that influence adherence and persistence to PrEP among AGYW. We will partner with a PEPFAR-sponsored DREAMS Initiative program that provides AGYW access to PrEP in Kisumu, Kenya. Participants in the proposed research will take photographs and write captions to describe the context of the images in the photographs. Using this approach, participants record, reflect, and discuss the personal and shared realities surrounding HIV prevention that are salient within their communities and shape their day-to-day lives. In Aim 1, we will identify and describe multi-level factors that affect adherence to PrEP among AGYW through using Photovoice with AGYW enrolled in DREAMS who have initiated PrEP, AGYW who have not initiated PrEP (peers), male partners and male peers, family members, and community members, including healthcare providers. Participants will engage in intra-cohort discussions (where a single study population, e.g., AGYW who have initiated PrEP, meet to share and discuss their photographs and perspectives) and inter-cohort discussions (where two study populations, e.g., AGYW and community members, share and discuss their photographs and perspectives). In-depth interviews with AGYW who have initiated PrEP will follow to determine how the broader level factors that were collectively identified during the Photovoice discussions influence individual behavior. Using a similar process, we will engage the same population groups in Aim 2 to identify and describe the multi-level factors that affect persistence to PrEP, including “seasons of risk”, among AGYW. By identifying and describing factors from multiple levels of AGYW’s social ecology that influence PrEP adherence and persistence among AGYW, we will be equipped to identify and position components of future interventions in areas that matter most in supporting adherence and persistence to PrEP among AGYW. We will then develop and evaluate the intervention as part of future research.