Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women

最大限度地提高青春期女孩和年轻女性的艾滋病毒预防、感染率和保留率

• 批准号: 9761594
• 负责人: Maryam Shahmanesh
• 金额: $ 49.04万
• 依托单位: KWAZULU-NATAL RESEARCH INSTITUTE TB-HIV
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-18 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9761594
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Adolescence; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Area; Attitude; Behavior Therapy; Biological Markers; Caring; Clinical; Communities; Contraceptive methods; Data; Epidemic; Epidemiologist; Event; Exposure to; Family; Female Adolescents; Financial cost; Gender; Goals; HIV; Health; Health care facility; Home environment; Household; Human immunodeficiency virus test; Hygiene; Incidence; Individual; Interdisciplinary Study; Intervention; Interview; Life Cycle Stages; Life Expectancy; Link; London; Male Circumcision; Medical; Mentors; Modeling; Outcome Measure; Paper; Population; Population Analysis; Population Surveillance; Prevention; Prevention program; Prevention therapy; Preventive Intervention; Provider; Psychologist; Public Sector; Records; Research; Research Institute; Risk; Risk Behaviors; Rural; Schools; Science; Scientist; Services; Sex Behavior; Site; South Africa; Survival Analysis; Testing; Time; Tropical Medicine; United States National Institutes of Health; Universities; Work; Youth; adaptive intervention; adolescent HIV prevention; antiretroviral therapy; college; condoms; empowered; family caregiving; family support; gender-based violence; high risk; improved; innovation; male; migration; mortality; multidisciplinary; novel; peer; peer networks; peer support; population health; pre-exposure prophylaxis; programs; prospective; response; rural South Africa; rural setting; scale up; social; social stigma; success; surveillance data; therapy design; therapy development; treatment program; uptake; young woman

Project Summary Our overarching goal is to arrest the HIV epidemic and its negative impact on young people in sub Saharan African (SSA) through improving the uptake, retention and adherence of multi-level combination HIV prevention by AGYW and male partners. South Africa has an estimated 6.3 million people living with HIV – the highest in the world. Despite having the largest HIV treatment program in the world, HIV incidence in Adolescent Girls and Young Women (AGYW aged 15-24) remains extremely high. Whilst there have been significant innovations in combination HIV prevention, e.g. universal test and treat (UTT) and Pre-exposure prophylaxis (PrEP), this has far outpaced the ability to deliver them. To control the HIV epidemic here is an urgent to significantly improve uptake and retention of HIV prevention by AGYW and male partners, alongside UTT of those testing positive. In this project we have a unique opportunity to leverage a key time-sensitive events in a poor and rural hyperendemic area of KwaZulu-Natal: The roll out of eight new youth-focused multi- level HIV prevention interventions for AGYW and their male partners by PEPFAR’s Determined, Resilient, Empowered, AIDS free, Mentored, and Safe (DREAMS) program in the context of a state of the art demographic and health surveillance, where data on individual HIV biomarkers, sexual behaviors, HIV prevention and ART exposure are linked to public-sector clinical records for HIV and other care. We will achieve this through three interlinked aims: Specific aim 1: Quantify how multiple levels of social dynamics interact to predict uptake of DREAMS components. Approach: We will use hierarchical analysis of population surveillance data to evaluate how community, household and interpersonal-level exposures predict uptake of each intervention, and two composite outcome measures: 1) Exposure to community-level DREAMS interventions, 2) uptake of the individual-level HIV care and prevention. Specific aim 2: Elucidate how individuals’ life-course transitions and exposure to DREAMS affect retention and adherence to HIV care and prevention. Approach: We will use both survival analysis of the population surveillance data and in-depth qualitative interviews to evaluate how specific life-course events affect HIV prevention and care cascade trajectories and how community-level DREAMS exposures moderate the impact of life-course transitions on adherence and retention. Specific aim 3: Ascertain whether family- and peer-network strategies improve uptake and adherence to combination prevention interventions by young people. Approach: we will work with youth to adapt existing models of community and peer-support to develop an intervention informed by aims 1 and 2. We will pilot the acceptability and feasibility of this approach on improving AGYW and male peers uptake and retention of HIV care and prevention. Our multidisciplinary team includes HIV epidemiologists, a biostatistician, social scientists, psychologist and intervention development expertise from the Africa Health Research Institute, University College London, Southampton and the London School of Hygiene and Tropical Medicine. Moving forward, this will provide answers to an NIH priority area: Can using peer, family and community-level networks harness the full mortality and HIV incidence reducing potential of multi-level HIV prevention for adolescents and young people in rural SSA?

项目摘要 我们的首要目标是遏制艾滋病毒流行及其对撒哈拉以南年轻人的负面影响 非洲(SSA)通过改善多水平组合艾滋病毒的吸收、保留和黏附 AGYW和男性伙伴的预防。据估计，南非有630万艾滋病毒携带者- 世界上最高的。尽管拥有世界上最大的艾滋病毒治疗计划，但艾滋病毒在 青春期少女和青年妇女(15-24岁的青春期妇女)仍然非常高。虽然已经有了 艾滋病毒预防组合方面的重大创新，例如普遍检测和治疗(UTT)和暴露前 预防(PrEP)，这已经远远超过了提供它们的能力。在这里控制艾滋病毒流行是一个 迫切需要显著改善AGYW和男性伙伴对艾滋病毒预防的接受和保留，以及 那些检测呈阳性的人中有一人。在此项目中，我们有一个独特的机会来利用关键的时间敏感型 夸祖鲁-纳塔尔贫穷和农村高流行地区的事件：推出了八个新的以青年为重点的多 为AGYW及其男性伴侣提供的艾滋病毒预防干预措施 最先进的授权、无艾滋病、有指导和安全(梦想)计划 人口和健康监测，其中关于个人艾滋病毒生物标记物、性行为、艾滋病毒 预防和抗逆转录病毒药物暴露与公共部门艾滋病毒和其他护理的临床记录有关。我们会 通过三个相互关联的目标来实现这一点：具体目标1：量化多层次的社会动态 相互作用，以预测对梦境组成部分的吸收。方法：我们将使用人口的层次分析 监测数据，以评估社区、家庭和人际层面的暴露如何预测 每项干预措施和两项综合结果衡量标准：1)接触社区层面的梦 干预措施，2)接受个人层面的艾滋病毒护理和预防。具体目标2：阐明如何 个人生命历程的转变和对梦想的接触会影响对艾滋病毒护理和治疗的保留和坚持 预防。方法：我们将使用人口监测数据的生存分析和深入的 评估特定生命过程事件如何影响艾滋病毒预防和护理级联的定性访谈 轨迹和社区层面的梦境暴露如何缓和生活过程转变对 坚持和保留。具体目标3：确定家庭和同伴网络战略是否有所改进 年轻人接受和坚持联合预防干预措施。方法：我们将与 青年适应社区和同伴支持的现有模式，以制定AIMS提供信息的干预措施1 2.我们将试行这一方法在改善AGYW和男性同行方面的可接受性和可行性 吸纳和保留艾滋病毒护理和预防。我们的多学科团队包括艾滋病毒流行病学家、 来自非洲卫生组织的生物统计学家、社会科学家、心理学家和干预发展专业知识 伦敦大学学院研究所、南安普敦大学和伦敦卫生与热带学院 医学。展望未来，这将为NIH的一个优先领域提供答案：可以使用同伴、家庭和 社区一级的网络充分利用死亡率和艾滋病毒发病率，减少多级别艾滋病毒的潜力 为农村SSA的青少年和年轻人提供预防？